scholarly journals Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa

2020 ◽  
Author(s):  
Gladys Kigozi ◽  
Christo Heunis ◽  
Michelle Engelbrecht
Keyword(s):  
South Africa ◽  
Community Health ◽  
Health Workers ◽  
Phase 1 ◽  
Linear Regression Analysis ◽  
Household Contact ◽  
Three Dimensions ◽  
Free State ◽  
Cross Sectional Survey ◽  
Team Commitment

Abstract Background South Africa faces a chronic shortage of professional health workers. Accordingly, community health workers (CHWs) are being employed to mitigate the ongoing health workforce deficiencies. As increased access to quality service delivery hinges upon their motivation, this study explored CHWs’ motivation to deliver systematic household contact tuberculosis (TB) investigation (SHCI). Methods In 2017, a cross-sectional survey was conducted among CHWs in the Mangaung Metropolitan District, Free State Province. Exploratory factor analysis was performed on a 30-item scale to determine the dimensions underlying CHW motivation. Items with factor loadings of 0.4 and above were retained. Descriptive and inferential analyses were used to determine CHW motivation levels. Multiple linear regression analysis was used to investigate the determinants of CHW motivation. Results Out of 235 participants, 89.2% were female. Participants’ median age was 39 (inter-quartile range: 33-45) years. CHW motivation was defined by 16 items across three dimensions — intrinsic job satisfaction, burnout and team commitment, together explaining 56.04% of the total variance. The derived scale showed satisfactory internal consistency (Cronbach’s alpha: 0.81), with a mean motivation score of 52.26 (standard deviation [sd]: 5.86) out of 64. Statistically significant differences were observed between formal CHWs — those with at least phase 1 standardised accredited training, and informal CHWs — those without such accredited training regarding team commitment scores (17.82 [sd: 2.48] vs. 17.07 [sd: 2.82]; t(233) = 2.157; p = 0.013). CHW age (β = 0.118, p = 0.029), location (β = 1.737, p = 0.041), length of service (β = -0.495, p <0.001), attendance of TB SHCI training (β = 1.809, p = 0.036), and TB SHCI competence (β = 0.706, p <0.001), contributed statistically significantly to CHW motivation. Conclusion CHW motivation to perform TB SHCI was both intrinsic and extrinsic. The high overall mean score implies that the CHWs were well-motivated to perform TB SHCI. To ensure sustained improved access to quality TB SHCI service provision, programme managers in the Free State and similar settings could potentially use the tool derived from this study to monitor and inform CHW motivation interventions. Interventions should pay close attention to the CHWs’ formalisation, competence and training.

scholarly journals Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Gladys Kigozi ◽  
Christo Heunis ◽  
Michelle Engelbrecht
Keyword(s):  
South Africa ◽  
Community Health ◽  
Health Workers ◽  
Phase 1 ◽  
Linear Regression Analysis ◽  
Household Contact ◽  
Three Dimensions ◽  
Free State ◽  
Cross Sectional Survey ◽  
Team Commitment

