scholarly journals An exploration of attributes effecting the relationship between competencies and performance of CHWs in a rural block.

Author(s):  
Revadi G ◽  
Ankur Joshi ◽  
Abhijit P Pakhare

Introduction: Induction of Community Health Workers (CHWs) into various health programs is considered as an integral strategy to achieve universal health coverage. Thus, it is prudent to explore and understand the CHWs individual and the system level interactions and their further translation into performance and actionable domains. Objective: To quantify the relationship structure between envisioned competencies and CHW performance with factors operating at individual and the immediate system level as effect modifiers. Methodology: A cross-sectional study was done in primary rural health care settings of Madhya Pradesh state in Central India. CHWs were stratified as relatively low performing (RLP) and relatively high performing (RHP) based on their annual performance-based incentives for the year (April 2017- March 2018). CHWs were administered a self-reported questionnaire that included socio demographic details, knowledge, skills assessment and availability of logistics. Results: Among the 90 eligible CHWs, 31 RLP and 30 RHP CHWs were interviewed. The CHWs performance was found to be significantly associated with age, education, caste, presence of under 5 children, knowledge and competency scores. However, while adjusting for the confounders only age and educational status were found to be significant. Further cluster analysis revealed two clusters based on individual and system characteristics which was found to influence the CHWs performance. Conclusion: The relationship between the CHWs truest competencies and performance based incentivisation tends to have been influenced by age and education which could help in developing a more focused supportive supervision catering to their needs. Keywords: community health worker, performance, health system, competency.

2020 ◽  
Author(s):  
Xuexue Deng ◽  
Ronghua Fang ◽  
Yaoting Cai

Abstract Background: A chronic state of imbalance between effort and reward can affect sleep quality. However, few studies have explored the relationship between variables in the ERI model and sleep quality in community health workers in mainland China. We investigated the relationship between effort–reward imbalance and sleep quality in community health workers. Methods: This cross-sectional study was conducted from September to November 2018 and involved 249 registered doctors and 223 registered nurses. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep disorder status of participants. The Effort-Reward Imbalance (ERI) questionnaire was administered to evaluate job-related stress. Multivariate logistic regression was performed to evaluate the factors related to sleep quality. Results: The ERI ratio of 472 health workers was 1.17 ± 0.22, and 273 health workers (57.84%) had PSQI scores >7. There were statistically significant differences in effort scores, overcommitment scores and the total ERI ratio between the health workers with sleep disorders and those without sleep disorders. The ERI ratio was an independent risk factor for sleep quality; age, education, type of work, shift work, and job title were related to the ERI ratio. Conclusions: This study found that sleep disorders were prevalent, work effort was greater than reward and a positive correlation between effort-reward and sleep quality among the health workers community in China. Managers should pay attention to the factors that influence sleep disorders among community health workers, balance the efforts and rewards of work, and reduce the incidence of sleep disorders.


2020 ◽  
Vol 35 (7) ◽  
pp. 819-828
Author(s):  
Abdu A Adamu ◽  
Muktar A Gadanya ◽  
Rabiu I Jalo ◽  
Olalekan A Uthman ◽  
Charles S Wiysonge

Abstract Patent and proprietary medicine vendors (PPMVs) increase access to antibiotics through non-prescription sales in their drug retail outlets. This fosters irrational antibiotic use among people, thus contributing to the growing burden of resistance. Although training programmes on antibiotic use and resistance exist, they have disproportionately targeted health workers in hospital settings. It’s unclear if there is a relationship between such trainings and non-prescription sales of antibiotics among PPMVs which are more embedded in communities. Therefore, a cross-sectional study was conducted to elicit the determinants of non-prescription antibiotic sales among PPMVs in Kano metropolis, Nigeria. Through brainstorming, causal loop diagrams (CLDs) were used to illustrate the dynamics of factors that are responsible for non-prescription antibiotic sales. Multilevel logistic regression model was used to determine the relationship between training on antibiotic use and resistance and non-prescription antibiotic sales, after controlling for potential confounders. We found that two-third (66.70%) of the PPMVs reported that they have sold non-prescribed antibiotics. A total of three CLDs were constructed to illustrate the complex dynamics of the factors that are related to non-prescription antibiotic sales. After controlling for all factors, PPMVs who reported that they had never received any training on antibiotic use and resistance were twice as more likely to sell antibiotic without prescription compared with those who reported that they have ever received such training (OR = 2.07, 95% CI: 1.27–3.37). This finding suggests that there is an association between training on antibiotic use and resistance and non-prescription sales of antibiotics. However, the complex dynamics of the factors should not be ignored as it can have implications for the development of intervention programmes. Multifaceted and multicomponent intervention packages (incorporating trainings on antibiotic use and resistance) that account for the inherent complexity within the system are likely to be more effective for this setting.


2015 ◽  
Vol 2 ◽  
pp. 467-472 ◽  
Author(s):  
Laura Burdick ◽  
Gregore I. Mielke ◽  
Diana C. Parra ◽  
Grace Gomes ◽  
Alex Florindo ◽  
...  

