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Exploring perceptions of community health policy in Kenya and identifying implications for policy change

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McCollum, Rosalind, Otiso, L, Mireku, M, Theobald, Sally ORCID: https://orcid.org/0000-0002-9053-211X, de Koning, K, Hussein, S and Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536 (2015) 'Exploring perceptions of community health policy in Kenya and identifying implications for policy change'. Health Policy and Planning, Vol 31, Issue 1, pp. 10-20.

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Abstract

Background

Global interest and investment in close-to-community health services is increasing. Kenya is currently revising its community health strategy (CHS) alongside political devolution, which will result in revisioning of responsibility for local services. This article aims to explore drivers of policy change from key informant perspectives and to study perceptions of current community health services from community and sub-county levels, including perceptions of what is and what is not working well. It highlights implications for managing policy change.

Methods

We conducted 40 in-depth interviews and 10 focus group discussions with a range of participants to capture plural perspectives, including those who will influence or be influenced by CHS policy change in Kenya (policymakers, sub-county health management teams, facility managers, community health extension worker (CHEW), community health workers (CHWs), clients and community members) in two purposively selected counties: Nairobi and Kitui. Qualitative data were digitally recorded, transcribed, translated and coded before framework analysis.

Results

There is widespread community appreciation for the existing strategy. High attrition, lack of accountability for voluntary CHWs and lack of funds to pay CHW salaries, combined with high CHEW workload were seen as main drivers for strategy change. Areas for change identified include: lack of clear supervisory structure including provision of adequate travel resources, current uneven coverage and equity of community health services, limited community knowledge about the strategy revision and demand for home-based HIV testing and counselling.

Conclusion

This in-depth analysis which captures multiple perspectives results in robust recommendations for strategy revision informed by the Five Wonders of Change Framework. These recommendations point towards a more people-centred health system for improved equity and effectiveness and indicate priority areas for action if success of policy change through the roll-out of the revised strategy is to be realized.

Item Type: Article
Subjects: WA Public Health > WA 100 General works
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1093/heapol/czv007
Depositing User: q Moody
Date Deposited: 03 Aug 2015 08:46
Last Modified: 06 Feb 2018 13:10
URI: http://archive.lstmed.ac.uk/id/eprint/5257

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