"I Am Now Five Steps Ahead": How Co-design Platforms Sustain Kenyan Community Health Volunteer Engagement

"I Am Now Five Steps Ahead":How Co-design Platforms Sustain Kenyan Community Health Volunteer Engagement Hanna-Joy Renner, BA, MSc, Naomi W. Makobu, BS, Simon Mbugua, BA, Wilson Karuri Kamiru, HND, Dorothy Oluoch, BA, MSc, DPhil, Angela Donelson, PhD, and Mary B. Adam, MD, MA, PhD What Is the Purpose of this Study/Review? • Community health work matters. Decisions made at the household level are critical to helping people and communities achieve better health outcomes. Human-centered design (HCD) is a way of putting community health volunteers (CHVs) in the driver seat to plan and prioritize their work. Because it uses teamwork it is a way to build trust among the partners. • The purpose of this study is to see how involvement in the planning and priority setting of their work might help sustain the engagement of CHVs. It also looks at a way to track the way trust building that might function to explain CHV motivation in self-directed and self-funded community health activities. What Is the Problem? • CHVs in Kenya work at the household level. They are not paid because the government health systems in low- and middle-income countries struggle financially. They are not re-imbursed for expenses and are rarely given opportunity to give their own voice to local health priorities. This makes sustaining their engagement in community health work difficult. What Are the Findings? • This study identifies HCD (a co-production framework) as a valuable and underutilized mechanism for motivating sustained engagement. • It builds the evidence base for measurement of self-interest, common goal, gratitude/indebtedness as ways to measure theoretical constructs for trust building. Who Should Care Most? • Both local communities who want better health for their citizens and health policy leaders should care because effective ways of getting health promotion to the household level is essential for better health outcomes. Recommendations for Action • Try more participatory approaches like HCD in more settings to see if it consistently gets positive results and if there is longer term impact. • Look at how trust building-as evidenced by tracking of self-interest, common goal, and gratitude and indebtedness may be an important aspect of what is making things work. [End Page e9] Hanna-Joy Renner Freiburg, Germany Naomi W. Makobu Freiburg, Germany Simon Mbugua Kijabe Maternal Newborn Community Health (KMNCH), AIC Kijabe Hospital Wilson Karuri Kamiru Kijabe Maternal Newborn Community Health (KMNCH), AIC Kijabe Hospital Dorothy Oluoch Kenya Medical Research Institute) Angela Donelson Donelson Consulting Mary B. Adam Kijabe Maternal Newborn Community Health (KMNCH), AIC Kijabe Hospital The Africa Consortium for Quality Improvement Research in Frontline Healthcare (ACQUIRE) Copyright © 2023 Johns Hopkins University Press