Abstract Background South Africa faces a chronic shortage of professional health workers. Accordingly, community health workers (CHWs) are being employed to mitigate the ongoing health workforce deficiencies. As increased access to quality service delivery hinges upon their motivation, this study explored CHWs’ motivation to deliver systematic household contact tuberculosis (TB) investigation (SHCI). Methods In 2017, a cross-sectional survey was conducted among CHWs in the Mangaung Metropolitan District, Free State Province. Exploratory factor analysis was performed on a 30-item scale to determine the dimensions underlying CHW motivation. Items with factor loadings of 0.4 and above were retained. Descriptive and inferential analyses were used to determine CHW motivation levels. Multiple linear regression analysis was used to investigate the determinants of CHW motivation. Results Out of 235 participants, 89.2% were female. Participants’ median age was 39 (inter-quartile range: 33–45) years. CHW motivation was defined by 16 items across three dimensions — intrinsic job satisfaction, burnout and team commitment, together explaining 56.04% of the total variance. The derived scale showed satisfactory internal consistency (Cronbach’s alpha: 0.81), with a mean motivation score of 52.26 (standard deviation [sd]: 5.86) out of 64. Statistically significant differences were observed between formal CHWs — those with at least phase 1 standardised accredited training, and informal CHWs — those without such accredited training regarding team commitment scores (17.82 [sd: 2.48] vs. 17.07 [sd: 2.82]; t(233) = 2.157; p = 0.013). CHW age (β = 0.118, p = 0.029), location (β = 1.737, p = 0.041), length of service (β = − 0.495, p < 0.001), attendance of TB SHCI training (β = 1.809, p = 0.036), and TB SHCI competence (β = 0.706, p < 0.001), contributed statistically significantly to CHW motivation. Conclusion CHW motivation to perform TB SHCI was both intrinsic and extrinsic. The high overall mean score implies that the CHWs were well-motivated to perform TB SHCI. To ensure sustained improved access to quality TB SHCI service provision, programme managers in the Free State and similar settings could potentially use the tool derived from this study to monitor and inform CHW motivation interventions. Interventions should pay close attention to the CHWs’ formalisation, competence and training.

scholarly journals Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa

2020 ◽  
Author(s):  
Gladys Kigozi ◽  
Christo Heunis ◽  
Michelle Engelbrecht
Keyword(s):  
South Africa ◽  
Community Health ◽  
Health Workers ◽  
Phase 1 ◽  
Linear Regression Analysis ◽  
Household Contact ◽  
Three Dimensions ◽  
Free State ◽  
Team Commitment ◽  
Item Scale

Abstract Background South Africa faces a chronic shortage of professional health workers. Accordingly, community health workers (CHWs) are being employed to mitigate the ongoing health workforce deficiencies. As increased access to quality service delivery hinges upon their motivation, this study explored CHWs’ motivation to deliver systematic household contact TB investigation (SHCI). Methods In 2017, a cross-sectional survey was conducted among CHWs in the Mangaung Metropolitan District, Free State Province. Exploratory factor analysis was performed on a 30-item scale to determine the dimensions underlying CHW motivation. Items with factor loadings of 0.4 and above were retained. Descriptive and inferential analyses were used to determine CHW motivation levels. Multiple linear regression analysis was used to investigate the determinants of CHW motivation. Results Out of 235 participants, 89.2% were female. Participants’ median age was 39 (interquartile range: 33-45) years. CHW motivation was defined by 16 items across three dimensions — intrinsic job satisfaction, burnout and team commitment, together explaining 56.04% of the total variance. The derived 16-item scale showed satisfactory internal consistency (Cronbach’s alpha: 0.81), with a mean motivation score of 51.29 (standard deviation [sd]: 5.14) out of 64. Statistically significant differences were observed between formal CHWs — those with at least phase 1 standardised accreditation, and informal CHWs — those with non-standardised accreditation regarding mean team commitment scores (17.82 [sd: 2.48] vs. 17.07 [sd: 2.82]; t(233) = 2.157; p = 0.013). CHW age (β = 0.118, p = 0.029), location (β = 1.737, p = 0.041), length of service (β = -0.495, p <0.001), attendance of TB SHCI training (B = 1.809, p = 0.036), and TB SHCI competence (β = 0.706, p <0.001), contributed statistically significantly to CHW motivation. Conclusion: CHW motivation to perform TB SHCI was both intrinsic and extrinsic. The high overall mean score implies that the CHWs were well-motivated to perform TB SHCI. To ensure sustained improved access to quality TB SHCI service provision, programme managers in the Free State and similar settings could potentially use the tool derived from this study to monitor and inform CHW motivation interventions. Interventions should pay close attention to the CHWs’ formalisation, competence and training.

scholarly journals Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa

2020 ◽  
Author(s):  
Gladys Kigozi ◽  
Christo Heunis ◽  
Michelle Engelbrecht
Keyword(s):  
South Africa ◽  
Community Health ◽  
Health Workers ◽  
Statistical Significance ◽  
Linear Regression Analysis ◽  
Household Contact ◽  
Three Dimensions ◽  
Free State ◽  
Team Commitment ◽  
Item Scale

