Strengthening the community health worker programme for health improvement through enhancing training, supervision and motivation in Wakiso district, Uganda

Musoke, David; Ssemugabo, Charles; Ndejjo, Rawlance; Atusingwize, Edwinah; Mukama, Trasias; Gibson, Linda

doi:10.1186/s13104-019-4851-6

Cited by 28 publications

(33 citation statements)

References 11 publications

(8 reference statements)

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“…This framework is based on the notion that CHWs leverage the existing health care delivery infrastructure, such as health centers and community health promoters. Conversely, a recent study in central Uganda found that provision of non-financial incentives and support supervision to CHWs improved CHW performance [44].…”

Section: Discussionmentioning

confidence: 87%

Acceptability of Patient-centered Hypertension Education Delivered by Community Health Workers among People Living with HIV/AIDS in Rural Uganda

Batte

Mukisa

Rykiel

et al. 2020

Preprint

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Background The prevalence of hypertension is increasing among people living with HIV/AIDS (PLWHA) in low- and middle-income countries (LMICs). However, knowledge of the complications and management of hypertension among PLWHA in Uganda remains low. We explored the acceptability of implementing hypertension (HTN) specific health education by community health workers (CHWs) among PLWHA in rural Uganda. Methods We conducted a qualitative study consisting of 22 in-depth interviews (14 PLWHA/HTN and 8 CHWs), 3 focus group discussions (FGDs), 2 with PLWHA/HTN and 1 with CHWs from Nakaseke district, Uganda. Participants were interviewed after a single session interaction with the CHW. Data were transcribed from luganda (local language) into English and analyzed using thematic analysis. We used Sekhon’s model of acceptability of health Interventions to explore participants’ perceptions. Results Participants believed CHWs utilized easy-to-understand, colloquial, non-technical language during education delivery, had a pre-existing rapport with the CHWs that aided faster communication, and had more time to explain illness than medical doctors had. Participants found the educational material ( PocketDoktor Ô ) to be simple and easy to understand, and perceived that the education would lead to improved health outcomes. Participants stated their health was a priority and sought further disease-specific information. We also found that CHWs were highly motivated to carry out the patient-centered education. While delivering the education, CHWs experienced difficulties in keeping up with the technical details regarding hypertension in the PocketDoktor Ô , financial stress and patient questions beyond their self-perceived skill level and experience. PLWHA/HTN had challenges accessing the health facility where the intervention was delivered and preferred a household setting.Conclusions Hypertension patient-centered education delivered by CHWs using the PocketDoktorÔ was acceptable to PLWHA and hypertension in Nakaseke area in rural, Uganda. There is need for further studies to determine the cost implications of delivering this intervention among PLWHA across LMIC settings.

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Section: Discussionmentioning

confidence: 87%

Acceptability of Patient-centered Hypertension Education Delivered by Community Health Workers among People Living with HIV/AIDS in Rural Uganda

Batte

Mukisa

Rykiel

et al. 2020

Preprint

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“…Specifically, focus group discussions were held with healthcare workers at these clinics who are experienced in providing reproductive health services, including dispensing contraceptives and counselling women on family planning. Community healthcare workers and Village Health Teams (VHTs) are an essential aspect of healthcare in Sub-Saharan Africa, as they bridge the gap between healthcare services and rural communities who might otherwise struggle to access basic care [ 21 , 22 ]. The participants had insight on the specific reproductive healthcare services in their district and offered valuable information about the needs specific to their respective clients.…”

Section: Introductionmentioning

confidence: 99%

Understanding perceived access barriers to contraception through an African feminist lens: a qualitative study in Uganda

