Paid staff or volunteers – does it make a difference? The impact of staffing on child outcomes for children attending community-based programmes in South Africa and Malawi

Abstract

Background: Globally, and in low and middle income countries (LMIC) specifically, there is a critical shortage of workers. The use of volunteers to support such care delivery systems has been examined, there is scant literature on the impact of volunteers on child outcome in high human immunodeficiency virus (HIV)-affected communities. Objectives: To examine the differential impact of paid versus volunteer workforce in Community Based Organisations (CBOs) providing care to children and families affected by the HIV epidemic in South Africa and Malawi on child outcomes over time. Methods: This study compared child outcomes for 989 consecutive children attending CBOs (0.7% refusal) at baseline and 854 at follow-up (86.3% response rate). Results: Children attending CBOs with paid staff had higher self-esteem, fewer emotional/behavioural problems and less perceived stigma. Likewise, children attending CBOs with paid staff had fewer educational risks, and 20 heightened cognitive performance, and the digit-span memory test. After controlling for outcome at baseline, gender, age, HIV status, and disability, attending a CBO with paid staff remained a significant independent predictor of higher self-esteem scores, less perceived stigma, as well as fewer educational risks and better performance on the drawing test. We found no associations between CBO attendance – paid or volunteer – and children’s depressive and trauma symptoms. Conclusions: Our findings show that in order to most optimally impact on child outcome 30 community-based workers (CBWs) should ideally be paid with trained staff. Specialised input for more severe child difficulties is needed.

Cognitive and Educational Interventions for Orphans and Vulnerable Children Affected by HIV/AIDS: A Meta‐Analysis

“…While these education‐related outcomes differed between studies, they were generally related to motivation or performance within school, and may be considered to be measures of educational risk. Previous studies have combined various measures of school attendance and performance into an overall measure of educational risk (Tomlinson et al, 2017). One study included both educational and cognitive outcomes (Tomlinson et al, 2017); it was included in both analyses.…”

“…Previous studies have combined various measures of school attendance and performance into an overall measure of educational risk (Tomlinson et al, 2017). One study included both educational and cognitive outcomes (Tomlinson et al, 2017); it was included in both analyses.…”

“…Another intervention that took place in Zimbabwe consisted of either unconditional cash transfers, or cash transfers conditional on the family applying for a birth certificate, maintaining up‐to‐date vaccinations, and attending growth monitoring clinics, attending school for 90% per month, and a representative from the household attending local parenting classes (Crea et al, 2015). Lastly, there were two studies investigating community‐based interventions, providing services related to education, HIV prevention, provision of meals, and psychological counseling through home‐based caregivers or at a community center in Zambia (Chatterji et al, 2010; Tomlinson, Sherr, Macedo, & Hunt, Sherr, 2017).…”

Diffusing and scaling evidence‐based interventions: eight lessons for early child development from the implementation of perinatal home visiting in South Africa

“…Similarly, recent work has shown that adequate remuneration is not only essential for staff retention, 56,57 but also plays a role in intervention efficacy. 58 As noted by Gladstone et al, 59 CHWs may feel that they are performing tasks over and above those befitting their pay. Rather than focusing on individual health-workers capacity to deliver a verbatim intervention, the focus should be on assessing whether individual staff members feel confident in their work, and guided by the overall mission, vision, and values of the intervention.…”

“…If projects are to endure and be sustainable, all staff need to have opportunities for growth. Similarly, recent work has shown that adequate remuneration is not only essential for staff retention, but also plays a role in intervention efficacy . As noted by Gladstone et al ., CHWs may feel that they are performing tasks over and above those befitting their pay.…”