Implementation framework for Income Generating Activities identified by community heath volunteers: a strategy to reduce CHV attrition rate in Kilifi County Kenya

Abstract

Background Strategy Implementation has increasingly become a focus of scientific studies. Failure of strategy implementation may result in high monetary costs, wasted time and human resources, and reduced community enthusiasm and diminished trust in project sponsors. This study sought to investigate viable modalities for implementing Income Generating Activities (IGAs) for Community Health Volunteers (CHV) in Kilifi County Kenya as a strategy to improve their livelihoods, increase motivation and reduce attrition. Methods: This was an exploratory qualitative research study. Key informant in-depth interviews were conducted among sub-county Ministry officials and multi-lateral stakeholder representatives. A further 10 Focus group discussions with CHVs were conducted. The data were thematically analysed using MAXQDA 20.2 software. Data codding, analysis and presentation was guided by the Okumu’s (2003) Strategy Implementation framework on factors to consider when implementing strategic decisions: 1) Need for Strategy (Income Generating activities) development, 2) Operational process [ (i) IGAs selection strategy, ii) Resources, iii) people & iv) controls. A new variable, however, emerged from the findings; namely, networks. Results: A need for stable income was identified as the driving factor for CHVs seeking IGAs, as their health volunteer work is non-remunerative. Contextualized projects that acknowledged diversity of CHVs in terms of environmental conditions of origin, experience, culture, and market viability, informed their IGA selection strategy. Self-savings through table-banking, seeking funding support through loans xx from government funding agencies (e.g., Uwezo Fund, Women Enterprise fund, Youth Fund), grants from corporate agencies, politicians, and other donors were proposed. Formal registration of IGAs with a Government Ministry, developing a guiding constitution, empowering CHVs with leadership skills, project and group diversity management, and entrepreneurial skills, and connecting them to support agencies, were the control measures proposed by the CHVs & Key Informants to enhance sustainability of IGAs. Group owned and managed IGAs were preferred over individual IGAs. Conclusion: CHVs are in need of IGAs and proposed their own implementation strategies informed by local context. Agencies supporting IGAs should therefore be guided by the modalities proposed by CHVs and local stakeholders.