Staff attrition among community health workers in home-based care programmes for people living with HIV and AIDS in western Kenya.

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.