Abstract Background South Africa faces a chronic shortage of professional health workers. Accordingly, community health workers (CHWs) are being employed to mitigate the ongoing health workforce deficiencies. In addition to facilitating linkages between communities and primary health care (PHC) facilities, CHWs are entrusted with a range of crucial tuberculosis (TB), HIV/AIDS and maternal health services. As increased access to quality service delivery hinges upon their motivation, this study explored CHWs’ motivation to deliver systematic household contact TB investigation (SHCI). Methods In 2017, a cross-sectional survey was conducted among CHWs enrolled in the ward-based PHC outreach teams in the Mangaung Metropolitan District in the Free State Province. Exploratory factor analysis (EFA) was performed on a 30-item scale to determine the dimensions underlying CHW motivation. Items with factor loadings of 0.4 and above were retained. Descriptive and inferential analyses were used to determine CHW motivation levels. Multiple linear regression analysis was used investigate the determinants of CHW motivation. Statistical significance was determined at p ≤ 0.05. Results Out of 235 participants, the majority were female (89.2%). Participants’ median age was 39 (inter-quartile range: 33-45) years. CHW motivation was defined by 16 items across three dimensions — intrinsic job satisfaction, burnout and team commitment, together explaining 56.04% of the total variance. The derived 16-item scale showed satisfactory internal consistency (Cronbach’s α: 0.81), with a mean motivation score of 51.29 (sd: 5.14) out of 64. Formal CHWs — with at least phase 1 of standardised training scored statistically significantly higher than informal CHWs – with non-standardised training on the team commitment sub-scale (mean: 17.82; sd: 2.48) vs. 17.07; sd: 2.82; t(233) = 2.157; p = 0.013). CHW age (β = 0.117, p = 0.030), location (β = 1.759, p = 0.038), length of service (β = -0.505, p <0.001), attendance of TB SHCI training (B = 1.833, p = 0.33), and TB SHCI competence (β = 0.713, p <0.001), contributed statistically significantly to CHW motivation. Conclusion CHW motivation to perform TB SHCI was both intrinsic and extrinsic. The high overall mean score implies that the CHWs were well-motivated to perform TB SHCI. To ensure sustained improved access to quality TB SHCI service provision, the tool derived from this study could potentially be used by TB programme managers in the Free State and similar settings to monitor and inform CHW motivation interventions. Interventions should especially pay close attention to the CHWs’ formalisation, competence and training.

scholarly journals Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa

2020 ◽  
Author(s):  
Gladys Kigozi ◽  
Christo Heunis ◽  
Michelle Engelbrecht
Keyword(s):  
South Africa ◽  
Job Satisfaction ◽  
Community Health ◽  
Internal Consistency ◽  
Health Workers ◽  
Statistical Significance ◽  
Phase 1 ◽  
Linear Regression Analysis ◽  
Household Contact ◽  
Team Commitment

