Effect of multiple interventions on community health workers’ adherence to clinical guidelines in Siaya district, Kenya

Abstract

Evaluation of a community health worker (CHW) programme in Siaya district, Kenya, showed CHWs commonly made errors in managing childhood illness. We assessed the effect of multiple interventions on CHW healthcare practices. A sample of 192 ill-child consultations performed by 114 CHWs in a hospital outpatient department between February and March 2001 were analysed. The mean percentage of assessment, classification and treatment procedures performed correctly for each child was 79.8% (range 13.3-100%). Of the 187 children who required at least one treatment or referral to a health facility, only 38.8% were prescribed all treatments (including referral) recommended by the guidelines. Multivariate analyses found no evidence that the intervention-related factors studied (refresher training, supervision, involvement of community women in the CHW selection process, adequacy of medicine supplies, and use of a guideline flipchart during consultations) were significantly associated with overall or treatment-specific guideline adherence. A multivariate linear regression analysis revealed that several non-intervention-related factors, such as patient characteristics, were significantly associated with overall guideline adherence. Given that our study was cross-sectional and our measurement of exposure to several interventions was based on CHW recall, the estimated effects of the interventions should be interpreted with caution. Despite these limitations, however, our results raise questions about the effectiveness, in the setting of Siaya district, of several interventions commonly used to improve the quality of care given by CHWs.

Supervising community health workers in low-income countries – a review of impact and implementation issues

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The performance of community health workers in the management of multiple childhood infectious diseases in Lira, northern Uganda – a mixed methods cross-sectional study

“…This finding may to a great extent explain the overall poor performance of CHWs because they need regular training in order to maintain a good level of knowledge and skills (25–28). It is therefore important to hold regular refreshment training for CHWs to ensure good job performance.…”

Assessment of the impact of quality improvement interventions on the quality of sick child care provided by Health Extension Workers in Ethiopia

“…The evidence from this small number of studies is also mixed. Some found positive associations between quality of care and training [55,56] and supervision [56], while others showed no significant associations with training [57,58] or supervision [58]. Two recent studies in Ethiopia showed associations between supportive supervision [59] and PRCMM [60] and improved consistency in iCCM patient registers between HEWs’ assessment, classification, and treatment of sick children.…”