Working with community health workers to improve maternal and newborn health outcomes: implementation and scale-up lessons from eastern Uganda
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
Global Health Action
Abstract
Preventable maternal and newborn deaths can be averted through simple
evidence-based interventions, such as the use of community health workers (CHWs), also
known in Uganda as village health teams. However, the CHW strategy faces implementation
challenges regarding training packages, supervision, and motivation.
Objectives: This paper explores knowledge levels of CHWs, describes the coverage of home
visits, and shares lessons learnt from setting up and implementing the CHW strategy.
Methods: The CHWs were trained to conduct four home visits: two during pregnancy and
two after delivery. The aim of the visits was to promote birth preparedness and utilization of
maternal and newborn health (MNH) services. Mixed methods of data collection were
employed. Quantitative data were analyzed using Stata version 13.0 to determine the level
and predictors of CHW knowledge of MNH. Qualitative data from 10 key informants and 15
CHW interviews were thematically analyzed to assess the implementation experiences.
Results: CHWs’ knowledge of MNH improved from 41.3% to 77.4% after training, and to
79.9% 1 year post-training. However, knowledge of newborn danger signs declined from
85.5% after training to 58.9% 1 year later. The main predictors of CHW knowledge were age
(≥ 35 years) and post-primary level of education. The level of coverage of at least one CHW
visit to pregnant and newly delivered mothers was 57.3%. Notably, CHW reports complemented
the facility-based health information. CHWs formed associations, which improved
teamwork, reporting, and general performance, and thus maintained low dropout rates at
3.6%. Challenges included dissatisfaction with the quarterly transport refund of 6 USD and
lack of means of transportation such as bicycles.
Conclusions: CHWs are an important resource in community-based health information and
improving demand for MNH services. However, the CHW training and supervision models
require strengthening for improved performance. Local solutions regarding CHW motivation
are necessary for sustainability.
Description
Keywords
Maternal and newborn health, Community mobilization, Community health workers, Implementation science, Training and supervision
Citation
Gertrude Namazzi, Monica Okuga, Moses Tetui, Rornald Muhumuza Kananura, Ayub Kakaire, Sarah Namutamba, Aloysius Mutebi, Suzanne Namusoke Kiwanuka, Elizabeth Ekirapa-Kiracho & Peter Waiswa (2017) Working with community health workers to improve maternal and newborn health outcomes: implementation and scale-up lessons from eastern Uganda, Global Health Action, 10:sup4, 1345495, DOI: 10.1080/16549716.2017.1345495