Application Of The Ultra-Poverty Graduation Model In Understanding Community Health Volunteers’ Preferences For Socio-Economic Empowerment Strategies: A Qualitative Study In Kilifi, Kenya

Abstract Background: There is a significant shortage of healthcare workforce globally. In order to achieve Universal Healthcare coverage, governments need to enhance their community-based healthcare provider programmes. Community health volunteers (CHVs) are essential personnel in achieving this objective, however their needs remain unmet hence their high attrition rates.Methods: This study adopted an exploratory mixed methods qualitative approach including Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs). Using a semi-structured questionnaire, out of the 17 Community Health Units (CHUs), we conducted 10 FGDs based on the number of CHUs in each of the two sub-counties, three from Rabai Sub-county and seven from Kaloleni Sub-county. We conducted 10 key-informant interviews from participants who included County and sub -county Ministry of Health (MOH) and Ministry of Agriculture (MOA) officials as well as multi-lateral stakeholders’ representatives from Kaloleni and Rabai sub-counties. Data was audio-recorded and transcribed verbatim. Transcripts were analysed using NVivo qualitative data software version 10. Researcher triangulation supported the first round of analysis of the data in this study. Data was mapped and findings interpreted using a theory driven analysis based on the Ultra-Poverty Graduation (UPG) model. Results: The results are presented using the Ultra Poverty Graduation (UPG) model, which involves a six-step intervention. It consists of the provision of asset transfer of an in-kind good such as poultry or livestock, weekly stipends with consumption support to stabilize consumption, hands-on training on how to care for assets and run a business, savings and financial support to build assets and instil financial discipline, healthcare provision and access and finally social integration.Conclusion: The results of this study provides a user-identified approach to identify and assess the strategic needs of CHVs for socio-economic empowerment. The study further applies a sustainable economic empowerment model to provide further understanding on how these needs can be addressed in order to enhance retention of CHVs.