“…The importance of income was an underlying theme, with CHWs crystallizing their expectations on the transport refund as the only existing financial incentive. This is consistent with previous studies highlighting that despite being volunteers, CHWs may see their role as income-generating 21 , 38 , 41 . Prior research has also shown that CHWs often feel disgruntled at the lack of material benefits 22 , 38 , 39 .…”
Section: Discussionsupporting
confidence: 93%
“…Enhanced status and the receptivity of others to their advice galvanized intrinsic feelings of altruism and satisfaction with helping others. Other studies also highlight social prestige and social responsibility as enabling factors 21 – 23 , 38 . Our findings reinforce the potential of public recognition as a strategy for magnifying the positive behavioral traits that underlie CHWs' commitment.
Public recognition of CHWs can help keep them motivated.
In Uganda, community-based health programs using volunteers should focus on strengthening support systems to address transportation and stockout issues and on improving links with the health structure while reinforcing effort recognition, status, and acquisition of new skills.
“…The importance of income was an underlying theme, with CHWs crystallizing their expectations on the transport refund as the only existing financial incentive. This is consistent with previous studies highlighting that despite being volunteers, CHWs may see their role as income-generating 21 , 38 , 41 . Prior research has also shown that CHWs often feel disgruntled at the lack of material benefits 22 , 38 , 39 .…”
Section: Discussionsupporting
confidence: 93%
“…Enhanced status and the receptivity of others to their advice galvanized intrinsic feelings of altruism and satisfaction with helping others. Other studies also highlight social prestige and social responsibility as enabling factors 21 – 23 , 38 . Our findings reinforce the potential of public recognition as a strategy for magnifying the positive behavioral traits that underlie CHWs' commitment.
Public recognition of CHWs can help keep them motivated.
In Uganda, community-based health programs using volunteers should focus on strengthening support systems to address transportation and stockout issues and on improving links with the health structure while reinforcing effort recognition, status, and acquisition of new skills.
“…Moreover, VHTs' expanded role appeared to improve their motivation through enhanced visibility and technical skills. This is consistent with other studies showing that status and skills are important motivators for volunteers [17][18][19][20] . The main areas identified for improvement are integrated messages and system support.…”
Little is known on integrating HIV and family planning (FP) services in community settings. Using a cluster randomized controlled design, we conducted a formative assessment in two districts in Uganda where community health workers, called VHTs, already offered FP. Thirty-six trained VHTs also provided HIV testing and counseling (HTC) during the intervention. We surveyed all 36 VHTs and 256 FP clients, and reviewed service statistics. In the intervention group, VHTs tested 80% of surveyed clients for HIV, including 76% they already saw for FP and 22% who first came to them for HTC before receiving FP. Comparing clients' experiences in the intervention and control groups, adding HTC does not appear to have negatively affected FP service quality. VHTs reported more monthly clients, but rated their workload as easy to manage. This integrated model seems feasible and beneficial for both VHTs and clients, while not resulting in any negative effects. This study was registered with ClinicalTrials.gov, number [NCT02244398].
(Afr J Reprod Health 2017; 21[2]: 73-80).Keywords: family planning, HIV, community health workers, integration, Uganda
RésuméPeu d'informations sont disponibles sur l'intégration des services de planification familiale (PF) et du VIH dans les milieux communautaires. En utilisant un plan randomisé contrôlé par grappes, nous avons mené une évaluation formative dans deux districts en Ouganda dans lesquels les agents de santé communautaire qui sont appelés VHT offraient déjà des services de PF. Trente-six VHT formés ont également fourni des services de conseil et dépistage du VIH (CDV). Nous avons enquêté les 36 ASC et 256 clientes PF, et nous avons examiné les statistiques sur les services. Dans le groupe d'intervention, les VHT ont testé 80% des clients enquêtées pour le VIH, y compris 76% que les VHT voyaient déjà pour la PF et 22% qui sont d'abord venus pour le CDV avant avant de recevoir la PF. En comparant les expériences des clientes dans les groupes avec et sans intervention, l'ajout du CDV ne semble pas avoir affecté négativement la qualité des services PF. Les VHT ont signalé plus de clients mensuellement, mais ont évalué leur charge de travail comme étant aussi facile à gérer. Ce modèle intégré semble faisable et bénéfique pour les VHT et les clients, et sans entraîner d'effet négatif. Cette étude a été enregistrée auprès de ClinicalTrials.gov, numéro [NCT02244398]. (Afr J Reprod Health 2017; 21[2]: 73-80).
“…In regard to their community, CHWs feel that they are closely related to it, that their social status has improved, and that villagers manifestly value their work. These mechanisms are related to key performance factors identified by numerous studies on CHWs (Alam et al, 2012;Bhattacharyya et al, 2001;Bhutta et al, 2010;Liu et al, 2011;Perry and Zulliger, 2012;Puett et al, 2013).…”
The use of community health workers to administer prompt treatments is gaining popularity in most sub-Saharan African countries. Their performance is a key challenge because it varies considerably, depending on the context, while being closely associated with the effectiveness of case management strategies. What determines community health workers' performance is still under debate. Based on a realist perspective, a systematic review recently hypothesized that several mechanisms are associated with good performance and successful community interventions. In order to empirically investigate this hypothesis and confront it with the reality, we conducted a study in Burkina Faso, where in 2010 health authorities have implemented a national program introducing community case management of malaria. The objective was to assess the presence of the mechanisms in community health workers, and explore the influence of contextual factors. In 2012, we conducted semi-structured interviews with 35 community health workers from a study area established in two similar health districts (Kaya and Zorgho). Results suggest that they perceive most of the mechanisms, except the sense of being valued by the health system and accountability to village members. Analysis shows that drug stock-outs and past experiences of community health workers simultaneously influence the presence of several mechanisms. The lack of integration between governmental and non-governmental interventions and the overall socio-economic deprivation, were also identified as influencing the mechanisms' presence. By focusing on community health workers' agency, this study puts the influence of the context back at the core of the performance debate and raises the question of their ability to perform well in scaled-up anti-malaria programs.
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