Association between a complex community intervention and quality of health extension workers’ performance to correctly classify common childhood illnesses in four regions of Ethiopia

Abstract

Background Due to low care utilization, a complex intervention was done for two years to optimize the Ethiopian Health Extension Program. Improved quality of the integrated community case management services was an intermediate outcome of this intervention through community education and mobilization, capacity building of health workers, and strengthening of district ownership and accountability of sick child services. We evaluated the association between the intervention and the health extension workers’ ability to correctly classify common childhood illnesses in four regions of Ethiopia. Methods Baseline and endline assessments were done in 2016 and 2018 in intervention and comparison areas in four regions of Ethiopia. Ill children aged 2 to 59 months were mobilized to visit health posts for an assessment that was followed by re-examination. We analyzed sensitivity, specificity, and difference-in-difference of correct classification with multilevel mixed logistic regression in intervention and comparison areas at baseline and endline. Results Health extensions workers’ consultations with ill children were observed in intervention (n = 710) and comparison areas (n = 615). At baseline, re-examination of the children showed that in intervention areas, health extension workers’ sensitivity for fever or malaria was 54%, 68% for respiratory infections, 90% for diarrheal diseases, and 34% for malnutrition. At endline, it was 40% for fever or malaria, 49% for respiratory infections, 85% for diarrheal diseases, and 48% for malnutrition. Specificity was higher (89–100%) for all childhood illnesses. Difference-in-differences was 6% for correct classification of fever or malaria [aOR = 1.45 95% CI: 0.81–2.60], 4% for respiratory tract infection [aOR = 1.49 95% CI: 0.81–2.74], and 5% for diarrheal diseases [aOR = 1.74 95% CI: 0.77–3.92]. Conclusion This study revealed that the Optimization of Health Extension Program intervention, which included training, supportive supervision, and performance reviews of health extension workers, was not associated with an improved classification of childhood illnesses by these Ethiopian primary health care workers. Trial registration ISRCTN12040912, http://www.isrctn.com/ISRCTN12040912.

Exploring complementary and competitive relations between non-communicable disease services and other health extension programme services in Ethiopia: a multilevel analysis

“…In the current study, the involvement of woreda administrators in HEWs supervision also did not show any significant association with improving NCD prevention service coverage. While some studies found results like ours, 37 the absence of association in the current research is contrary to evidence that supportive supervision is critical for programme success and effective NCD service delivery by CHWs. 14 17 24 As evidence suggests, supervision needs to be linked to performance goals, targeted to a specific group and focused on particular knowledge and skillset to have the desired effect.…”

Health extension workers’ perceived health system context and health post preparedness to provide services: a cross-sectional study in four Ethiopian regions

“…23 Unfortunately, the intervention, which included community engagement, training, supportive supervision and performance reviews of health workers neither increased care-seeking for sick children 24 nor improved the classification of childhood illnesses by these primary healthcare workers. 25 The failure of such an intervention could, at least partly, be attributed to the context of the health extension workers. There is a need for accurate measurements that reflect the health system context in which care is provided to patients and populations.…”

Quality of sick child management by health extension workers: role of a complex improvement intervention

“…The intervention had no effect on household participation in community engagement forums, nor on indicators of district accountability of child health services [ 32 ]. Another study based on the same survey data also revealed a lack of association between the intervention and correct classification of sick children 2–59 months by the health extension workers as compared to health officers who served as a gold standard [ 58 ].…”