Gaps in Team Communication About Service Statistics Among Health Extension Workers in Ethiopia: Secondary Data Analysis (Preprint)

Abstract

BACKGROUND Team communication is an important component for effective teamwork but community-based health workers in low-resource settings may face challenges in team communication for service statistics due to their extensive travel and outreach activities. Particularly, it has been known that health extension workers (HEWs) in rural Ethiopia spend approximately 75% of their working time on outreach activities and 15.5% on travel. Therefore, there could be gaps in team communication for service statistics among HEWs in terms of scheduling a meeting in a physical location and generating basic statistics from paper-based field book they carry while traveling. OBJECTIVE The study aimed to identify gaps in team communication for service statistics among HEWs in Ethiopia and to explore the potential for mobile communication and data collection as a tool for bridging these gaps. METHODS Most recent Performance Monitoring and Accountability 2020 service delivery point data was used for analysis. Logistic regression analysis was performed to identify disparities in team communication for service statistics on family planning, which is a major component of HEWs’ task. The disparities were examined across health facilities with different levels of HEW integration into their staffing structure. Additionally, chi-square test was conducted to examine disparities in access to electricity for exploring the potential for mobile communication and data collection. RESULTS 427 health facilities of 4 different types were included for analysis. 84 out of 95 health posts (88%) had HEWs as the only staff position while no health clinic has integrated HEW model in their staffing structure. For these 84 facilities, the odds of having team meetings on family planning service statistics during last 12 months were 0.48 times the odds for those without HEWs (p-value=0.02). No statistically significant difference was found between HEW-only facilities and facilities with at least 1 HEW. 83% of health facilities with HEWs as the only staff had no electricity at the time of the survey while 71% of them had electricity but out for 2 or more hours that day. There were statistically significant differences in access to electricity among health facilities with different levels of HEW integration (chi-square p-value<0.001). CONCLUSIONS Facilities with HEWs as the only staff position were less likely to have regular team communication for discussing service statistics. Considering their responsibilities for extensive outreach and travel involving paper-based recordkeeping, empowering them with mobile communication and data collection can be a workable solution. The empirical evidence in disparities in access to electricity also supports the need for and feasibility of this approach.