Supporting children and adolescents who have experienced sexual abuse to access services: community health workers’ experiences in Kenya

Child sexual abuse (CSA) is a global health problem with signi?cant health consequences. The World Health Organization recommends immediate and long-term treatment for all survivors. However, in low- and middle-income countries, less than 10 % of sexually abused children seek health services. Community health workers (CHWs) can potentially increase uptake of services, but, the risks and bene?ts of services provided by CHWs are poorly understood. Methods: Through in-depth interviews, we examined the experiences of CHWs providing services to children in Kenya. Sixteen CHWs were purposively selected from two locations. Data were audio-recorded, transcribed verbatim and analysed thematically. Findings: Nearly all the CHWs reported assisting children who had experienced sexual abuse. Children were brought to their attention by caregivers, neighbours, teachers, local authorities or the police. CHWs roles included providing information and advice, assisting the child to report to the police, access healthcare or ?nd shelter. Multiple challenges were reported including lack of support from formal institutions; community norms; safety concerns; inadequate resources and interference from family, perpetrators and local authorities. Lack of protocols and training on how to handle children was evident. Conclusions: CHWs are a crucial community-level resource for CSA survivors and their caregivers. However, community norms, lack of guidelines and training may compromise the quality of services provided. There is a signi?cant gap in literature on service models for CHWs delivering CSA services. Data are lacking on what services CHWs can e?ectively o?er, how they should be delivered and what factors may in?uence delivery, acceptance and uptake of services.