Impact of Community Health Promoters on Kenya’s Devolved Healthcare: Mixed-Methods Analysis of 47 Counties

This mixed-methods study assessed Community Health Promoters’ (CHPs) impact on healthcare delivery across Kenya’s 47 counties. Data from 3,158 stakeholders including County Health Directors, CHPs, and community residents revealed significant improvements in disease detection: malaria reduction (34%, p < 0.001), tuberculosis case finding (+ 42%, p < 0.001), hypertension screening coverage (+ 56%, p < 0.001), and diabetes referrals (+ 38%, p < 0.01). Critical infrastructure gaps emerged, with only 23% of CHPs having consistent digital connectivity and 67% reporting real-time data transmission challenges. County variation was significant (F = 12.43, p < 0.001), with technology access explaining 47% of effectiveness variance (R²=0.47, p < 0.001). Training needs include digital literacy (89%), non-communicable disease management (76%), and mental health first aid (82%). Qualitative findings from 235 transcripts identified four overarching themes: technology as transformative but inequitably distributed; supervision as variable and under-resourced; NCD management as an emerging but unmet mandate; and data sharing failures as system governance failures. Triangulation of quantitative and qualitative findings confirmed convergence across major themes while revealing important discordances around supervision quality metrics. Recommendations include systematic digitalisation of CHP workflows, standardised capacity building, and integration into county health information systems to advance Universal Health Coverage.