Our aim in this article was to explore implementation strategies of IGAs for CHVs in Kilifi County, Kenya. From the study, it emerged that livelihood support such as buying clothing for children, paying for school fees, health care and other household expenditures was the driving factor for CHVs wanting to establish IGAs. Income generating activities are important for promoting the welfare of the household in general. Other studies have also observed that IGAs play a critical role in rural households because they help promote access to additional revenues that may improve food security and alleviate poverty [19, 20]. The need for IGAs exists since CHV work is not remunerated, yet families tend to expect monetary returns from this work. Consequently, the majority of CHVs in the study area are engaged in individual micro-IGAs, mostly in the informal sector such as working as day labourers on farms or construction sites, domestic servants, petty traders, or small-scale subsistence farmers, as a way of earning a living. Such informal occupations are seasonal, low paying, and vulnerable to climate & market fluctuations. Engaging in subsistence micro-income activities in the informal sectors is more common in developing and emerging economies, especially in rural areas [21] [10, 22] mainly because of high rates of illiteracy, inadequate credit facilities, [23]. Most CHVs especially in Kilifi County are often from low socio-economic backgrounds and have no formal professional training. They are therefore highly likely to be more vulnerable to exploitation, hence the need to be supported by the health system considering the important role they play in promoting community health [5, 23, 24]. This may be especially relevant in Kilifi County based on high rates of illiteracy (68%) and food insecurity (48%) [25]
It has also been established that the ability to earn a livelihood and attend to their family and community needs is compromised by the voluntary nature of their work. Poor compensation for CHVs is a common phenomenon in LMICs [6, 11] and has been linked to a high attrition rate in many places [6, 9–11, 26].
Operational Planning
Many factors that influence the success of strategy implementation have been identified in literature, ranging from project selection, resources (people, finances, and time), the systems or mechanisms in place for coordination and control [13].
Project Selection:
Participants of this study proposed several IGAs that they wish to be engaged in, as presented in the results sections and in our previous articles [10, 12]. The selection of IGAs by CHVs was guided by their contextual background. Contextualized projects that acknowledge diversity of environmental conditions, experience, culture, and market viability were preferred. Participants also preferred projects that have an element of value-chain addition, whereas others proposed advancement of the IGAs that they are already engaged in.
Studies have affirmed that before setting up any IGAs in a location, community development agents must identify and understand the dynamics of the local community (its nature, population, socio-economic characteristics, history, ethos, culture and interests) [27]. This can be achieved through stakeholder engagement. Stakeholders have insider knowledge on their environment and context and can therefore provide guidance relevant to their communities. Projects that are imposed on communities risk selection of irrelevant IGAs, engendering resistance to IGAs, and even efforts to hinder implementation if IGAs conflict with their values, culture, and expectations [27–29]. Imposed projects also create feelings of powerlessness in the community and may reduce the degree of ownership and responsibility taken by the community toward programs [27–29].
Resources
Financial and human resources are necessary for successful implementation of IGAs. They are required to help carryout tasks of the project. Hence, resources need to be assessed and allocated before a project begins.
People
Communally owned projects were preferred by CHVs over individual projects. The reasons why CHVs prefer group IGAs is because this enhances a sense of unity, group cohesiveness and a feeling of community. In fact, many sponsors prefer supporting group projects. This arrangement may make it easier to share responsibilities and create time to attend to CHV work. However, there is a need to empower groups with basic skills such as how to select viable projects, how to write a business plan, project management, how to manage group diversity and how to source for markets, before implementation of any project. These skills can also be acquired by visiting similar projects that are already in advanced stages. Even after capacity building and implementation of IGAs, respondents felt that there was need for continued support and close periodic monitoring of these projects by the sponsors.
In Kenya, for groups to be considered for registration in the Ministry of social development they must comprise of at least ten persons, or five in the case of a special interest group [30]. Studies have confirmed that properly structured group projects can reinforce skills that are relevant to both group and individual work, including community coalition, the ability to break complex tasks into manageable parts, plan and manage time, and refine understanding [31]. Similarly, Okumus (2003) stated that there is a need for training to enable employees and management to improve their understanding and skills on key issues such as: recruitment of relevant staff for new strategy implementation, acquisition and development of new skills, and knowledge to implement the new strategy and general policies and practices on implementing strategy [16]. Other studies have further confirmed that most IGA projects are not effective in contributing to retention of CHVs in PHC due to the lack of adequate capital for scaling up, as well as poor management due to lack of training in business management and group dynamics [11]. Therefore, empowering groups with basic IGAs business management skills may be a key to their success.
Group projects were also preferred in this study because it makes it easier for extension officers to reach out to these groups whenever they need support than when they are running independent projects and that it easier to keep track on the project progress. It is has been identified in literature that group supervision when well-coordinated and managed offers certain benefits that cannot be obtained through individual supervision alone. It is indicated that group supervision provides unique opportunities to establish critical professional repertoires, accelerate job completion, enable members brainstorm for solutions, and to recognize their strengths and weaknesses [31] Other unique characteristics and benefits associated with learning experiences that occur in a group setting include peer feedback, social networking, having multiple listeners for the same event, observational learning, developing empathy, modeling and rehearsing positive and productive discussion, practicing public speaking and presenting, developing professional repertoires, it also helps supervisors recognize individual talents and reveal the direction for future work assignments [32]
Funding
Members proposed several ways to raise funds for starting up IGAs, ranging from government funding (e.g., Uwezo fund, women enterprise funds, Youth Funds), weekly self-savings of certain agreed upon amounts, merry-go-round savings (table banking), corporate CSR funding from politicians and other sponsors and philanthropists. Several people in literature have attested that they were able to start up business enterprises through these funding initiatives which actually improved their entrepreneurial skills through the trainings offered, it also improved their income and witnessed positive change in their livelihoods.
Control/ Sustainability –
Various project control measures were identified in this study. Respondents insisted on having a constitution that clearly defined membership, relations among members, rights and duties of members, as well as rules and regulations governing membership and IGA operations. Respondents also emphasized having IGAs registered with the Ministry of Labour and Social Protection as a control measure.
In Kenya, it is a requirement for groups to be registered and obtain approval from the Ministry of Labour and Social Protection before embarking into an IGA. A group can only be registered if it has ten or more members. The group should also have by-laws or a constitution that guide its activities and dictate its membership, including its officials, and should clearly indicate the group’s mission, goals, and objectives [30] Project controls are perceived to be important or critical to the performance and success of enterprise projects [33] .
Networking:
To enhance sustainability of IGAs, respondents saw the need to create networks. Various institutions with which CHVs can partner were identified in the study. The most reported supportive institution was perceived to be the Ministry of Gender, Children and Social Development through the Youth Enterprise Fund, Women Enterprise Funds, and Uwezo Fund. These departments were reported to be sources of empowerment trainings on entrepreneurial and leadership skills before implementation of IGAs.