Motivation of Community Health Volunteers in rural Uganda: the interconnectedness of knowledge, relationship and action

Singh, Debra; Cumming, Robert; Mohajer, Nicole; Negin, Joel

doi:10.1016/j.puhe.2016.01.010

Cited by 29 publications

(50 citation statements)

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“…These were considered more critical barriers to the expanstion of the VHT role than the lack of financial incentivization for VHT work. A lack of financial support has been identified as a major factor limiting CHW motivation in prior research [24,25] , though our findings suggest otherwise and are consistent with another recent study among CHWs in Uganda, which described community relationships and trust as being the most important motivators for CHW work [26]. Participants in the present study described how they would be motivated by greater availibility of equipment, uniforms, and transportation, while payment for their work was very rarely mentioned.…”

Section: Barriers To Vht Roles In Preventing Ncds In Communitiessupporting

confidence: 86%

Exploring knowledge and attitudes toward non-communicable diseases among Village Health Teams in Eastern Uganda: a cross-sectional mixed methods study

Ojo

Hawley

Desai

et al. 2017

Preprint

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Section: Barriers To Vht Roles In Preventing Ncds In Communitiessupporting

confidence: 86%

Exploring knowledge and attitudes toward non-communicable diseases among Village Health Teams in Eastern Uganda: a cross-sectional mixed methods study

Ojo

Hawley

Desai

et al. 2017

Preprint

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“…Some of these have been identified as being significant factors in motivation of CHVs (13, 14, 17, 18, 25, 26). …”

Section: Discussionmentioning

confidence: 99%

“…Individual, group, and program factors have each been shown to influence the performance of CHVs (1, 3, 5, 6, 8–15, 17–19, 25). Factors previously reported to result into improved performance include the female gender, regular supervision and provision of feedback, higher education, the availability of job aides and other tools, and feeling “connected” with the system (3, 5, 6, 9–11, 13, 14, 17, 18). …”

Section: Discussionmentioning

confidence: 99%

“…Implementation mechanisms in the country have varied and have been largely steered by government partners, including local and foreign non-governmental organizations, as government funding and resources have dwindled since inception (7). Some of the factors described to improve their performance include support from the community and health facilities, adequate work resources, regular feedback, and supervision (3, 6, 11, 13, 17, 18). Challenges have been attributed to lack of or low remuneration, lack of uniform and regular contact with supervisors, or lack of motivation, high workload, and inadequate skills (3, 12).…”

Section: Background and Rationalementioning

confidence: 99%

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Community Health Volunteers in Primary Healthcare in Rural Uganda: Factors Influencing Performance

Kuule¹,

Dobson²,

Woldeyohannes

et al. 2017

Front. Public Health

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IntroductionCommunity health volunteers (CHVs) play an integral role in primary healthcare. Several countries rely on CHV programs as a major element in improving access to care and attaining universal health coverage. However, their performance has been heterogeneous and at times context-specific, and influenced by multiple factors. We describe the socio-demographic and workplace characteristics affecting CHVs’ performance in a public health program in rural western Uganda.MethodsThis was a cross-sectional study based on routine program data of CHVs serving the catchment of Bwindi Community Hospital, Kanungu District, South Western Uganda, in 2014 and 2015. Information was collected on individual socio-demographic and workplace characteristics of the CHVs. To assess their work output, we defined study-specific targets in terms of attendance at monthly CHVs’ meetings with community health nurses, households followed-up and reported, children screened for malnutrition, immunization coverage, and health facility deliveries. Frequencies and proportions are reported for characteristics and outputs and odds ratios for study-specific factors associated with overall performance.ResultsOf the 508 CHVs, 65% were women, 48% were aged 35 years and below, and 37% took care of more than the recommended 20–30 households. Seventy-eight percent of the CHVs had ≥80% of pregnant women under their care delivering in health units, 71% had ≥95% of the children on schedule for routine immunization, while 27% screened ≥75% of the children under 5 years for malnutrition. More refresher trainings was associated with better overall performance [adjusted odds ratio (aOR): 12.2, 95% confidence interval (CI): 1.6–93.6, P = 0.02] while overseeing more than the recommended 20–30 households reduced overall performance (aOR: 0.6, 95% CI: 0.4–0.9, P = 0.02).ConclusionBeing in-charge of more than the recommended households was associated with reduced performance of CHVs, while more refresher trainings were associated with improved performance. If the CHVs are to remain a strategic pillar in universal health coverage, it is imperative to address those factors known to impact on their performance.

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“…Uganda, which described community relationships and trust as being the most important motivators for 287 CHW work [26]. Participants in the present study described how they would be motivated by greater 288 availibility of equipment, uniforms, and transportation, while payment for their work was very rarely 289 mentioned.…”

Section: Barriers To Vht Roles In Preventing Ncds In Communities 281mentioning

confidence: 77%

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1Background: Community health workers are essential personnel in resource-limited settings. In Uganda, 2 they are organized into Village Health Teams (VHTs) and are focused on infectious diseases and 3 maternal-child health; however, their skills could potentially be utilized in national efforts to reduce the 4 growing burden of non-communicable diseases (NCDs). We sought to assess the knowledge of, and 5 attitudes toward NCDs and NCD care among VHTs in Uganda as a step toward identifying their potential 6 role in community NCD prevention and management. 7Methods: We administered a knowledge, attitudes and practices questionnaire to 68 VHT members from 8Iganga and Mayuge districts in Eastern Uganda. In addition, we conducted four focus group discussions 9 with 33 VHT members. Discussions focused on NCD knowledge and facilitators of and barriers to 10 incorporating NCD prevention and care into their role. A thematic qualitative analysis was conducted to 11 identify salient themes in the data. 12Results: VHT members possessed some knowledge and awareness of NCDs but identified a lack of 13 knowledge about NCDs in the communities they served. They were enthusiastic about incorporating 14 NCD care into their role and thought that they could serve as effective conduits of knowledge about 15NCDs to their communities if empowered through NCD education, the availability of proper reporting 16 and referral tools, and visible collaborations with medical personnel. The lack of financial remuneration 17 for their role did not emerge as a major barrier to providing NCD services. 18Conclusions: Ugandan VHTs saw themselves as having the potential to play an important role in 19improving community awareness of NCDs as well as monitoring and referral of community members for 20 NCD-related health issues. In order to accomplish this, they anticipated requiring context-specific and 21 culturally adapted training as well as strong partnerships with facility-based medical personnel. A lack of 22 financial incentivization was not identified to be a major a barrier to such role expansion. Developing a 23 PeerJ Preprints | https://doi.org/10.7287/peerj.preprints.3196v1 | CC BY 4.0 Open Access | rec Declarations 349Ethical approval and consent to participate: This study received ethical approval from the Human 350

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Motivation of Community Health Volunteers in rural Uganda: the interconnectedness of knowledge, relationship and action

Cited by 29 publications

References 10 publications

Exploring knowledge and attitudes toward non-communicable diseases among Village Health Teams in Eastern Uganda: a cross-sectional mixed methods study

Exploring knowledge and attitudes toward non-communicable diseases among Village Health Teams in Eastern Uganda: a cross-sectional mixed methods study

Community Health Volunteers in Primary Healthcare in Rural Uganda: Factors Influencing Performance

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