Perceptions and experiences on community work improvement teams: the case of community health units in Kasarani sub-county, Nairobi, Kenya

Background: In Kenya, guidelines have been developed and activities undertaken aimed at improving the quality of health services in health facilities and communities. These efforts could help in contributing to the country’s goal of the highest standards of health for citizens. Current research on the subject is limited to whether the novel idea is understood and its benefits. This study takes a deep emic dive to understand the dynamics of work improvement teams (WITs) in the case of five community units within Kasarani sub-county of Nairobi City County, Kenya. Methods: : Focus group discussions and key informant interviews were conducted with members of WIT. Interviews were recorded and transcribed, after which analysis conducted using NVIVO software was based on inductive coding. Results: : Participants vividly recollect core WIT training and implementation aspects in particular the power of teamwork, the mentoring role of community health assistants (CHAs), and community innovations. Appreciation of WIT training and implementation finds expression in warmer reception accorded mothers referred by community health volunteers (CHVs); more open sharing of health concerns due to the social nearness of CHVs to community members; community own-resource contributions. Members of work improvement teams share a sense of empowerment post-training and feel triumphant after winning in WIT competitions. Experiences of WIT members include championing roles such as the CHV as the health educator, the CHA as the captain, and the chief personifying Government’s effective presence in the community. Similarly, the experience of disconnections between the community and the formal health systems is evident in respondent narratives, as are gapping (identifying health problems in the community), and discussion steps during work improvement. Enabling factors for quality improvement through community work improvement teams include passion, commitment, and self-motivation as well as team household visits. Nevertheless, hurdles within and external to mother, CHV, and facility levels persist. Conclusion: Respondents present fresh recalls, appreciations, and experiences on WIT training and implementation in Kasarani sub-county. These imply WIT efforts as inflection events propelling performance of community health units. The intervention should be scaled to other community health units and regions, considering enablers and challenges.