title: Individual and contextual factors associated with community health workers' performance in Nyanza Province, Kenya: a multilevel analysis.
abstract: BACKGROUND
  Several African and South Asian countries are currently investing in new cadres of community health workers (CHWs) as a major part of strategies aimed at reaching the Millennium Development Goals. However, one review concluded that community health workers did not consistently provide services likely to have substantial effects on health and that quality was usually poor. The objective of this research was to assess the CHWs' performance in Western Kenya and describe determinants of that performance using a multilevel analysis of the two levels, individual and supervisor/community.
  
  
  METHODS
  This study conducted three surveys between August and September 2011 in Nyanza Province, Kenya. The participants of the three surveys were all 1,788 active CHWs, all their supervisors, and 2,560 randomly selected mothers who had children aged 12 to 23 months. CHW performance was generated by three indicators: reporting rate, health knowledge and household coverage. Multilevel analysis was performed to describe the determinants of that performance.
  
  
  RESULTS
  The significant factors associated with the CHWs' performance were their marital status, educational level, the size of their household, their work experience, personal sanitation practice, number of supervisions received and the interaction between their supervisors' better health knowledge and the number of supervisions.
  
  
  CONCLUSIONS
  A high quality of routine supervisions is one of the key interventions in sustaining a CHW's performance. In addition, decreasing the dropout rate of CHWs is important both for sustaining their performance and for avoiding the additional cost of replacing them. As for the selection criteria of new CHWs, good educational status, availability of supporters for household chores and good sanitation practices are all important in selecting CHWs who can maintain their high performance level.
authors.affiliation: JICA SEMAH project, Kisumu, Kenya. y.kawakatsu.0829@gmail.com.|Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan. y.kawakatsu.0829@gmail.com.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Kawakatsu
authors.affiliation: JICA SEMAH project, Kisumu, Kenya. sugitomo@jd5.so-net.ne.jp.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Sugishita
authors.affiliation: College of Social Sciences, Ritsumeikan University, Kyoto, Japan. jtsutsui@gmail.com.
authors.forename: Junya
authors.initials: J
authors.lastname: Tsutsui
authors.affiliation: Ministry of Public Health and Sanitation, Nairobi, Kenya. kendebbie2001@yahoo.com.
authors.forename: Kennedy
authors.initials: K
authors.lastname: Oruenjo
authors.affiliation: Ministry of Public Health and Sanitation, Nairobi, Kenya. swakhule34@gmail.com.
authors.forename: Stephen
authors.initials: S
authors.lastname: Wakhule
authors.affiliation: Ministry of Public Health and Sanitation, Nairobi, Kenya. tiropkennedy@gmail.com.
authors.forename: Kennedy
authors.initials: K
authors.lastname: Kibosia
authors.affiliation: Ministry of Public Health and Sanitation, Nairobi, Kenya. wereerick@yahoo.com.
authors.forename: Eric
authors.initials: E
authors.lastname: Were
authors.affiliation: Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan. honda@nagasaki-u.ac.jp.
authors.forename: Sumihisa
authors.initials: S
authors.lastname: Honda
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards*; D003150:Community Health Workers / Q000592:standards*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006792:House Calls / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007630:Kenya; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D009035:Mothers / Q000706:statistics & numerical data; D055361:Multilevel Analysis; D012423:Rural Health; D011795:Surveys and Questionnaires