Reliable and timely health information is an essential foundation of public health action and health systems strengthening, both nationally and internationally [1, 3]. Being able to plan for and address the health needs requires information about the health status of a community. This kind of information is mostly unavailable in developing countries, partly due to lack of vital registration. Information that is available is derived from hospitals, yet most illness and death occur outside the health system [8, 11].
The need for sound information is especially urgent in the case of emergent diseases and other acute health threats, where rapid awareness, investigation and response can save lives and prevent broader national outbreaks and even global pandemics .
Measurement of population health, its causes and distribution is fundamental to the development of evidence for health policies and for the evaluation and planning of health systems and intervention programs . Valid, reliable and comparable measures of health states of individuals are critical components of the evidence base for health policy .
The government of Kenya, through the ministry of public health and sanitation has rolled out the community health strategy as a way of improving health care at the household level. This strategy involves community health workers collecting health status data at the household level, which is then used for dialogue at all the levels to encourage improvement in health status through informed decisions and actions by various stakeholders.
Community health workers have been known to collect health related data at the community level. They have been used to collect data for screening for Tuberculosis in many countries, achieving high rates of case detection in Bangladesh . CHWs can prepare and interpret malaria Rapid Diagnostic Tests correctly and safely when supported by clear instructions and appropriate training. Findings from other studies show that a well-designed job aid and brief training can ensure high CHW performance . This continues to improve in time through continuous practice. Community health workers have also been used to manage neonatal infections in rural India .
A lot of health interventions have involved the community health workers in reaching out to the community and successfully implementing these health interventions. Large scale involvement of community health workers in government initiatives and most especially to collect health data for use in the health systems has been minimal due to the assumption that the data may not be accurate, hence not useful by the government.
The Problem Statement
Western Kenya has consistently provided low health and development indicators despite presence of an array of interventions initiated by the NGOs and the government of Kenya . These low performing indicators beg for multiple interventions and concerted efforts on all sides to ensure that a reversal is achieved. These interventions require frequent, timely, valid and accurate information on the health status of the targeted populations for them to be effective. This information is for the most part unavailable.
Population-based sample surveys, Demographic and Health Surveys (DHS), and sentinel surveillance methods, are commonly used as substitutes for more widespread, consistent health and demographic monitoring and intervention studies . Nevertheless, sentinel surveillance methods, has been criticised for being expensive and time consuming, and can be applicable only in isolated populations. It is therefore necessary to determine whether other methods can be used to attain similar results, yet not as expensive in time and financial terms. With the rolling out of the community health strategy, a lot of information that can be used to determine the health status of a community can be available. Additionally, the information can be available to the local stakeholders which is not the case with sentinel surveillance data.
CHWs and other lay community workers have been known to provide health care services such as home visits, health education, referral and management of birth related problems at the household level and collect a wide range of health information [2, 6]. However, little is known as to whether this information can be relied on to measure population health, its causes and distribution. Moving from Demographic Surveillance Systems and Demographic Health Survey data to Community Based data collected by Community Health Workers to estimate burden of disease has not been looked at widely.
It is therefore necessary that the validity and reliability of the data collected by community health workers be determined, whether this kind of data can be used for planning and policy formulation for the communities from which it is collected and processed. This would go a long way to settle speculation on whether the data collected by these workers is of acceptable quality for use in determining the health status, its causes and leading to decisions on actions for its improvement.
To investigate the reliability of Community Based Information.
What is the reliability of data collected at the Community level by Community health workers?