[01] M. Kaseje, Faculty of Arts and Sciences, Great Lakes University of Kisumu, Kisumu, Kenya. [02] L. Thomas, Faculty of Health Science, Department of Public Health, Maseno University, Kisumu, Kenya.

Introduction: Training of the community level health workforce has posed challenges to the health system, both in providing adequately trained personnel who in most cases are volunteers, in finding a niche for them within the formal health sector and in meeting costs for their training. These cadre, also known as community health workers, community volunteers or lay health workers play key linkage points to households that the formal sector cannot accomplish alone, more so within constrained resources and shortages of formal health workers. Community colleges provide an alternative to formal training especially of lay workers. Great Lakes University of Kisumu introduced the formal community college training program in 2013 where 169 community health workers were enrolled in five sites. The program aimed to increase the number of certified community health workers for improved health uptake and to provide them with a career path. Objectives: This study set out to determine the cost elements related to the community college training program in order to ascertain its viability and long-term sustainability. Methodology: The study used a qualitative approach where data was collected from records of a convenience sample of 140 students enrolled in five community college sites. This information was triangulated with interviews of college tutors and program staff. Results: Most students were interested in the certified training provided by the community colleges. Females (60%) were the majority of students. Trainee ages ranged between 19 to 60 years with the majority in the 21to 30 years age group. Educational entry point varied, with the majority (78%) having secondary level education as compared to those with informal training. The main cost centres for the community college program were transport costs to the training sites (78%), staff wages and allowances (13%), training materials (7%) and refreshments for the trainers (2%). Only 4% of the expected fee revenue had been collected from students at the time of the study, with the balance expected at the end of the training. Conclusion and Recommendations: Community colleges are viable alternatives to formal training of community health workers. Initial training program costs pose constraints to student enrolment and may require alternative pre-funding sources or may have to be provided at a high unit cost until enrolment rises to an economical unit cost.

Community College, Community Health Worker, Lay Health Worker, Health Systems, Human Resources, Training Costs

[01] Agodini, R. & Dynarski, M. (2004). Are Experiments the Only Option? A Look at Dropout Prevention Programs.The Review of Economics and Statistics,Vol. 86, No. 1, Pages 180-194. [02] Anand, S.& Barnighausen, T. (2004). Human resources and health outcomes: cross-country econometric study. Lancet , 364:1603-09. [03] Baum, S., Little, K., & Payea, K. (2011). Trends in Community College Education: Enrollment, Prices, Student Aid and Debt Level. New York: The College Board Advocacy and Policy Center. [04] Borgi, J., Osrin, D., et al. (2005). Economic evaluation of a women's group intervention to improve birth outcomes in rural Nepal. Lancet , 366:1882-84. [05] Brown, C., Belfield, C., & Field, S. (2002). Cost effectiveness of continuing professional development in health care: a critical review of the evidence. BMJ , 324:652-655. [06] Chen, L., Evans, T., & Anand, S. (2004). Human resources for health: overcoming the crisis. Lancet, 364:1984-90. [07] Clerk, K. (2008, April). How much does college cost? Estimating the price tag for Community Colleges, state schools and Private schools. American College Board. [08] Manandhar, D., Osrin, D., Shrestha, B. et al. (2004). Effect of a participatory intervention with women's groups on birth outcomes in Nepal: cluster-randomized controlled trial. Lancet , 364:970-79. [09] Fryatt, R., Mills, A., & Nordstrom, A. (2010). Financing of health systems to achieve the health Millennium Development Goals in low-income countries. Lancet , 375:419-26. [10] Haines, A., Sanders, D., Lehmann, U., Rower, A., Lawn, J., Steve, J., et al. (2007). Achieving child survival goals: Potential contribution of Community Health Workers. Lancet , Volume 369, No 9579, p2121-2131. [11] Hongoro, C., & McPake, B. (2004). How to bridge the gap in human resources for health. Lancet , 364, 1451-1456. [12] Hunt, S. (2009). Lady Health Worker Programme: Third Party Evaluation of Performance . Oxford Publishers. [13] James, E. (1978). Product Mix and Cost Disaggregation: A Reinterpretation of the Economics of Higher Education. Human Resources, Vol.13, issue 2, pages 157-186. [14] Kaseje, M. (2015). The Application of a Community College Model in Recruiting Community Health Workforce in Western Kenya. Journal of Social Sciences and Humanities, Vol. 1, No. 4, pages 297-307. [15] Kinfu, Y., Dal Poz, M., Mercer, H., & Evans, D. (2009). The Health worker shortage in Africa: are enough physicians and nurses being trained? Bull WHO , 87:225-230. [16] Lewin S1, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M, Scheel IB. (2010). Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD004015. doi: 10.1002/14651858.CD004015.pub3. [17] McCord, G., Liu, A., & Singh, P. (2013, February). Deployment of community health workers across rural sub-Saharan Africa: financial considerations and operational assumptions. [18] Schneider, M., & Yin, L. (2011). The Hidden Costs of Community Colleges. American Institutes for Research. [19] Viswanathan, M. K., Kraschnewski, J., Nishikawa, B., & Morgan, L. (2010). Outcomes and costs of community health worker interventions: a systematic review. [20] WHO. (2006). Working together for Health: World Health Report. Geneva: World Health Organization