| dc.description.abstract | The goal of community health strategy is to increase participation in improving the
quality of health services in Kenya by incorporating health users' voices. The
community's health workforce consists of community health assistants/officers and
community health volunteers. Their position in the health system enables them to act
as community mouthpieces, combating inequities and advocating for community
rights and needs to government structures. However, knowledge asymmetry,
inadequate supportive supervision, and provision of working tools affect how
community health volunteers advocate for themselves and their communities. The
study's overarching goal was to assess the effect of community health strategy on
advancing social accountability in Kenya's health system. The specific objectives
were to evaluate the influence of Community Health Volunteers' characteristics and
practices, contextual factors, and community dialogue in advancing social
accountability in the health systems. In addition, the effect of training community
health volunteers on social accountability was evaluated. This was a quasiexperimental study design with a pre-test and post-test carried out in Embakasi North
and Embakasi Central sub-counties in Nairobi County, Kenya. It took over 12
months to design and implement a training intervention that addressed key aspects of
social accountability, such as how to report complaints and compliments. The study
involved 180 Community Health Volunteers who consented to participate in the
intervention and comparison groups. Stratified sampling was used to select the
community health volunteers who participated in the study. To collect data and
interpret findings, a convergent mixed methods approach was used. Quantitative data
was analysed using SPSS version 28. The transcribed data from four focus group
discussions, 15 KII, and minutes were analysed using a thematic framework indexed
by Atlas.ti 22 software. After training, cumulative test scores improved significantly
with at pre-test score (mean= 48.2, SD = 9.5) and post-test score (mean = 71.1, SD =
9.36; p< 0.001). Findings showed that the number of CHVs reporting complaints in
the intervention group increased from 11 (12.2 %) to 57(63.3 %). In addition, the
likelihood of CHVs recording complaints in the intervention was (b=.554, p=.011,
OR=1.740) compared to the comparison group (b=.010, p=.506, OR=1.010) at the
end of the study. In conclusion, community health volunteers social accountability
practices were enhanced through training, supportive supervision and provision of
working tools. The study recommended that the Ministry of Health's department of
community health services adapt the social accountability-training guide. Further
research should be conducted to determine the extent to which the CHV's
intermediary role influences health system responsiveness. | en_US |
