title: Time savings--realized and potential--and fair compensation for community health workers in Kenyan health facilities: a mixed-methods approach.
abstract: BACKGROUND
  Sub-Saharan Africa faces a severe health worker shortage, which community health workers (CHWs) may fill. This study describes tasks shifted from clinicians to CHWs in Kenya, places monetary valuations on CHWs' efforts, and models effects of further task shifting on time demands of clinicians and CHWs.
  
  
  METHODS
  Mixed methods were used for this study. Interviews were conducted with 28 CHWs and 19 clinicians in 17 health facilities throughout Kenya focusing on task shifting involving CHWs, time savings for clinicians as a result of task shifting, barriers and enabling factors to CHWs' work, and appropriate CHW compensation. Twenty CHWs completed task diaries over a 14-day period to examine current CHW tasks and the amount of time spent performing them. A modeling exercise was conducted examining a current task-shifting example and another scenario in which additional task shifting to CHWs has occurred.
  
  
  RESULTS
  CHWs worked an average of 5.3 hours per day and spent 36% of their time performing tasks shifted from clinicians. We estimated a monthly valuation of US$ 117 per CHW. The modeling exercise demonstrated that further task shifting would reduce the number of clinicians needed while maintaining clinic productivity by significantly increasing the number of CHWs.
  
  
  CONCLUSIONS
  CHWs are an important component of healthcare delivery in Kenya. Our monetary estimates of current CHW contributions provide starting points for further discussion, research and planning regarding CHW compensation and programs. Additional task shifting to CHWs may further offload overworked clinicians while maintaining overall productivity.
authors: Johns Hopkins Bloomberg School of Public Health, 1000 E. Eager Street, Baltimore, MD, 21202, USA. lsande15@jhmi.edu.
authors: Laura D
authors: LD
authors: Sander
authors: Baylor International Pediatrics AIDS Initiative, Maseru, Lesotho. daveholtzman@gmail.com.
authors: David
authors: D
authors: Holtzman
authors: University of Pennsylvania Wharton School, Philadelphia, PA, USA. pauly@wharton.upenn.edu.
authors: Mark
authors: M
authors: Pauly
authors: Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. jecohn6@gmail.com.
authors: Jennifer
authors: J
authors: Cohn
mesh_terms: D017954:Africa South of the Sahara; D001291:Attitude of Health Personnel; D003150:Community Health Workers / Q000191:economics; D003695:Delivery of Health Care / Q000191:economics; D006268:Health Facilities / Q000191:economics; D006296:Health Services / Q000191:economics; D006801:Humans; D007630:Kenya; D009726:Nurses; D010820:Physicians; D036301:Qualitative Research; D012456:Salaries and Fringe Benefits; D014937:Work; D000078329:Workforce; D016526:Workload
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