Effect of Community Health Strategy in Advancing Social Accountability in the Health System in Nairobi County, Kenya

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.