Keeping community health workers in Uganda motivated: key challenges, facilitators, and preferred program inputs

Brunie, Aurélie; Wamala-Mucheri, Patricia; Otterness, Conrad; Akol, Angela; Chen, Mario; Bufumbo, Leonard; Weaver, Mark A.

doi:10.9745/ghsp-d-13-00140

Cited by 95 publications

(124 citation statements)

References 27 publications

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“…Moreover, VHTs' expanded role appeared to improve their motivation through enhanced visibility and technical skills. This is consistent with other studies showing that status and skills are important motivators for volunteers [17][18][19][20] . The main areas identified for improvement are integrated messages and system support.…”

Section: Discussionsupporting

confidence: 82%

“…This may be partly explained by the minimal transport implications of the new service, both in relation to trips to the health center and to movements around the community. Given that transport was the main challenge reported by VHTs in a recent study, this is important 17 . Moreover, VHTs' expanded role appeared to improve their motivation through enhanced visibility and technical skills.…”

Section: Discussionmentioning

confidence: 99%

“…However, supervision of HTC services was lacking, with many VHTs reportedly not receiving any support. Earlier findings show that VHTs do not always think of routine interactions with health centers as supportive supervision, even though they acknowledge debriefing on key challenges encountered and turning in reports 17 . More information on the content of interactions between VHTs and health center staff is needed to determine how supervision mechanisms can be strengthened for optimal support within the constraints inherent to the broader health system.…”

Section: Discussionmentioning

confidence: 99%

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Integrating Family Planning and HIV Services at the Community Level: Formative Assessment with Village Health Teams in Uganda

Brunie

Mucheri²,

Akol³

et al. 2017

Afr J Reprod Health

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Little is known on integrating HIV and family planning (FP) services in community settings. Using a cluster randomized controlled design, we conducted a formative assessment in two districts in Uganda where community health workers, called VHTs, already offered FP. Thirty-six trained VHTs also provided HIV testing and counseling (HTC) during the intervention. We surveyed all 36 VHTs and 256 FP clients, and reviewed service statistics. In the intervention group, VHTs tested 80% of surveyed clients for HIV, including 76% they already saw for FP and 22% who first came to them for HTC before receiving FP. Comparing clients' experiences in the intervention and control groups, adding HTC does not appear to have negatively affected FP service quality. VHTs reported more monthly clients, but rated their workload as easy to manage. This integrated model seems feasible and beneficial for both VHTs and clients, while not resulting in any negative effects. This study was registered with ClinicalTrials.gov, number [NCT02244398]. (Afr J Reprod Health 2017; 21[2]: 73-80).Keywords: family planning, HIV, community health workers, integration, Uganda RésuméPeu d'informations sont disponibles sur l'intégration des services de planification familiale (PF) et du VIH dans les milieux communautaires. En utilisant un plan randomisé contrôlé par grappes, nous avons mené une évaluation formative dans deux districts en Ouganda dans lesquels les agents de santé communautaire qui sont appelés VHT offraient déjà des services de PF. Trente-six VHT formés ont également fourni des services de conseil et dépistage du VIH (CDV). Nous avons enquêté les 36 ASC et 256 clientes PF, et nous avons examiné les statistiques sur les services. Dans le groupe d'intervention, les VHT ont testé 80% des clients enquêtées pour le VIH, y compris 76% que les VHT voyaient déjà pour la PF et 22% qui sont d'abord venus pour le CDV avant avant de recevoir la PF. En comparant les expériences des clientes dans les groupes avec et sans intervention, l'ajout du CDV ne semble pas avoir affecté négativement la qualité des services PF. Les VHT ont signalé plus de clients mensuellement, mais ont évalué leur charge de travail comme étant aussi facile à gérer. Ce modèle intégré semble faisable et bénéfique pour les VHT et les clients, et sans entraîner d'effet négatif. Cette étude a été enregistrée auprès de ClinicalTrials.gov, numéro [NCT02244398]. (Afr J Reprod Health 2017; 21[2]: 73-80).

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Integrating Family Planning and HIV Services at the Community Level: Formative Assessment with Village Health Teams in Uganda

Brunie

Mucheri²,

Akol³

et al. 2017

Afr J Reprod Health

Self Cite

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“…Firstly, though it has been argued that to strengthen CHWs, financial remuneration in a predictable fashion should be considered (Maes, 2010), it is equally recognized that other non-monetary benefits can play a big role in motivating CHWs (Brunie et al, 2014). Indeed, VHTs showed great appreciation for the symbolic rewards they received for being volunteers such as social respect and other interpersonal relationships.…”

Section: Discussionmentioning

confidence: 99%

Towards Promotion of Community rewards to Volunteer Community Health Workers? Lessons from Experiences of Village Health Teams in Luwero, Uganda

Turinawe¹,

Rwemisisi²,

Musinguzi³

et al. 2016

RHS

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“…This gives a sense of ownership and reduces attrition rates. Village health workers should also be motivated because lack of motivation can also cause attrition [58]. They should be the first level of contact with the national health system.…”

Section: Considering Potential Roles For Village Health Workers In Thmentioning

confidence: 99%

Village Health Workers: Considering their Potential Role in the Current Ebola Virus Disease (EVD) Outbreak

2015

Int Arch Med

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An overview of the Ebola virus disease (EVD) in the current outbreak was discussed. The void created by the loss of health care workers and the increased need for village health workers (VHWs) was highlighted. The clinical manifestations of EVD in past and current outbreaks were also examined. The implementation of VHWs in various countries before the 1978 Declaration of Alma, Ata was reviewed. Village health workers are also called community health workers (CHW). They are called by different names around the world and they have different levels of training. Some are trained in only one area like the traditional birth attendants. The village health care worker was identified as part of Primary Health Care and their roles in different countries were explored. The positive impact in the health status of the communities after the introduction of VHW was also highlighted. In this present outbreak, there has been antagonism towards health care workers which has sometimes ended fatally. As part of community participation, VHWs are selected by the community they serve and this would reduce the antagonism sometimes directed at health care workers that are viewed as strangers and not as members of the community. The potential role of VHW as contact tracers, counselors, health educators, temperature monitors and first contact with the health system in the control of EVD was also highlighted. The governments of the three most affected countries should collaborate with countries that have employed the use of VHWs in EVD outbreaks.Village health workers: considering their potential role in the current ebola Virus disease (eVd) outbreak revIew

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Keeping community health workers in Uganda motivated: key challenges, facilitators, and preferred program inputs

Abstract: In Uganda, community-based health programs using volunteers should focus on strengthening support systems to address transportation and stockout issues and on improving links with the health structure while reinforcing effort recognition, status, and acquisition of new skills.

Cited by 95 publications

References 27 publications

Integrating Family Planning and HIV Services at the Community Level: Formative Assessment with Village Health Teams in Uganda

Integrating Family Planning and HIV Services at the Community Level: Formative Assessment with Village Health Teams in Uganda

Towards Promotion of Community rewards to Volunteer Community Health Workers? Lessons from Experiences of Village Health Teams in Luwero, Uganda

Village Health Workers: Considering their Potential Role in the Current Ebola Virus Disease (EVD) Outbreak

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