Increasing community health worker productivity and effectiveness: a review of the influence of the work environment

Abstract

BackgroundCommunity health workers (CHWs) are increasingly recognized as a critical link in improving access to services and achieving the health-related Millennium Development Goals. Given the financial and human resources constraints in developing countries, CHWs are expected to do more without necessarily receiving the needed support to do their jobs well. How much can be expected of CHWs before work overload and reduced organizational support negatively affect their productivity, the quality of services, and in turn the effectiveness of the community-based programmes that rely on them? This article presents policy-makers and programme managers with key considerations for a model to improve the work environment as an important approach to increase CHW productivity and, ultimately, the effectiveness of community-based strategies.MethodsA desk review of selective published and unpublished articles and reports on CHW programs in developing countries was conducted to analyse and organize findings on the elements that influence CHW productivity. The search was not exhaustive but rather was meant to gather information on general themes that run through the various documents to generate perspectives on the issue and provide evidence on which to formulate ideas. After an initial search for key terminology related to CHW productivity, a snowball technique was used where a reference in one article led to the discovery of additional documents and reports.ResultsCHW productivity is determined in large part by the conditions under which they work. Attention to the provision of an enabling work environment for CHWs is essential for achieving high levels of productivity. We present a model in which the work environment encompasses four essential elements—workload, supportive supervision, supplies and equipment, and respect from the community and the health system—that affect the productivity of CHWs. We propose that when CHWs have a manageable workload in terms of a realistic number of tasks and clients, an organized manner of carrying out these tasks, a reasonable geographic distance to cover, the needed supplies and equipment, a supportive supervisor, and respect and acceptance from the community and the health system, they can function more productively and contribute to an effective community-based strategy.ConclusionsAs more countries look to scale up CHW programmes or shift additional tasks to CHWs, it is critical to pay attention to the elements that affect CHW productivity during programme design as well as implementation. An enabling work environment is crucial to maximize CHW productivity. Policy-makers, programme managers, and other stakeholders need to carefully consider how the productivity elements related to the work environment are defined and incorporated in the overall CHW strategy. Establishing a balance among the four elements that constitute a CHW’s work environment will help make great strides in improving the effectiveness and quality of the services provided by CHWs.

Fatores que influenciam na qualidade de vida dos agentes comunitários de saúde

“…(13) Therefore, the worker is exposed to long hours, impaired quality of life and work performance. (15) Workers with education of 12 years or less were associated with lower quality of life scores in Bodily Pain and Mental Health. It is noteworthy that higher levels of education contributes to proper understanding of health concepts, allowing better work performance and providing mental health, as it allows greater understanding of oneself and the everyday.…”

Importance of the Welfare Facilities in the Workplace: Issues in Perspectives

“…It should also be provided based on the feeling of care and compassion to the workers considering that some of them will spend the whole of their life time working for the organisation (Hartman et al, 2004). Conducive, safe and heathy work environment will enable workers to give their best and perform effective and efficiently (Jaskiewicz & Tulenko, 2012). This standard is recognised all over the world and is codified in national and international laws for purposes of application, implementation and enforcement (Servais, 2009).…”

“…Socioeconomica -The Scientific Journal for Theory and Practice of Socio-economic Development 2015, 4(7): [23][24][25][26][27][28][29][30][31][32][33][34] Welfare facilities provided outside the work place are known as non-statutory welfare facilities. They include provision of housing, recreation, medical, transport facilities and so on (Venugopal et al, 2011).…”

“…Labour welfare is in the interest of the labour, the employer and the society as a whole (Streeck, 2005). Ramana et al, (2015) noted that employees' welfare refers to "the efforts made to provide good life worth for [23][24][25][26][27][28][29][30][31][32][33][34] employees." It is against the backdrop of this that Patro (2015) points out that "in order to increase employee welfare facilities, employers need to offer extra incentives in the form of employee welfare schemes, and to make it possible to pursue employees to be more committed to their work.…”

Needs and challenges of lay community health workers in a palliative care environment for orphans and vulnerable children

“…Clearly, the need for training in palliative care by LCHWS, who served the community, is fundamental. Jaskiewicz and Tulenko (2012) suggest that a community's perception of community health workers' knowledge, skills and ability to assist communities' with their health needs is critical in inspiring respect and acceptance of their services. The cadres of LCHWs, in this study, were people with skill-resourcing needs, and they were responsible for the palliative care of OVC, and despite their lack of knowledge in palliative care, they persevered to improve the lives of the OVC.…”