Towards Promotion of Community rewards to Volunteer Community Health Workers? Lessons from Experiences of Village Health Teams in Luwero, Uganda

Turinawe, Emmanueil Benon; Rwemisisi, Jude T.; Musinguzi, Laban Kashaija; Groot, Marije de; Muhangi, Denis; Kaawa-Mafigiri, David; Vries, Daniel H. de; Pool, Robert

doi:10.22158/rhs.v1n2p85

Cited by 9 publications

(11 citation statements)

References 21 publications

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“…The remoteness of rural communities has been reported in other studies as a barrier to mothers’ ability to reach the healthcare facilities [ 5 , 39 – 41 ]. These findings suggested the need for effective and sustainable means of transport in community-based interventions designed to improve access by linking communities to the health system through SMAGs [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups

2018

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BackgroundA community-based intervention known as Safe Motherhood Action Groups (SMAGs) was implemented to increase coverage of maternal and neonatal health (MNH) services among the poorest and most remote populations in Zambia. While the outcome evaluation demonstrated statistically significant improvement in the MNH indicators, targets for key indicators were not achieved, and reasons for this shortfall were not known. This study was aimed at understanding why the targeted key indicators for MNH services were not achieved.MethodsA process evaluation, in accordance with the Medical Research Council (MRC) framework, was conducted in two selected rural districts of Zambia using qualitative approaches. Focus group discussions were conducted with SMAGs, volunteer community health workers, and mothers and in-depth interviews with healthcare providers. Content analysis was done.ResultsWe found that SMAGs implemented much of the intervention as was intended, particularly in the area of women’s education and referral to health facilities for skilled MNH services. The SMAGs went beyond their prescribed roles to assist women with household chores and personal problems and used their own resources to enhance the success of the intervention. Deficiencies in the intervention were reported and included poor ongoing support, inadequate supplies and lack of effective transportation such as bicycles needed for the SMAGs to facilitate their work. Factors external to the intervention, such as inadequacy of health services and skilled healthcare providers in facilities where SMAGs referred mothers and poor geographical access, may have led SMAGs to engage in the unintended role of conducting deliveries, thus compromising the outcome of the intervention.ConclusionWe found evidence suggesting that although SMAGs continue to play pivotal roles in contribution towards accelerated coverage of MNH services among hard-to-reach populations, they are unable to meet some of the critical sets of MNH service-targeted indicators. The complexities of the implementation mechanisms coupled with the presence of setting specific socio-cultural and geographical contextual factors could partially explain this failure. This suggests a need for innovating existing implementation strategies so as to help SMAGs and any other community health system champions to effectively respond to MNH needs of most-at-risk women and promote universal health coverage targeting hard-to-reach groups.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0766-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups

2018

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“…Some of these have been identified as being significant factors in motivation of CHVs (13, 14, 17, 18, 25, 26). …”

Section: Discussionmentioning

confidence: 99%

“…Whether it is the imparted knowledge, the continuous engagement with the formal health sector, the feeling of belonging, the fringe benefits or a combination of such, it is imperative for programs to continually provide an enabling environment to enhance performance of CHVs. It has been reported by Turinawe et al that although the CHVs in central Uganda were recruited as volunteers they still expected some incentives (26). …”

Section: Discussionmentioning

confidence: 99%

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

Kuule¹,

Dobson²,

Woldeyohannes

et al. 2017

Front. Public Health

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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.

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“…Inadequate support and supervision along with weak communication skills in volunteers and instructors were among other problems that the participants mentioned. In an ethnographic study in Uganda, the researchers found that the volunteers needed authorities to clarify how they should communicate with the healthcare team, local government, and medical structures [ 26 ]. Moreover, volunteers in south Africa stated that unsuitable communication with each other and inadequate team supervision were their weak points [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Empowering health volunteer’s through participatory action research in a comprehensive healthcare center

et al. 2021

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Background Health volunteers act as the link between the society and the healthcare system and are a symbol of people’s participation in the health maintenance and promotion. Despite the important role of health volunteers in the health system, it seems that they experience several problems. The aim of this study was empowering health volunteers through an action research. Methods This participatory action research was conducted through two continuous cycles of reflection and acting for change over 20 months, in a comprehensive health center in Southern of Fars province in Iran. Participants included 25 health volunteers; two instructors and an academic researcher as facilitator. In the first cycle the participants discovered the challenges of health volunteers, prioritized them, designed an action plan, and implemented it. At the end of this cycle, evaluation was done with the participants’ cooperation. The second cycle began with reflecting on the results of the first cycle and then after designing and implementing second action plan, final evaluation was done. Results Qualitative content analysis in the first phase led to the emergence of four categories, including role confusion, inadequate volunteer training, deficits in attracting and keeping volunteers, and being unfamiliar to the public. After the implementation of the action plan the participants learned through reflection and immersing in action. Finally, quantitative and qualitative data showed improvement of knowledge and performance, satisfaction, effectiveness of programs and improvement in volunteer’s competence. Conclusions Clarification of volunteers’ roles, supporting volunteers to improve their knowledge and skills with coherent planning based on their educational needs, are appropriate management plans to attract and retain volunteers. By presenting their services to the society, they will be empowered and motivated to continue.

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Towards Promotion of Community rewards to Volunteer Community Health Workers? Lessons from Experiences of Village Health Teams in Luwero, Uganda

Abstract: In the debate regarding volunteer Community Health Workers (CHWs)

Cited by 9 publications

References 21 publications

Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups

Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups

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

Empowering health volunteer’s through participatory action research in a comprehensive healthcare center

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