Potasse

Yaya

2021

BMC Public Health

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Background There are many barriers that impact a woman’s access to contraception in rural sub-Saharan Africa, such as financial constraints, supply shortages, stigma, and misconceptions. Through and African Feminist lens, this study examines how these perceived barriers intersect with each other, and how they negatively impact women’s access to family planning and their perceived value of contraceptives in Luweero, Uganda. Methods This qualitative study analyzed data collected from healthcare workers at one private clinic and one public clinic that offer family planning services in four focus group discussions in Luweero, Central Region, Uganda. Two focus group discussions were held in each clinic. Eligible participants spoke English, were at least 18 years of age, and had at least 3 years of experience as a healthcare worker in Luweero. Among the participants were nurses, midwives, family planning counsellors, and village health workers, both male and female. Coded transcripts were analyzed using a reflexive methodology through an African Feminist lens. Results Most of the responses indicated that financial constraints experienced either by the clinic or the women significantly impact access to family planning. Certain social barriers were discussed, and the participants explained that barriers such as stigma, misconceptions, lack of knowledge, religiosity and cultural values impact women’s motivation or ability to access contraceptive methods. Side effects also have a significant role to play in women’s ability or motivation to navigate through these perceived social barriers. Conclusions Participants determined that increased funding for transportation for village health teams, consistent funding for free contraception, and expanded sensitization efforts that particularly target men would be some of the most impactful methods they can adapt to address some of these barriers.

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“…In addition, there is limited rigorous evidence of best practices for CHW recruitment, length of training and training modalities, supervision, CHW:population ratios, and data collection and use. [4][5][6][7][8] In Madagascar, a country with substantial geographic and financial barriers to care, community health workers (CHWs) provide community-based primary care services throughout the country. 9 Ministry of Public Health (MoPH) policy dictates that there should be two CHWs in every fokontany (smallest administrative level comprising one or several villages and ranging in size from 400 to 4,500 people); CHWs are appointed by their community.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of a novel approach to community health care delivery in Ifanadiana District, Madagascar

Razafinjato

Rakotonirina

et al. 2020

Preprint

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Despite the widespread global adoption of community health (CH) systems, there are evidence gaps in how to best deliver community-based care aligned with global best practice in remote settings where access to health care is limited and community health workers (CHWs) may be the only available providers. PIVOT partnered with the Ministry of Public Health to pilot a new two-pronged approach for care delivery in rural Madagascar: one CHW provided care at a stationary CH site while 2-5 additional CHWs provided care via proactive household visits. The pilot included professionalization of the CHW workforce (i.e. recruitment, training, financial incentive) and twice monthly supervision of CHWs. We evaluated the impact of the CH pilot on utilization and quality of integrated community case management (iCCM) in the first six months of implementation (October 2019-March 2020).We compared utilization and proxy measures of quality of care (defined as adherence to the iCCM protocol for diagnosis, classification of disease severity, treatment) in the intervention commune and five comparison communes, using a quasi-experimental study design and relying on routinely collected programmatic data. Average per capita monthly under-five visits were 0.28 in the intervention commune and 0.22 in the comparison communes. In the intervention commune, 40.0% of visits were completed at the household via proactive care. CHWs completed all steps of the iCCM protocol in 77.8% of observed visits in the intervention commune (vs 49.5% in the comparison communes, p-value=<0.001). A two-pronged approach to CH delivery and professionalization of the CHW workforce increased utilization and demonstrated satisfactory quality of care. National stakeholders and program managers should evaluate program re-design at a local level prior to national or district-wide scale-up.

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Strengthening the community health worker programme for health improvement through enhancing training, supervision and motivation in Wakiso district, Uganda

Cited by 28 publications

References 11 publications

Acceptability of Patient-centered Hypertension Education Delivered by Community Health Workers among People Living with HIV/AIDS in Rural Uganda

Acceptability of Patient-centered Hypertension Education Delivered by Community Health Workers among People Living with HIV/AIDS in Rural Uganda

Understanding perceived access barriers to contraception through an African feminist lens: a qualitative study in Uganda

Evaluation of a novel approach to community health care delivery in Ifanadiana District, Madagascar

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