Abstract BackgroundSouth Africa faces a chronic shortage of professional health workers. Accordingly, community health workers (CHWs) are being employed to mitigate the ongoing deficiencies. In addition to facilitating linkages between communities and primary health care (PHC) facilities, CHWs are entrusted with a range of crucial tuberculosis (TB), HIV/AIDS and maternal health services. As increased access to quality service delivery hinges upon their motivation, this study investigated CHWs’ motivation to deliver systematic household contact TB investigation (SHCI).MethodsIn 2017, a cross-sectional survey was conducted among CHWs enrolled in the ward-based PHC outreach teams in the Mangaung Metropolitan District. Descriptive, exploratory factor analysis and multiple linear regression analysis were conducted to establish the dimensions, levels and determinants of CHW motivation. Statistical significance was determined at p ≤ 0.05.ResultsOut of 235 participants, the majority were female (89.2%). Participants’ median age was 39 (inter-quartile range: 33-45) years. Job satisfaction, burnout and team commitment characterised CHW motivation or lack thereof, together explaining 56.04% of the total variance, with a mean score of 51.59 (standard deviation: 5.14) out of 64. The full scale showed satisfactory internal consistency (Cronbach α: 0.734). The individual sub-scales also had acceptable internal consistency (Cronbach α—job satisfaction: 0.83; burnout: 0.83; and team commitment: 0.73). CHW category (i.e. formal — with at least phase 1 of standardised training vs. informal — with non-standardised training) and TB SHCI training and knowledge significantly influenced CHW motivation. Formal CHWs scored twice higher (β = 2.020; p = 0.009) than informal CHWs on the motivation scale. Motivation scores increased by 0.841 (p = 0.007) times with every unit increase in CHW TB SHCI knowledge. Scores were more than twice lower (β = -2.289; p = 0.003) among CHWs who did not attend TB SHCI training than those who did.ConclusionThe high mean score implies that the CHWs were motivated to perform TB SHCI. The TB programme in the Free State should ensure sustained CHW motivation to effect improved access to quality TB SHCI service provision. To this end, the TB programme should pay close attention to the CHWs’ formalisation, TB knowledge and training.

TB/HIV-related training, knowledge and attitudes of community health workers in the Free State province, South Africa

2013 ◽  
Vol 12 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Christo Heunis ◽  
Edwin Wouters ◽  
Gladys Kigozi ◽  
Ega Janse van Rensburg-Bonthuyzen ◽  
Nandipha Jacobs
Keyword(s):  
South Africa ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Free State ◽  
Free State Province ◽  
Knowledge And Attitudes

scholarly journals Post-trial perceptions of a symptom-based TB screening intervention in South Africa: implementation insights and future directions for TB preventive healthcare services

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Nicole Salazar-Austin ◽  
Minja Milovanovic ◽  
Nora S. West ◽  
Molefi Tladi ◽  
Grace Link Barnes ◽  
...  
Keyword(s):  
South Africa ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Implementation Strategies ◽  
Healthcare Services ◽  
Preventive Therapy ◽  
Provider Perceptions ◽  
Symptom Screening ◽  
Study Implementation

Abstract Background Tuberculosis is a top-10 cause of under-5 mortality, despite policies promoting tuberculosis preventive therapy (TPT). We previously conducted a cluster randomized trial to evaluate the effectiveness of symptom-based versus tuberculin skin-based screening on child TPT uptake. Symptom-based screening did not improve TPT uptake and nearly two-thirds of child contacts were not identified or not linked to care. Here we qualitatively explored healthcare provider perceptions of factors that impacted TPT uptake among child contacts. Methods Sixteen in-depth interviews were conducted with key informants including healthcare providers and administrators who participated in the trial in Matlosana, South Africa. The participants’ experience with symptom-based screening, study implementation strategies, and ongoing challenges with child contact identification and linkage to care were explored. Interviews were systematically coded and thematic content analysis was conducted. Results Participants’ had mixed opinions about symptom-based screening and high acceptability of the study implementation strategies. A key barrier to optimizing child contact screening and evaluation was the supervision and training of community health workers. Conclusions Symptom screening is a simple and effective strategy to evaluate child contacts, but additional pediatric training is needed to provide comfort with decision making. New clinic-based child contact files were highly valued by providers who continued to use them after trial completion. Future interventions to improve child contact management will need to address how to best utilize community health workers in identifying and linking child contacts to care. Trial registration The results presented here were from research related to NCT03074799, retrospectively registered on 9 March 2017.

scholarly journals Community health worker models in South Africa: a qualitative study on policy implementation of the 2018/19 revised framework

2020 ◽  
Author(s):  
Joshua P Murphy ◽  
Aneesa Moolla ◽  
Sharon Kgowedi ◽  
Constance Mongwenyana ◽  
Sithabile Mngadi ◽  
...  
Keyword(s):  
South Africa ◽  
Qualitative Study ◽  
Policy Implementation ◽  
Community Health ◽  
Resource Constraints ◽  
Health Workers ◽  
Healthcare Providers ◽  
Successful Implementation ◽  
Programme Implementation ◽  
Healthcare Facilities