2021 ◽  
Author(s):  
Najmunnisa K P ◽  
Susan Thomas Thomas ◽  
Mary Shimi S Gomez ◽  
Jesline Merly James ◽  
Vivek Narayan

Abstract BackgroundBeliefs and attitudes of community health workers affect their oral health behaviour and knowledge which in turn affects their potential to motivate the public to undertake preventive oral health measures. This study was performed to assess knowledge, attitude, and practices as well as determinants of oral health behaviour among community health workers in rural regions of Kerala.MethodsA cross-sectional study was conducted among 123 community healthcare workers at primary health centres in the Ettumanoor block zone, Kottayam. A two-stage cluster sampling method was used. Data regarding knowledge, attitude, and practice of oral health were acquired through self-administered questionnaires and analyzed using SPSS software version 25. Statistical association between responses in different group of health workers were determined by using Chi-square test. Independent t-test and ANOVA were used to test the difference in attitude and knowledge scores. Bivariate and multivariate regression analyses were applied to identify factors associated with the oral health behaviour of community health workers.ResultsAbout 65% of the participants exhibited poor oral health behaviour. A positive attitude has a significant relation with oral health behaviour status of the participants (p=0.003). Community health workers who attended an oral health education program had a better oral health behaviour status when compared to those who had not attended (p=0.006). ConclusionsThe results emphasize that oral health education should be given to all the community health workers to enhance their awareness about preventive oral health care.


2019 ◽  
Vol 19 (3) ◽  
pp. 2784-2797
Author(s):  
David Musoke ◽  
Rawlance Ndejjo ◽  
Edwinah Atusingwize ◽  
Trasias Mukama ◽  
Charles Ssemugabo ◽  
...  

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.


2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Kennedy Diema Konlan ◽  
Nathaniel Kossi Vivor ◽  
Isaac Gegefe ◽  
Imoro A. Abdul-Rasheed ◽  
Bertha Esinam Kornyo ◽  
...  

Background. Home visit is an integral component of Ghana’s PHC delivery system. It is preventive and promotes health practice where health professionals render care to clients in their own environment and provide appropriate healthcare needs and social support services. This study describes the home visit practices in a rural district in the Volta Region of Ghana. Methodology. This descriptive cross-sectional study used 375 households and 11 community health nurses in the Adaklu district. Multistage sampling techniques were used to select 10 communities and study respondents using probability sampling methods. A pretested self-designed questionnaire and an interview guide for household members and community health nurses, respectively, were used for data collection. Quantitative data collected were coded, cleaned, and analysed using Statistical Package for Social Sciences into descriptive statistics, while qualitative data were analysed using the NVivo software. Thematic analysis was engaged that embraces three interrelated stages, namely, data reduction, data display, and data conclusion. Results. Home visit is a routine responsibility of all CHNs. The factors that influence home visiting were community members’ education and attitude, supervision challenges, lack of incentives and lack of basic logistics, uncooperative attitude, community inaccessibility, financial constraint, and limited number of staff. Household members (62.3%) indicated that health workers did not adequately attend to minor ailments as 78% benefited from the service and wished more activities could be added to the home visiting package (24.5%). Conclusion. There should be tailored training of CHNs on home visits skills so that they could expand the scope of services that can be provided. Also, community-based health workers such as community health volunteers, traditional birth attendants, and community clinic attendants can also be trained to identify and address health problems in the homes.


2020 ◽  
Author(s):  
Joanna Raven ◽  
Haja Wurie ◽  
Ayesha Idriss ◽  
Abdulai Jawo Bah ◽  
Amuda Baba ◽  
...  

Abstract Background: Community Health Workers (CHWs) are critical players in fragile settings, where staff shortages are particularly acute, health indicators are poor and progress towards Universal Health Coverage is slow. Like other health workers, CHWs need support to contribute effectively to health programmes and promote health equity. Yet the evidence base of what kind of support works best is weak. We present evidence from three fragile settings - Sierra Leone, Liberia and Democratic Republic of Congo on managing CHWs, and synthesise recommendations for best approaches to support this critical cadre.Methods: We used a qualitative study design to explore how CHWs are managed, the challenges they face and potential solutions. We conducted interviews with decision makers and managers (n=37), life history interviews with CHWs (n=15) and reviewed policy documents. Results: Fragility disrupts education of community members so that they may not have the literacy levels required for the CHW role. This has implications for the selection, role, training and performance of CHWs. Policy preferences about selection need discussion at the community level, so that they reflect community realities. CHWs scope of work is varied and may change over time, requiring ongoing training. The modular, local, and mix of practical and classroom training approach worked well, helping to address gender and literacy challenges and developing a supportive cohort of CHWs. A package of supervision, community support, regular provision of supplies, performance rewards and regular remuneration is vital to retention and performance of CHWs. But there are challenges with supervision, scarcity of supplies, inadequate community recognition and unfulfilled promises about allowances. Clear communication about incentives with facility staff and communities is required as is their timely delivery.Conclusions: This is the first study that has explored the management of CHWs in fragile settings. CHWs interface role between communities and health systems is critical because of their embedded positionality and the trusting relationships they (often) have. Their challenges are aligned to those generally faced by CHWs but chronic fragility exacerbates them and requires innovative problem solving to ensure that countries and communities are not left behind in reforming the way that CHWs are supported.


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