Implementation and Evaluation of an mOral Health Training Program for Community Health Workers in Kenya

Abstract

Given the acute shortage of oral health professionals, the WHO Global Strategy for Oral Health adopted at the 75th World Health Assembly recommended the development and implementation of workforce models that enable sufficient numbers of adequately trained, motivated, and well-distributed health workers to provide oral health services through a collaborative and interprofessional network. The Consortium of Universities for Global Health (CUGH) provided guidance on competency-based oral health education and in 2023, the Harvard School of Dental Medicine in partnership with the WHO-AFRO developed the first competency-based m-oral health curriculum designed specifically for CHWs in Africa. This study evaluates the effectiveness of the pilot implementation of the mOral health curriculum in preparing CHWs to deliver oral health care to underserved communities and identifies barriers and facilitators to implementing the training program to inform future scalability. A mixed-methods evaluation was conducted using a convergent parallel design. Quantitative data were obtained from the OpenWHO platform, and a structured course feedback survey was distributed to all registered course participants in English, French and Portuguese through the platform. Qualitative data were collected through focus group discussions with CHWs and designated trainers (DTs) selected through purposeful sampling in four pilot counties in Kenya. Observational data collected through participation in planning meetings and digital ethnographic analysis of stakeholder discussions, were used to triangulate findings and assess implementation dynamics. Descriptive statistics were applied to quantitative survey data, while qualitative data were thematically analyzed to identify key facilitators and barriers to implementation. The online course enrolled 5,957 learners globally, with 2,403 earning a record of achievement. The feedback survey in English received 371 responses, French had 123 responses and Portuguese had 46 giving us response rates of 6.2%, 10.9% and 8.9% respectively. Survey responses demonstrated high engagement, with 90% of participants affirming the course’s relevance to their work. A total of 1,265 CHWs and 39 DTs participated in the pilot implementation in Kenya. Focus group discussions were conducted with 40 CHWs (10 from each county) and 18 DTs. Qualitative findings highlighted the program’s success in addressing a critical knowledge gap, increasing CHW confidence in oral health promotion, and fostering interprofessional collaboration and quantitative findings confirmed their high satisfaction with the course curriculum and features. Implementation challenges included digital access barriers, insufficient logistical and financial support, and highlighted gaps in integration of CHWs into formal referral systems. The study provides evidence supporting the feasibility of integrating CHWs into oral health service delivery through digital training. Key facilitators included the flexibility of the online format, the effectiveness of the mOral health curriculum, and the strong peer support networks among CHWs and DTs. Challenges such as technological barriers, and a lack of formalized referral pathways must be addressed for effective scale-up. While Kenya had a strong strategic plan that guided this work with highly engaged stakeholders, strengthening implementation through strategic policy support, provision of offline training resources, and sustainable funding mechanisms will be critical for expanding this model across other low and middle income settings. These study findings contribute to the broader discourse on workforce capacity-building and the role of digital learning in advancing universal health coverage.