Abstract
Background: Few studies have reported on the autonomous continuation of Community Health Worker (CHW) activities after external supervision and support have ended.Objective: The study reports CHW activity continuation in Thegon Township, Bago Region, Myanmar, observed after the supervision by the external organization is completed.Method: Following the completion of a child nutrition program in Thegon Township, CHWs were left unsupervised and uninformed of a follow-up at 10, 23, and 40 months from the end of the program survey due to unforeseen circumstances. In a follow-up survey in 2014, data on the activity implementation status from CHWs and activity attendance from caregivers of the target children were collected. Focus group discussions were held with caregivers concerning their information sources on child nutrition and health.Results: On average, CHWs were found to have continued with 2.6 of the four core activities, often with modifications, irrespective of the time since completion of the non-profit-organization-led program. Meanwhile, caregiver attendance decreased over time. Caregivers recognized CHWs as information sources.Discussion: Although unsupervised, CHWs ambitiously continued with their activities, but sorted through and modified them, which may have been unrelated to the local acceptance of the program, as caregiver attendance decreased even as CHWs continued the activities. The observation may highlight the importance of proactive engagement and thus, the autonomy of CHWs in their activity continuation.
Highlights
METHODIncreasing attention is being paid to public health program sustainability, few programs have evaluated their longterm impacts beyond their active engagement [1,2,3,4] as a result of methodological constraints, including uncertainty in relation to terminology [3, 5].Pluye summarized that program sustainability matters because the programs’ long-term effects are indispensable in relation to individuals’ behavioral changes, and their ultimate health outcomes [6]
Responses were obtained from Community Health Worker (CHW) in all 90 villages
CHWs had maintained their activities for up to 40 months after the end of the non-profit organization (NPO)-led program. They had sorted through and modified some activities once the NPO-led program ended, continuing with the activities thereafter with little change and several activity patterns: “continuity with modification” for cases of Nutrition Education and Peer Counseling, “relatively high continuity without modification” in Growth Monitoring, and “total discontinuation” in Cooking Demonstration. Such activity patterns may reflect the proactive ingenuity of CHWs, which can be a factor to promote program sustainability [2, 4, 22, 23], rather than program deterioration
Summary
The study reports CHW activity continuation in Thegon Township, Bago Region, Myanmar, observed after the supervision by the external organization is completed. Method: Following the completion of a child nutrition program in Thegon Township, CHWs were left unsupervised and uninformed of a follow-up at 10, 23, and 40 months from the end of the program survey due to unforeseen circumstances. In a follow-up survey in 2014, data on the activity implementation status from CHWs and activity attendance from caregivers of the target children were collected. Focus group discussions were held with caregivers concerning their information sources on child nutrition and health
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