Facilitators of Community Health Promoters Service Provision in Nandi County

Abstract

Community Health Promoters (CHPs) play a vital role in expanding access to primary healthcare services in rural areas of Kenya. This study examined the key facilitators of service provision by CHPs in Nandi County, focusing on security of tenure, capacity building, financial incentives, and the availability of essential supplies and commodities. A descriptive research design was adopted. The target population comprised 1,567 CHPs serving across six sub-counties in Nandi County. Using Cochran’s formula, a sample of 306 respondents was determined through stratified sampling to ensure adequate representation. Data were collected using a structured Likert-scale questionnaire, which was pretested on 30 CHPs in Uasin Gishu County to ensure validity and reliability. A 93.8% response rate was achieved (n = 287). Descriptive analysis revealed moderate adequacy in working conditions across the four variables. Many CHPs cited unclear job contracts and a lack of employment assurance as demotivating factors. Capacity-building opportunities varied in frequency and quality, affecting service delivery. Irregular remuneration and delayed stipends were identified as major financial challenges. Additionally, the inconsistent availability of supplies and commodities disrupted service provision. Inferential analysis using Pearson correlation and multiple linear regression revealed significant positive associations between all four variables and service provision: security of tenure (r = 0.441, p < 0.01), capacity building (r = 0.518, p < 0.01), financial incentives (r = 0.486, p < 0.01), and supplies and commodities (r = 0.529, p < 0.01). Combined, these factors explained 47.3% of the variance in service provision (R² = 0.473, F = 52.763, p < 0.000). The findings indicate that CHPs with clear employment terms, continuous professional development opportunities, timely financial support, and adequate tools and materials provide higher levels of service. Strengthening these facilitators is essential for improving CHP performance and sustaining community health services in rural Kenya. The study recommends formalizing CHPs’ contracts, institutionalizing capacity-building programs, ensuring predictable financial incentives, and enhancing supply chain systems to support universal health coverage goals.