Performance of community health workers managing malaria, pneumonia and diarrhoea under the community case management programme in central Uganda: a cross sectional study

Bagonza, James; Kibira, Simon P. S.; Rutebemberwa, Elizeus

doi:10.1186/1475-2875-13-367

Cited by 57 publications

(86 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although initial selection, training, supervision and equipping of iCCM CHWs is feasible with good planning and support, our experiences should also serve as caution for planning larger and longer implementation. The real-life challenges we faced are also well described by others 9,38 and can be partly mitigated by careful planning, support, and adequate long-term funding at the national level prior to broader scale-up. This study's ultimately very short intervention period creates a major limitation in interpreting results.…”

Section: Discussionmentioning

confidence: 99%

“…Our study is complimentary suggesting multi-illness iCCM using CHWs with variable formal education is feasible, which is supportive of work in Eastern Uganda 23,[27][28][29][30] ; however, caution is needed to further understand quality of work, an issue highlighted by a recent study from Central Uganda. 38 A strength of this implementation study was existing government health structure integration, which demonstrated real-life iCCM-programming feasibility and outcomes. Decision-makers were key in planning, procuring drug supplies, and district and national health professionals provided training and CHW support.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Where there is no doctor: can volunteer community health workers in rural Uganda provide integrated community case management?

et al. 2017

View full text Add to dashboard Cite

Introduction: Integrated community case management (iCCM) involves assessment and treatment of common childhood illnesses by community health workers (CHWs). Evaluation of a new Ugandan iCCM program is needed. Objectives: The objectives of this study were to assess if iCCM by lay volunteer CHWs is feasible and if iCCM would increase proportions of children treated for fever, pneumonia, and diarrhoea in rural Uganda. Methods: This pre/post study used a quasi-experimental design and non-intervention comparison community. CHWs were selected, trained, and equipped to assess and treat children under five years with signs of the three illnesses. Evaluation included CHW-patient encounter record review plus analysis of pre/post household surveys. Results: 196 iCCM-trained CHWs reported 6,276 sick child assessments (45% fever, 46% pneumonia, 9% diarrhoea). 93% of cases were managed according to algorithm recommendations. Absolute proportions of children receiving treatment significantly increased post-intervention: antimalarial for fever (+24% intervention versus +4% control) and oral rehydration salts/zinc for diarrhoea (+14% intervention versus +1% control). Conclusion: In our limited-resource, rural Ugandan setting, iCCM involving lay CHWs was feasible and significantly increased the proportion of young children treated for malaria and diarrhoea.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Where there is no doctor: can volunteer community health workers in rural Uganda provide integrated community case management?

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Assessments of the CHV program in Uganda have shown that CHVs face multiple challenges resulting in poor performance (7, 11, 12). Implementation mechanisms in the country have varied and have been largely steered by government partners, including local and foreign non-governmental organizations, as government funding and resources have dwindled since inception (7).…”

Section: Background and Rationalementioning

confidence: 99%

“…Implementation mechanisms in the country have varied and have been largely steered by government partners, including local and foreign non-governmental organizations, as government funding and resources have dwindled since inception (7). Some of the factors described to improve their performance include support from the community and health facilities, adequate work resources, regular feedback, and supervision (3, 6, 11, 13, 17, 18). Challenges have been attributed to lack of or low remuneration, lack of uniform and regular contact with supervisors, or lack of motivation, high workload, and inadequate skills (3, 12).…”

Section: Background and Rationalementioning

confidence: 99%

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

Kuule¹,

Dobson²,

Woldeyohannes

et al. 2017

Front. Public Health

View full text Add to dashboard Cite

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.

show abstract

“…Multivariable logistic regression analysis with backward stepwise elimination was undertaken to determine factors independently associated with performance (good vs. poor). Potential predictors of CHW performance were selected from evidence and local knowledge and were retained where p <0.2 (21). The multivariable analysis shows AORs with corresponding 95% CIs.…”

Section: Designsmentioning

confidence: 99%

The performance of community health workers in the management of multiple childhood infectious diseases in Lira, northern Uganda – a mixed methods cross-sectional study

Wanduru

Tetui

Tuhebwe

et al. 2016

Global Health Action

Self Cite

View full text Add to dashboard Cite

BackgroundCommunity health workers (CHWs) have the potential to reduce child mortality by improving access to care, especially in remote areas. Uganda has one of the highest child mortality rates globally. Moreover, rural areas bear the highest proportion of this burden. The optimal performance of CHWs is critical. In this study, we assess the performance of CHWs in managing malaria, pneumonia, and diarrhea in the rural district of Lira, in northern Uganda.DesignsA cross-sectional mixed methods study was undertaken to investigate the performance of 393 eligible CHWs in the Lira district of Uganda. Case scenarios were conducted with a medical officer observing CHWs in their management of children suspected of having malaria, pneumonia, or diarrhea. Performance data were collected using a pretested questionnaire with a checklist used by the medical officer to score the CHWs. The primary outcome, CHW performance, is defined as the ability to diagnose and treat malaria, diarrhea, and pneumonia appropriately. Participants were described using a three group performance score (good vs. moderate vs. poor). A binary measure of performance (good vs. poor) was used in multivariable logistic regression to show an association between good performance and a range of independent variables. The qualitative component comprised seven key informant interviews with experts who had informed knowledge with regard to the functionality of CHWs in Lira district.ResultsOverall, 347 CHWs (88.3%) had poor scores in managing malaria, diarrhea, and pneumonia, 26 (6.6%) had moderate scores, and 20 (5.1%) had good scores. The factors that were positively associated with performance were secondary-level education (adjusted odds ratio [AOR] 2.72; 95% confidence interval [CI] 1.50–4.92) and meeting with supervisors in the previous month (AOR 2.52; 95% CI 1.12–5.70). Those factors negatively associated with CHW performance included: serving 100–200 households (AOR 0.24; 95% CI 0.12–0.50), serving more than 200 households (AOR 0.22; 95% CI 0.10–0.48), and an initial training duration lasting 2–3 days (AOR 0.13; 95% CI 0.04–0.41). The qualitative findings reinforced the quantitative results by indicating that refresher training, workload, and in-kind incentives were important determinants of performance.ConclusionsThe performance of CHWs in Lira was inadequate. There is a need to consider pre-qualification testing before CHWs are appointed. Providing ongoing support and supervision, and ensuring that CHWs have at least secondary education can be helpful in improving their performance. Health system managers also need to ensure that the CHWs’ workload is moderated as work overload will reduce performance. Finally, although short training programs are beneficial to some degree, they are not sufficient and should be followed up with regular refresher training.

show abstract

Performance of community health workers managing malaria, pneumonia and diarrhoea under the community case management programme in central Uganda: a cross sectional study

Cited by 57 publications

References 23 publications

Where there is no doctor: can volunteer community health workers in rural Uganda provide integrated community case management?

Where there is no doctor: can volunteer community health workers in rural Uganda provide integrated community case management?

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

The performance of community health workers in the management of multiple childhood infectious diseases in Lira, northern Uganda – a mixed methods cross-sectional study

Contact Info

Product

Resources

About