Evaluating the Effectiveness of Community Health Worker-Led Surgical Screening in Remote Pastoralist Communities of Northern Kenya

This original research addresses the critical gap in access to essential surgical care within remote pastoralist communities of Northern Kenya, where profound geographical and infrastructural barriers exist. The study evaluated the diagnostic accuracy and feasibility of a community health worker (CHW)-led programme for screening common surgical conditions. Employing a mixed-methods design across five sub-counties between 2023 and 2025, trained CHWs screened 2,847 adults using a standardised protocol for conditions including hernias, hydroceles, and soft tissue tumours. Screen-positive individuals received specialist verification. The primary outcome was the diagnostic accuracy of CHW screening against a surgeon’s assessment. Results demonstrated that CHWs identified 412 screen-positive cases, with a surgeon-confirmed prevalence of 12.1%. The programme achieved a sensitivity of 88% and a specificity of 94%. Qualitatively, the model was found to be highly culturally acceptable. Furthermore, it reduced the average patient travel distance to initial assessment by over 80 kilometres. The study concludes that task-shifting initial surgical screening to CHWs is an accurate, effective, and feasible strategy for early case detection in these marginalised settings. These findings advocate for the integration and scale-up of such CHW-led initiatives within national surgical plans to strengthen health systems and advance equitable access to care across similar regions.