Performance of community health workers and associated factors in a rural community in Wakiso district, Uganda

Abstract

Background: Community health workers (CHWs) continue to play a crucial role in supporting health service delivery globally. Several CHW programmes around the world face vast challenges which affect their performance.Objectives: This study assessed the performance of CHWs and associated factors in a rural community in Wakiso district, Uganda.Methods: This was a cross-sectional study that employed a structured questionnaire to collect quantitative data from 201 CHWs in Wakiso district. The main study variable was CHW performance based on various roles carried out by CHWs. Multivariable logistic regression in STATA was used to establish the predictors of CHW performance.Results: Only 40 (19.9%) of the CHWs had a high performance which was associated with having attended additional / refresher trainings [AOR=12.79 (95% CI: 1.02-159.26)], and having attained secondary level education and above [AOR=3.93 (95% CI: 1.17-13.24)]. CHWs who were married [AOR=0.29 (95% CI: 0.09-0.94)] were less likely to perform highly. Among CHWs who had received essential medicines for treatment of childhood illnesses, the majority 90.3% (112/124) had experienced stock-outs in the 6 months preceding the study. Despite the majority of CHWs, 198 (98.5%), stating that being motivated was very important in their work, only 91 (45%) said that they were motivated.Conclusion: Additional / refresher trainings are necessary to enhance performance of CHWs. In addition, level of education should be considered while selecting CHWs. The health system challenges of low motivation of CHWs as well as stock-out of medicines need to be addressed to support their work.Keywords: Community health workers, performance, motivation, satisfaction, stock-outs, village health teams, Uganda.

Access, use and disposal of antimicrobials among humans and animals in Wakiso district, Uganda: a qualitative study

“…However, CHWs only manage three diseases—pneumonia, malaria and diarrhoea—and only among children under 5 years of age as part of integrated community case management of childhood illnesses. In addition, CHWs in Uganda also face regular stock-out of antimicrobials [ 38 , 39 ]. These challenges are not specific to antimicrobials, but reflect the general constraints on primary health care services in Uganda and other LMICs [ 40 ].…”

Barriers and facilitators of implementation of a community cardiovascular disease prevention programme in Mukono and Buikwe districts in Uganda using the Consolidated Framework for Implementation Research

“…However, where complex interventions are involved, a selection criterion that requires a higher education level would help to increase efficiency and impact. Indeed, higher education levels are associated with improved knowledge and performance among CHWs [ 38 , 39 ] though they may come with higher attrition levels [ 40 ] and thus should be considered cautiously. Uganda’s CHW is voluntary with no remuneration [ 28 – 30 ] and CHWs continue to face other competing demands due to personal and social responsibilities [ 18 , 41 ].…”

“…Beyond workload, CHW self-efficacy, motivation and commitment are key attributes that should be explored a priori during recruitment in line with the World Health Organization (WHO) guidelines on health policy and system support to optimise CHW programmes [ 40 ]. Motivated CHWs are more likely to be performers and invest time in supporting intervention implementation [ 38 , 42 ] though motivation avenues should be continually incorporated within programmes. During intervention implementation, CHWs also reported some forms of mistrust by community members which although had been anticipated [ 18 ] is a concern for the success of community interventions.…”

“…Weather challenges also required that CHWs were provided with personal protective equipment including gumboots, umbrellas and t-shirts which were good motivation avenues and supported their identification within communities. As with most previous programmes, training was a key facilitator of intervention implementation [ 21 , 38 , 42 ] as CHWs had not interfaced with CVD interventions previously [ 18 ] supporting their understanding and contextualization of the disease, its risk factors and intervention [ 22 ]. The CHWs training programme was both didactic and experiential allowing CHWs to obtain the theoretical knowledge and field experience while receiving important feedback to improve, which was beneficial.…”

Enhancing Performance and Sustainability of Community Health Worker Programs in Uganda: Lessons and Experiences From Stakeholders

“…The capacity-building avenues include initiation and refresher training and supportive supervision whose relevance has previously been emphasized. 7 , 11 , 17 , 20 , 21 Previous studies have also underscored the importance of supportive supervision for CHWs by health care providers, including accompaniment and shadowing, which gives them important feedback and confidence to perform their roles, improves their acceptability, and builds community trust. 22 – 24 Although not fully explored in Uganda, capacity building of CHWs using technology has been recognized for facilitating other tasks, such as data collection and reporting, and improving outcomes, such as CHW motivation and empowerment.…”