Referral to Health Facilities in Kenya – Factors that support Community Health Volunteers in Linking

the Community and Health System Maryline Mireku

1st International Symposium on Community Health Workers21 -23 Feb 2017

Kampala, Uganda

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Background

•CHWs are key in achieving universal health coverage

•CHW referral enhances access to formal health care system

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Importance of CHW Referral

•Enhances uptake of skilled services at the facility •Enhances coordinated care between facility and community•A successful community referral process motivates CHVsSources: (Oliver et. al, 2015; Mireku et.al, 2014, Crigler et.al, 2014, Brooks et.al,2014; Ministry of Health Kenya, 2013)

Study Aim

To explore factors influencing CHWs referral during provision of community health services.

CHW Work Structure in Kenya

Source: Ministry of Health, Kenya. Strategy for Community Health (2014-2019)

Methods

Participants:•98 Community members; 46 CHVs; 10 Community Health Committee members; 11 CHV SupervisorsData Collection•Qualitative (IDI and FGDs) – Referral process, logistics, and uptake•Quantitative – Assessment of referral uptake

Nairobi

Kitui

CHW Factors

• Presence of a standardized referral process

• Availability of logistics – referral tools

• Regular Supportive Supervision (educative, supportive, administrative)

• Knowledge of available services• Motivation CHV supervision

meeting_ Kitui

Client Factors

• Low cost of referral uptake• Perceived attitude of facility health workers• CHV escort to facility• Illness-related stigma• Type of relationship with CHV*

Facility Factors

• Distance from community

• Cost of care

• Availability of services

• Limited waiting timeGatikwera Community Unit

Selected quotes

…come back the next day, it was lunch time and people were on lunch break and at 2 they are not found in their offices. This really disturbed me when my leg was unwell, God healed my leg (FGD_Kitui_Community)

…you don't have the money to pay for the test, so you just go back home and keep quiet and you look like someone who received no help at all because you will not go back to them and tell them that you don't have the money to pay for the test and they themselves are as poor as you are, so you just keep quiet.(FGD_Nairobi_Community).

they think if they get there (facility) you will investigate them and want to know what they are suffering from and they do not want to tell the disease they have (IDI_CHV_Nairobi)

Conclusion and Recommendations

• Lack of logistics is a threat to referral uptake in community health service provision

• Strengthening bi-directional feedback between CHWs and health facility can improve uptake of referrals

• There is need for clarification and management of community expectations of the referral process

Co-authors

1. Lillian Otiso (LVCT Health)

2. Linet Okoth (LVCT Health)

3. Nelly Muturi (LVCT Health)

4. Robinson Karuga (LVCT Health)

5. Miriam Taegtmeyer (Liverpool School of Tropical Medicine)

6. Rosalind McCollum (Liverpool School of Tropical Medicine)

Maryline Mireku Research Officer

LVCT Health MMireku@lvcthealth.org

merylinem@gmail.comwww.lvcthealth.org

www.reachoutconsortium.org

REACHOUT is funded by the European Union Seventh Framework Programme ([FP7/2007-2013] [FP7/2007-2011])

under grant agreement n° 306090