Cargando…

Contextual variations in costs for a community health strategy implemented in rural, peri-urban and nomadic sites in Kenya

BACKGROUND: Many low and middle income countries have developed community health strategies involving lay health workers, to complement and strengthen public health services. This study explores variations in costing parameters pertinent to deployment of community health volunteers across different...

Descripción completa

Detalles Bibliográficos
Autores principales: Wafula, Charles Ouma, Edwards, Nancy, Kaseje, Dan C. O.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330022/
https://www.ncbi.nlm.nih.gov/pubmed/28241872
http://dx.doi.org/10.1186/s12889-017-4140-z
_version_ 1782511176484126720
author Wafula, Charles Ouma
Edwards, Nancy
Kaseje, Dan C. O.
author_facet Wafula, Charles Ouma
Edwards, Nancy
Kaseje, Dan C. O.
author_sort Wafula, Charles Ouma
collection PubMed
description BACKGROUND: Many low and middle income countries have developed community health strategies involving lay health workers, to complement and strengthen public health services. This study explores variations in costing parameters pertinent to deployment of community health volunteers across different contexts outlining considerations for costing program scale-up. METHODS: The study used quasi experimental study design and employed both quantitative and qualitative methods to explore community health unit implementation activities and costs and compare costs across purposively selected sites that differed socially, economically and ecologically. Data were collected from November 2010 to December 2013 through key informant interviews and focus group discussions. We interviewed 16 key informants (eight District community health strategy focal persons, eight frontline field officers), and eight focus group discussions (four with community health volunteers and four with community health committee) and 560 sets of monthly cost data. Cost data were tabulated using Microsoft Excel. Qualitative data were transcribed and coded using a content analysis framework. RESULTS: Four critical elements: attrition rates for community health volunteers, geography and population density, livelihood opportunity costs and benefits, and social opportunity benefits, drove cost variations across the three sites. Attrition rate was highest in peri-urban site where population is highly mobile and lowest in nomadic site. More households were covered by community health workers in the peri-urban area making per capita costs considerably less than in the nomadic settings where long distances had to be covered to reach sparsely distributed households. Livelihood opportunity costs for Community Health Volunteers were highest in nomadic setting, while peri-urban ones reported substantial employability benefits resulting from training. Social opportunity benefits were highest in rural site. CONCLUSIONS: Results show that costs of implementing community health strategy varied due to different area contextual factors in Kenya. This study identified four critical elements that drive cost variations: attrition rates for community health volunteers, geography and population density, livelihood opportunity costs and benefits, and social opportunity benefits. Health programme managers and policy-makers need to pay attention to details of contextual factors in costing for effective implementation of community health strategies. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12889-017-4140-z) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-5330022
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-53300222017-03-03 Contextual variations in costs for a community health strategy implemented in rural, peri-urban and nomadic sites in Kenya Wafula, Charles Ouma Edwards, Nancy Kaseje, Dan C. O. BMC Public Health Research Article BACKGROUND: Many low and middle income countries have developed community health strategies involving lay health workers, to complement and strengthen public health services. This study explores variations in costing parameters pertinent to deployment of community health volunteers across different contexts outlining considerations for costing program scale-up. METHODS: The study used quasi experimental study design and employed both quantitative and qualitative methods to explore community health unit implementation activities and costs and compare costs across purposively selected sites that differed socially, economically and ecologically. Data were collected from November 2010 to December 2013 through key informant interviews and focus group discussions. We interviewed 16 key informants (eight District community health strategy focal persons, eight frontline field officers), and eight focus group discussions (four with community health volunteers and four with community health committee) and 560 sets of monthly cost data. Cost data were tabulated using Microsoft Excel. Qualitative data were transcribed and coded using a content analysis framework. RESULTS: Four critical elements: attrition rates for community health volunteers, geography and population density, livelihood opportunity costs and benefits, and social opportunity benefits, drove cost variations across the three sites. Attrition rate was highest in peri-urban site where population is highly mobile and lowest in nomadic site. More households were covered by community health workers in the peri-urban area making per capita costs considerably less than in the nomadic settings where long distances had to be covered to reach sparsely distributed households. Livelihood opportunity costs for Community Health Volunteers were highest in nomadic setting, while peri-urban ones reported substantial employability benefits resulting from training. Social opportunity benefits were highest in rural site. CONCLUSIONS: Results show that costs of implementing community health strategy varied due to different area contextual factors in Kenya. This study identified four critical elements that drive cost variations: attrition rates for community health volunteers, geography and population density, livelihood opportunity costs and benefits, and social opportunity benefits. Health programme managers and policy-makers need to pay attention to details of contextual factors in costing for effective implementation of community health strategies. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12889-017-4140-z) contains supplementary material, which is available to authorized users. BioMed Central 2017-02-28 /pmc/articles/PMC5330022/ /pubmed/28241872 http://dx.doi.org/10.1186/s12889-017-4140-z Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Wafula, Charles Ouma
Edwards, Nancy
Kaseje, Dan C. O.
Contextual variations in costs for a community health strategy implemented in rural, peri-urban and nomadic sites in Kenya
title Contextual variations in costs for a community health strategy implemented in rural, peri-urban and nomadic sites in Kenya
title_full Contextual variations in costs for a community health strategy implemented in rural, peri-urban and nomadic sites in Kenya
title_fullStr Contextual variations in costs for a community health strategy implemented in rural, peri-urban and nomadic sites in Kenya
title_full_unstemmed Contextual variations in costs for a community health strategy implemented in rural, peri-urban and nomadic sites in Kenya
title_short Contextual variations in costs for a community health strategy implemented in rural, peri-urban and nomadic sites in Kenya
title_sort contextual variations in costs for a community health strategy implemented in rural, peri-urban and nomadic sites in kenya
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330022/
https://www.ncbi.nlm.nih.gov/pubmed/28241872
http://dx.doi.org/10.1186/s12889-017-4140-z
work_keys_str_mv AT wafulacharlesouma contextualvariationsincostsforacommunityhealthstrategyimplementedinruralperiurbanandnomadicsitesinkenya
AT edwardsnancy contextualvariationsincostsforacommunityhealthstrategyimplementedinruralperiurbanandnomadicsitesinkenya
AT kasejedanco contextualvariationsincostsforacommunityhealthstrategyimplementedinruralperiurbanandnomadicsitesinkenya