Community Health Volunteers in Primary Healthcare in Rural Uganda: Factors Influencing Performance

Abstract

IntroductionCommunity health volunteers (CHVs) play an integral role in primary healthcare. Several countries rely on CHV programs as a major element in improving access to care and attaining universal health coverage. However, their performance has been heterogeneous and at times context-specific, and influenced by multiple factors. We describe the socio-demographic and workplace characteristics affecting CHVs’ performance in a public health program in rural western Uganda.MethodsThis was a cross-sectional study based on routine program data of CHVs serving the catchment of Bwindi Community Hospital, Kanungu District, South Western Uganda, in 2014 and 2015. Information was collected on individual socio-demographic and workplace characteristics of the CHVs. To assess their work output, we defined study-specific targets in terms of attendance at monthly CHVs’ meetings with community health nurses, households followed-up and reported, children screened for malnutrition, immunization coverage, and health facility deliveries. Frequencies and proportions are reported for characteristics and outputs and odds ratios for study-specific factors associated with overall performance.ResultsOf the 508 CHVs, 65% were women, 48% were aged 35 years and below, and 37% took care of more than the recommended 20–30 households. Seventy-eight percent of the CHVs had ≥80% of pregnant women under their care delivering in health units, 71% had ≥95% of the children on schedule for routine immunization, while 27% screened ≥75% of the children under 5 years for malnutrition. More refresher trainings was associated with better overall performance [adjusted odds ratio (aOR): 12.2, 95% confidence interval (CI): 1.6–93.6, P = 0.02] while overseeing more than the recommended 20–30 households reduced overall performance (aOR: 0.6, 95% CI: 0.4–0.9, P = 0.02).ConclusionBeing in-charge of more than the recommended households was associated with reduced performance of CHVs, while more refresher trainings were associated with improved performance. If the CHVs are to remain a strategic pillar in universal health coverage, it is imperative to address those factors known to impact on their performance.

A Retrospective Cross Sectional Study of the Effectiveness of a Project in Improving Infant Health in Bwindi, South Western Uganda

“…Elsewhere in Uganda, visits by trained CHVs who are able to contact nurses by mobile phone have been shown to increase health center deliveries and improve timely care-seeking for newborn illness ( 13 ), and to reduce deaths and illness in children under-5 ( 11 ). However, in our study all pregnant mothers and newborns were visited by the trained CHVs and it may be that the criteria used to assess if they were “high performing,” based on a previous study ( 17 ), were not the most relevant ones when it came to the effectiveness of their work with mothers and babies. In another Ugandan study ( 13 ), in the control area without the trained CHVs only 28% of deliveries were in health facilities, compared with 86% in the areas with the trained CHV.…”

“…The independent variables collected were the number of nurse-led pre-birth visits; number of nurse-led visits to assess the neonate; a household in a hard to reach area; CHV participation level [defined as “high” if the CHV (a) attended ≥75% of expected monthly meetings, and (b) visited his/her households and collected / submitted ≥75% of expected monthly reports on pregnant women, newborn babies, and sick members of his/her catchment households, and (c) screened and monitored ≥75% of the children under-5 years of age in his/her catchment households; ( 17 )].…”

Longitudinal analysis of the capacities of community health workers mobilized for seasonal malaria chemoprevention in Burkina Faso

“…The progress is significant even though the baselines are already quite high and margins for progress are naturally limited. Research suggests that the capacities of community health workers tend to wane rather quickly [11,23,24] and that refresher training effectively enhances their performance [12,25,26]. The CBDs of the 2017 and 2018 campaigns thus seemed to have benefited from the cumulative contribution of each initial campaign training session, the supervision provided by the health teams during each round, and the regular refresher training preceding each round.…”

Moving to a strong(er) community health system: analysing the role of community health volunteers in the new national community health strategy in Malawi

“…District authorities and project partners need to deliberate on appropriate forms of support that respect and enhance the critical role of community-based structures and civil society in healthcare delivery. Options applied elsewhere in the region include development of a standardised costing structure for volunteer-led work, which takes into consideration workload, nature of tasks and opportunity costs, as illustrated by a Ugandan study31; or provision of non-financial incentives such as bicycles in remote settings, stationery support and other forms of recognition such as certificates 27 32 48…”