Implementation framework for Income Generating Activities identified by Community Heath Volunteers (CHVs): a strategy to reduce CHVs attrition rate in Kilifi County Kenya

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Abstract Background Poorly designed project implementation strategy may not only reduce the morale and trust of the community but may also become a costly undertaking due to delayed project schedules and demotivation of project team. This study sought to identify viable modalities for implementing Income Generating Activities (IGAs) for Community Health Volunteers (CHV) in Kilifi County in Kenya as a strategy to improve their livelihoods, increase motivation and reduce attrition. Methods: An exploratory qualitative research study design was used, which consisted of Focus group discussions with CHVs involved in health promotion and data collection activities in a local setting. Further, key informant in-depth interviews were conducted among local stakeholder representatives and Ministry of Health officials. Data were recorded, transcribed and thematically analysed using MAXQDA 20.2 software. Data coding, analysis and presentation was guided by the Okumu’s (2003) Strategy Implementation framework. Results: A need for stable income was identified as the driving factor for CHVs seeking IGAs, as their health volunteer work is non-remunerative. Factors that that considered the local context such as government regulations, knowledge and experience, culture, and market viability informed their preferred IGA strategy. Individual savings through table-banking, seeking funding support through loans from government funding agencies (e.g., Uwezo Fund, Women Enterprise fund, Youth Fund), grants from corporate organizations, politicians, and other donors were proposed as viable options for raising capital for IGAs. Formal registration of IGAs with Government regulatory agencies, developing a guiding constitution, empowering CHVs with entrepreneurial and leadership skills, project and group diversity management, and connecting them to support agencies were the control measures proposed to support implementation and enhance sustainability of IGAs. Group owned and managed IGAs were preferred over individual IGAs. Conclusion: CHVs are in need of IGAs and proposed their own implementation strategies informed by local context. Agencies seeking to support CHVs livelihoods should therefore engage with and be guided by the input from CHVs and local stakeholders.

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