Abstract South Africa has a long history of community health workers (CHWs). It has been a journey that has required balancing constrained resources and competing priorities. CHWs form a bridge between communities and healthcare service provision within health facilities and act as the cornerstone of South Africa’s Ward-Based Primary Healthcare Outreach Teams. This study aimed to document the CHW policy implementation landscape across six provinces in South Africa and explore the reasons for local adaptation of CHW models and to identify potential barriers and facilitators to implementation of the revised framework to help guide and inform future planning. We conducted a qualitative study among a sample of Department of Health Managers at the National, Provincial and District level, healthcare providers, implementing partners [including non-governmental organizations (NGOs) who worked with CHWs] and CHWs themselves. Data were collected between April 2018 and December 2018. We conducted 65 in-depth interviews (IDIs) with healthcare providers, managers and experts familiar with CHW work and nine focus group discussions (FGDs) with 101 CHWs. We present (i) current models of CHW policy implementation across South Africa, (ii) facilitators, (iii) barriers to CHW programme implementation and (iv) respondents’ recommendations on how the CHW programme can be improved. We chronicled the differences in NGO involvement, the common facilitators of purpose and passion in the CHWs’ work and the multitude of barriers and resource limitations CHWs must work under. We found that models of implementation vary greatly and that adaptability is an important aspect of successful implementation under resource constraints. Our findings largely aligned to existing research but included an evaluation of districts/provinces that had not previously been explored together. CHWs continue to promote health and link their communities to healthcare facilities, in spite of lack of permanent employment, limited resources, such as uniforms, and low wages.

scholarly journals Fidelity of HIV programme implementation by community health workers in rural Mopani district, South Africa: a community survey

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Nireshni Naidoo ◽  
Jean P. Railton ◽  
Sellina N. Khosa ◽  
Nthabiseng Matlakala ◽  
Gert Marincowitz ◽  
...  
Keyword(s):  
South Africa ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Community Survey ◽  
Programme Implementation

scholarly journals Compensation Models for Community Health Workers: Comparison of Legal Frameworks across Five Countries

2020 ◽  
Author(s):  
Madeleine Ballard ◽  
Carey Westgate ◽  
Rebecca Alban ◽  
Nandini Choudhury ◽  
Rehan Adamjee ◽  
...  
Keyword(s):  
South Africa ◽  
Public Sector ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Legal Framework ◽  
Law Firms ◽  
Advantages And Disadvantages ◽  
Compensation Mechanisms ◽  
Legal Frameworks

Abstract Background Despite the life-saving work they perform, community health workers (CHWs) have long been subject to global debate about their remuneration. There is now, however, an emerging consensus that CHWs should be paid. As the discussion evolves from whether to financially remunerate CHWs to how to do so, there is an urgent need to better understand the types of CHW payment models and their implications. Methods This study examines the legal framework on CHW compensation in five countries: Brazil, Ghana, Nigeria, Rwanda, and South Africa. In order to map the characteristics of each approach, a standardized questionnaire was developed and targeted at local law firms. The questionnaire covered legal structures and requirements for compensation of CHWs, CHW compensation mechanisms, CHW legal protections and benefits, and alignment of national CHW policies with global guidelines. Results The five countries profiled represent possible archetypes for CHW compensation: Brazil (public), Ghana (volunteer-based), Nigeria (private), Rwanda (cooperatives with performance based incentives) and South Africa (hybrid public/private). Advantages and disadvantages of each model with respect to (i) CHWs, in terms of financial protection, and (ii) the public sector, in terms of ease of implementation, are outlined. Conclusions While a strong legal framework does not necessarily translate into high-quality implementation, it is the first necessary step. While certain approaches to CHW compensation - particularly public-sector or hybrid models with public sector wage floors - best institutionalize recommended CHW protections, political will and long-term financing often remain obstacles. Removing ecosystem barriers - such as multilateral and bilateral restrictions on the payment of salaries - can help governments institutionalize CHW payment.

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