Profile, knowledge, and work patterns of a cadre of maternal, newborn, and child health CHWs focusing on preventive and promotive services in Morogoro Region, Tanzania

Abstract

BackgroundDespite impressive decreases in under-five mortality, progress in reducing maternal and neonatal mortality in Tanzania has been slow. We present an evaluation of a cadre of maternal, newborn, and child health community health worker (MNCH CHW) focused on preventive and promotive services during the antenatal and postpartum periods in Morogoro Region, Tanzania. Study findings review the effect of several critical design elements on knowledge, time allocation, service delivery, satisfaction, and motivation.MethodsA quantitative survey on service delivery and knowledge was administered to 228 (of 238 trained) MNCH CHWs. Results are compared against surveys administered to (1) providers in nine health centers (n = 88) and (2) CHWs (n = 53) identified in the same districts prior to the program’s start. Service delivery outputs were measured by register data and through a time motion study conducted among a sub-sample of 33 randomly selected MNCH CHWs.ResultsNinety-seven percent of MNCH CHWs (n = 228) were interviewed: 55% male, 58% married, and 52% with secondary school education or higher. MNCH CHWs when compared to earlier CHWs were more likely to be unmarried, younger, and more educated. Mean MNCH CHW knowledge scores were <50% for 8 of 10 MNCH domains assessed and comparable to those observed for health center providers but lower than those for earlier CHWs. MNCH CHWs reported covering a mean of 186 households and were observed to provide MNCH services for 5 h weekly. Attendance of monthly facility-based supervision meetings was nearly universal and focused largely on registers, yet data quality assessments highlighted inconsistencies. Despite program plans to provide financial incentives and bicycles for transport, only 56% of CHWs had received financial incentives and none received bicycles.ConclusionsInitial rollout of MNCH CHWs yields important insights into addressing program challenges. The social profile of CHWs was not significantly associated with knowledge or service delivery, suggesting a broader range of community members could be recruited as CHWs. MNCH CHW time spent on service delivery was limited but comparable to the financial incentives received. Service delivery registers need to be simplified to reduce inconsistencies and yet expanded to include indicators on the timing of antenatal and postpartum visits.Electronic supplementary materialThe online version of this article (doi:10.1186/s12960-015-0086-3) contains supplementary material, which is available to authorized users.

Enhancing the capacity and effectiveness of community health volunteers to improve maternal, newborn and child health: Experience from Kenya

“…Since the impact of CHV outreach depends on maximizing interactions with women, newborns and children, 6 CHVs' ability to monitor who has been seen and the counselling topics discussed minimizes duplication of effort, enhancing CHV efficiency and job satisfaction. Large catchment areas and increasing responsibilities coupled with poor support for planning and efficiency contribute to job stress and high attrition rates in CHW programs globally.…”

“…If scaled up, such improvements could reduce interrupted access to critical MNCH interventions, which has slowed progress in decreasing maternal, newborn and child mortality. 6 Demonstrating improved access to care is not enough to decrease maternal, newborn and child mortality. Improved access to MNCH interventions may not translate to improved MNCH outcomes if skilled, high-quality care is not provided at the point of access.…”

“…4 In 2011, Kenya introduced its Community Health Strategy, which aims to improve health outcomes, including MNCH, by promoting individual and community health 5 through the use of community health volunteers (CHVs -the name for CHWs in Kenya). To have maximum impact on MNCH, CHVs must regularly reach a high proportion of women and children throughout the continuum of care 6 to deliver key messages and link individuals to services. Monthly household visits, identifying targets and collecting aggregate data for health information systems (HIS) has accounted for much of CHVs' interactions with women and their families to date.…”

Timely Access to Maternal, Neonatal and Child Healthcare for rural communities in Rwanda: Job satisfaction of Community Health Workers delivering Community Based Maternal, Newborn and Child Healthcare

“…CHWs are mostly residents in these rural communities. Therefore, the decentralization of healthcare services to remote and rural settings through CHWs has the advantage of geographical proximity and readily accessible within rural settings which also helps bridge socio-cultural and linguistic barriers to health care delivery 9,10 . In a meta-analysis of maternal and child health by Kassebaum et al 11 , explained the positive impact of CHWs on reducing maternal and child mortality between 1990-2003 in varying contexts.…”

The Knowledge and Attitude Survey of Posyandu Cadres About the Health of Pregnant Mothers, Infants and Toddlers In Jatinangor Health Center, Jatinagor District, Sumedang Regency

“…In line with the time, problems arise that can hamper the implementation of Posyandu including the low in number of Posyandu cadres, the lack of cadres motivation, the high number of drop out cadres, and the lack of knowledge, attitudes and skills of Posyandu cadres. 4 There are two factors that influence a person's knowledge and attitudes, namely internal and external factors. The internal factors are education, work, age and interest, while the external factors are experience, culture and information.…”