CHWs (155) Social network analysis of community health committees in a rural and urban setting in Kenya

13 August, 2019

(with thanks to the "Community Health" Community of Practice (CH CoP))

Dear HIFA colleagues,

Individuals, families and health workers need healthcare inforamtion to guide decision making to protect their health and the health of others - to prevent and manage disease and injury.

This paper looks at other types of health information at community level, notably information on 'health care needs from the community, such as interventions needed from the health system to address communicable disease outbreaks'. We read that 'local Chiefs relayed information on government directives and policies such as directives against female genital mutilation, prevention of early marriage of girls, among others. CHCs would, in turn, inform the community policing committee of households that were defaulting health-related government policies and would enlist their support in enforcing them'.

CITATION: “It’s like these CHCs don’t exist, are they featured anywhere?”: Social network analysis of community health committees in a rural and urban setting in Kenya

Robinson Njoroge Karuga , Maryse Kok, Patrick Mbindyo, Femke Hilverda, Lilian Otiso, Daniel Kavoo, Jaqueline Broerse, Marjolein Dieleman

Published: August 8, 2019


Background: In Kenya, Community Health Committees (CHC) were established to enhance community participation in health services. Their role is to provide leadership, oversight in delivery of community health services, promote social accountability and mobilize resources for community health. CHCs form social networks with other actors, with whom they exchange health information for decision-making and accountability. This case study aimed to explore the structure of a rural and an urban CHC network and to analyze how health-related information flowed in these networks. Understanding the pathways of information in community settings may provide recommendations for strategies to improve the role and functioning of CHCs.

Methods: In 2017, we conducted 4 focus group discussions with 27 community discussants and 10 semi-structured interviews with health professionals in a rural area and an urban slum. Using social network analysis, we determined the structure of their social networks and how health related information flowed in these networks.

Results: Both CHCs were composed of respected persons nominated by their communities. Each social network had 12 actors that represented both community and government institutions. CHCs were not central actors in the exchange of health-related information. Health workers, community health volunteers and local Chiefs in the urban slum often passed information between the different groups of actors, while CHCs hardly did this. Therefore, CHCs had little control over the flow of health-related information. Although CHC members were respected persons who served in multiple roles within their communities, this did not enhance their centrality. It emerged that CHCs were often left out in the flow of health-related information and decision-making, which led to demotivation. Community health volunteers were more involved by other actors such as health managers and non-governmental organizations as a conduit for health-related information.

Conclusion: Social network analysis demonstrated how CHCs played a peripheral role in the flow of health-related information. Their perception of being left out of the information flow led to demotivation, which hampered their ability to facilitate community participation in community health services; hence challenging effective participation through CHCs.

Best wishes, Neil

Coordinator, HIFA Project on Community Health Workers

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: