| dc.description.abstract | The Community Health Volunteers (CHVs) :fundamental role in primary health care service delivery at household level has made them to be globally recognized for their effectiveness in reducing morbidity and averting mortality in mothers, newborns and• children. Their role includes identification of all expectant women and referral for antenatal care and skilled delivery at the health facilities. Regardless of the efforts made, women still die from preventable pregnancy related causes majorly due to unskilled attendance at birth which is 58 percent in the study area. From literature, the context factors in which the CHV s deliver their health care services has unique and critical influence on their performance. However, none of the studies done looked at individual based context factors that are likely to influence CHV performance to come up with an evidence-based context framework for improving maternal and neonatal health care outcomes in Nyando. This study was executed through a cross-sequential mixed method approach in three stages which included a census of 361 CHVs who serve in the study region. Stage (i) Establishment of contextual factors influencing performance at baseline (ii) Development and testing of the evidence-based context framework (iii) end line survey to evaluate the influence of the framework in CHVs performance. Descriptive analysis was done for the CHV s performance in frequencies and percentages while logistic regression models were run in odds ratios (COR and COR) at 95% confidence interval and p-values (p:S0.05). For qualitative data, a thematic analytical technique was used to identify emerging themes. Two Sample proportion Test was used to evaluate CHV performance between baseline and end line surveys. Results reveal that majority of the respondents were female 272 (75%) aged between 30-49(47%) years. Maternal record in use, CHVs knowledge in antenatal care services and security are the major context factors which significantly influenced CHVs performance p=0.011 ;( AOR =4.51, 95% Cl= 1.42-14.35), p=0.041 ;( AOR =2.53, 95%CI=l.04-6.19) and p<0.0001 ;( AOR =4.54, 95% CI= 2.00-10.31) respectively. This led to the development and testing of a 'CHV's Mother and Neonate Identification track booklet' as the framework. The evaluation findings show significant CHV s full performance improvement in FAN C, skilled birth attendance at HF and PNC outcomes by 222(61.52%), 285(79%) and 232(64.2%) respectively all at p <0. 0001. From this study, it is evident that the developed evidence ¬based context framework for CHV, improved the performance in maternal and neonatal health care outcomes in Nyando. Therefore, the County Health Management needs to adopt the framework to improve CHVs performance not only in maternal and neonatal health care outcomes but towards achievement of the Sustainable Development Goals (SDG) of attaining health for all. | en_US |