Background
Kenya has a national policy known as the Community Health Strategy (MOH, 2006) aimed at
reforming primary health care at the community level as a result of declining health
indicators. The strategy is based on the use of volunteers referred to as Community Health
Workers (CHWs) linked to primary health facilities through Community Health Extension
Workers (CHEWs). The programme has been implemented with varying degrees of success
in government-run primary health services as well as in vertical programmes run by nongovernmental
organizations (NGOs). The strategy is currently undergoing review with the
aim of increasing the number of CHEWs and their responsibilities and revising the role and
number of CHWs, to address shortcomings of the current strategy and align it with
successful models in other countries.
‘REACHOUT: Reaching out and linking in health systems and close-to-community services’ is
a five-year multi-country project funded by the European Union (EU) whose aim is to
maximize the equity, effectiveness and efficiency of close-to-community (CTC) services in
rural areas and urban slums in six countries: Bangladesh, Ethiopia, Indonesia, Kenya, Malawi
and Mozambique. This study represents the first phase of REACHOUT, which aims to identify
contextual factors that influence the performance of CTC providers and services in Kenya.
The results will inform implementation of two improvement cycles to test interventions for
improving CTC performance and their contribution to CTC services.

Methods
We conducted the study through a desk review, qualitative study and stakeholder mapping.
The desk review was done by reviewing secondary data on programmes that involve CTC
providers in Kenya. We reviewed journal articles, policy documents, grey literature,
programme reports and stakeholder consultations with partners and the Division of
Community Health Services.
Stakeholder mapping: We identified stakeholders involved in community health
programmes through consultations with LVCT staff and other local partners/NGOs and input
from the country advisory group members and the Division of Community Health Services.
The qualitative study adopted a descriptive exploratory design.
Study sites: We conducted the study in Nairobi and Kitui, selected due to the presence of
functional community units and LVCT’s history of working with them.