#### Introduction
This chapter encompasses the background, problem statement, objectives, research questions, significance, definitions, theoretical framework, and scope and delimitations of the study.
#### 1.1.0 Background of the Problem
Historically, many communities worldwide have relied on informal care systems (Satterfield et al., 2002; Spencer et al., 2010). Community Health Workers (CHWs) have played significant roles in public health, especially in developing countries where traditional practices gradually gave way to more formalized health services (Rosenthal et al., 1998; Bhutta et al., 2010). CHWs, often drawn from traditional birth attendants, are crucial for achieving health-related Millennium Development Goals (MDGs) by addressing local health issues through community engagement and primary health care approaches identified in the Alma Ata Conference (1978).
In Kenya, CHWs are integral to the Community Health Strategy, providing preventive services at the community level (Kenya’s Community Health Strategy 2006). However, criteria for CHW selection leave room for manipulation due to vague definitions of respect and literacy levels. Despite their essential role, CHWs face challenges such as lack of consistent supervision and inadequate funding, leading to low motivation and high dropout rates, which affects community health services (Kisumu District Strategic Plan 2011-2015).
#### 1.2.0 Statement of the Problem
The study seeks to address the issues affecting CHWs' performance and motivation in Seme Sub County, Kisumu. Despite efforts to achieve health targets set in the National Health Sector Strategic Plan, socio-cultural myths, inadequate information, and stigmatization hinder reproductive health improvements. High maternal and infant mortality rates, low antenatal care completion, and poor sanitation and water access exacerbate health challenges (Kisumu District Strategic Plan 2011-2015; Moumie, 2011).
#### 1.3.0 Main Objective
The primary aim is to investigate factors influencing CHWs' performance motivation in implementing the community health strategy in Seme Sub County.
#### 1.4.0 Specific Objectives
1. To ascertain if personal strengths of CHWs influence their performance motivation.
2. To determine if community support systems affect CHWs' performance motivation.
3. To examine the impact of management support systems on CHWs' performance motivation.
#### 1.5.0 Research Questions
1. What is the relationship between CHWs' personal strengths and their performance motivation?
2. How do community support systems influence CHWs' performance motivation?
3. Do management support systems affect CHWs' performance motivation?
#### 1.6.0 Significance of the Study
The study will provide insights into factors affecting CHWs' performance, helping to design better support systems and policies. This information is crucial for stakeholders, including the community, government, health workers, and researchers, to enhance CHWs' effectiveness and sustainability.
#### 1.7.0 Definition of Terms
- Interview schedule: A set of questions used during key informant interviews (Browne, 2011).
- Performance motivation: Defined as the CHWs' interest and willingness to undertake and improve community health responsibilities (ASHA study; Stuart-Kotze).
- Community Health Worker (CHW): A health worker performing essential services with standardized training and a defined community role (Criggler et al., 2011).
#### 1.7.0 Theoretical Framework/Conceptual Framework
The study applies Maslow’s Hierarchy of Needs to understand CHWs' motivation, analyzing their work satisfaction, community recognition, and self-actualization (Maslow, 1943). The conceptual framework is adapted from the ASHA study, focusing on individual and environmental factors influencing CHWs' performance.
#### 1.8.0 Scope and Delimitations of the Study
The research focuses on factors affecting CHWs in Kisumu West district, specifically those influencing their implementation of the community health strategy. Challenges include funding limitations and potential biases in information due to the dependence on NGOs.
### References
- Bhutta, Z. A., Lassi, Z. S., Pariyo, G., & Huicho, L. (2010). Global experience of community health workers for delivery of health-related Millennium Development Goals: a systematic review, country case studies, and recommendations for integration into national health systems. Global Health Workforce Alliance.
- Browne, K. E. (2011). Principles of Social Research. Palgrave Macmillan.
- Crigler, L., Hill, K., Furth, R., & Bjerregaard, D. (2011). Community Health Worker Assessment and Improvement Matrix (CHW AIM): A toolkit for improving CHW programs and services. USAID.
- Kenya Ministry of Health. (2006). Kenya Community Health Strategy.
- Kisumu District Strategic Plan 2011 – 2015.
- Maslow, A. H. (1943). A Theory of Human Motivation. Psychological Review, 50(4), 370-396.
- Moumie, N. B. (2011). Infant and under-five mortality in Kisumu, Kenya. Journal of Public Health in Africa, 2(1).
- Rosenthal, E. L., Wiggins, N., Brownstein, J. N., Johnson, S., Borbon, I. A., & Rael, R. (1998). The Final Report of the National Community Health Advisor Study: Weaving the Future. University of Arizona.
- Satterfield, D., Burd, C., Valdez, L., Hosey, G., & Shield, J. E. (2002). The "In-Between People": Participation of Community Health Representatives in Diabetes Prevention and Care in American Indian and Alaska Native Communities. Health Promotion Practice, 3(2), 166-175.
- Spencer, M. S., Gunter, K. E., & Palmisano, G. (2010). Community Health Workers and Their Value to Social Work. Social Work, 55(2), 169-180.
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