Objectives: This paper examines trends and underlying causes of attrition among volunteer
community health workers in home-based care for people living with HIV and AIDS in
western Kenya.
Methods: Ethnographic data were collected between January and November 2006 through
participant observation, focus group discussions and in-depth interviews with 30 CHWs,
NGO staff and health care providers and 70 PLWHA.
Results: An attrition rate of 33% was observed among the CHWs. The reasons for dropout
included: the cultural environment within which CHWs operated; lack of adequate support
from area NGOs; poor selection criteria for CHWs; and power differences between NGO
officials and CHWs which fostered lack of transparency in the NGOs’ operations.
Conclusions: In order to achieve well functioning and sustainable HBC services, factors
which influence retention/dropout of CHWs should be addressed taking into account the
socio-cultural, programmatic and economic contexts within which CHW activities are
implemented.