Application of the UPG model to the study findings:
In this section of the paper, we present data based on the six stages of UPG model.
1. Transfer of productive assets.
Asset transfer is suitable for those CHVs who desire to run their own business. This is what the CHVs in this study proffered could be offered in the form of cash or in-kind. CHVs from Kaloleni noted that the provisions of poultry or livestock could be beneficial as seen from the following quote.
“Apart from giving us money there are things that we can benefit from… If he gives us dairy cattle individually, that gives me milk…. Even if I will pay it as loan …through my CHV group. He will have given me something that will benefit me…” (R3, FGD 6, Kaloleni)
Similarly, CHVs from Rabai talked about the need to get financial assistance to sustain their current activities, in the form of purchase of a specific asset such as tents or chairs to conduct events hosting business.
“…we have sustained ourselves in this community group by looking for seats, hiring them,…a tent…,if we would receive funders so that we are given even if it is a rental lease”(R2, FGD 1 Rabai)
The KIIs likewise agreed with one stating that the benefit would not be purely to the CHVs themselves but to the community as a whole.
“…I can also think of…a boda-boda [motor bike]… used for referrals to the facility…that will boost health…if they have their own they will maybe charge lesser than the rest in the community.” (KII 02)
2. Weekly stipends/Consumption support
Food security is a key concern and may hinder CHVs from taking risks on long-term livelihood activities. Providing a safety net that meets the basic needs of the CHVs such as a stipend or compensation for the time they provide their services will allow them to engage better in programme activities as well enable them to focus on building self-sustaining livelihoods. The CHVs in this study requested for transport and other support to be able to carry out their duties. This was echoed by the KIIs.
“..[As] has been said….is that token… be increased….I worked with XXX… by that time, ‘85, ‘86, ‘89, [Ksh] 450 was little money but…, at [the] time, it used to be enough….they should look at what they will give the CHVs so that they can be well motivated.” (R3, FGD 5 Kaloleni)
“…if there could be some arrangement that they get some payment… I would support that…at least something that can make someone to feel that at the end of the month… he can move on.” (KII 01)
“….what can give us the morale is they think about us at least every month…someone will know even if I lose that way, when a certain day reaches I will get something.” (R4, FGD 3, Kaloleni)
“…This volunteer work…it doesn’t earn a salary… so I… plan myself…this week I need to give the report…under my watch… [I have] 68 houses…3 days I do my own work…I am a widow….so that my children can be able to go to school, so I will do them 2 days in a week, before the month ends I give out my report I will have finished my houses. I like this job [CHV] because it has grown my mind, it has opened me up, it has made me to be busy, it helps me” (R2, FGD 4, Rabai)
3. Intensive hands on training
The CHVs requested technical and vocational training to equip them with skills required for self-employment. Training is tailored to their unique needs and structured to link to a specific livelihood activity. The CHVs in this study requested for enhanced training in the informal sector, in entrepreneurship, best practice in agricultural farming and livestock rearing.
“I am a painter..., but I haven’t trained…..To improve the painting, is to be taken to study it and then get a certificate…if you find those people taking contracts… you show him that certificate that you are a painter, he will…employ you.” (R4, FGD 7 Kaloleni)
“…I feel we need to be brought training about rearing [livestock] so, that we can know how to keep chicken…and also those drugs that are used when chicken have been affected by any disease and the feeds.” (R7, FGD 9 Kaloleni)
“… We have talked about projects…that requires good management…if it would be possible to help us in bringing leadership training so that we… [Are] able to manage those projects that we are even given without difficulty so that we can succeed.” (R1, FGD 2 Rabai)
The KIIs felt that training was also important suggesting that it should accompany the health education training that is provided for the CHVs to perform their community related activities.
“…if they are taught about health, they should also have trainings teaching how to start their own businesses.” (KII 04).
“..Of their dairy cattle… but they are not producing simply because they haven't been held their hands and told this and that should be done.” (KII 03)
4. Savings
Learning how to save one’s income and resources is an integral tool. This may be through formal and informal financial settings. Consistently saving one’s income helps instil a saving culture as well as expand one’s assets. While one can plan for future investment, savings also provides a cushion for unexpected financial difficulties in future. The CHVs in this study expressed desire to be able to save as well as a need for education on how to save. These sentiments were shared by the KIIs as well.
“…The other way that can help us…. is to save money that can be capital…….the money…is given so that they can do something and return with interest…that money can sustain…and the group continues.” (R8, FGD 10 Kaloleni).
“…maybe if we get a sponsor we would like him to give us money that we can start table banking…it will uplift everyone.” (R8, FGD 8 Kaloleni)
“Okay, when the income comes by, [members contribute], we have opened an account… for the CU and we top up [the account] so that it can stay there and be able to add more [until]… it is enough.” (R2, FGD4, Rabai)
“…As I was telling you these guys [CHVs] they need to be given something you see, whatever they get they can invest in business or in other... activities.” (KII 03)
5. Healthcare
Having access to healthcare is a basic human right. Even as CHVs, many felt that they had limited access to healthcare resources. The financial burden of meeting their own healthcare needs was also enormous. CHVs are community champions of health. Providing CHVs direct access to healthcare services through tokens for them and their family members, would allow them the scope to be able to focus on the healthcare needs of their fellow community members.
“Sometimes back there was an organisation…they used to have the kitty. If CHVs can be given because sometimes you don’t have someone to assist you with Panadol….” (R1, FGD 5 Kaloleni)
“My request is for our hospital, XXX, they should stock the drugs for us because there are those who can go to the chemist and there are those who cannot….Our people suffer… She was taken there… told there is no medicine she has to go and buy, she returned and stayed at home with her illness. ” (R4, FGD 2 Rabai)
6. Social integration
The CHVs in this study emphasized a consistent thread of a need for community engagement, acceptability and identity. CHVs are the social link between communities and the healthcare system. A lack of identity by the community is a major challenge at meeting their programme related duties. The CHVs in this study requested that they get some form of recognition provided by the government or CHV programmes within the community. They also asked for formal introduction to the community leaders and consideration for engagement or inclusion during governance meetings that concern the communities within which they serve.
“…If we…can be recognized…we can get a badge, t-shirt so when we get in the community they know these are the CHVs,….there are places [where] we are despised,…we go just with our clothes…if you tell them to dig a toilet they tell you go tell the doctor who sent you to come and dig that toilet…but if we have the apparels…they will give us the respect and even our work will continue on well”. (R5, FGD 2 Rabai)
“We would like to have uniform...bags…, then people will respect us, they will say these women are working at the hospital.” (R7, FGD 6, Kaloleni)
When asked about social integration, the KII had this to say:
“…First there is the economic challenge,… also I don’t think if they have an office somewhere…even if we gave them space in our facility,…that they can have a central place where they can come and discuss their things with us.” (KII 06)
In this way, they are suggesting some shared space and partnership with the CHVs.