Challenges facing community health workers in promoting maternal and neonatal health in Bagamoyo and Mkuranga districts, Tanzania

Kabula Jumanne,Mwifadhi Mrisho,Liliane Pasape,Irene R Moshi

doi:10.4314/gmj.v55i2.4

Abstract

Objectives: Community health workers (CHWs) play significant roles in areas where professional health workforce succumb to serious human resource deficiencies. This study explored challenges the CHWs face in promoting maternal and neonatal health in two districts of Tanzania.Design: A cross-sectional study design was conducted in Bagamoyo and Mkuranga districts from March to May 2019.Methods: Qualitative data were collected using in-depth interviews from 30 CHWs, thematic analysis was carried out by identifying major key themes emerging from the data.Results: The study found little community support resulted from jealousy of male household heads, mistrust, socialcultural believes and lack of community appreciation on the role of CHWs. Little support from local government resulted by political grievances among local leaders due to change in political administration. Other challenges were lack of basic knowledge in maternal and neonatal health, including breastfeeding. Irregular working schedules dueto poor supervision, huge workload, old age and tirednessConclusion: CHWs programs in Bagamoyo and Mkuranga districts were inactive and required innovative strategies to raise community and local government cooperation. Jealousy among male household’s heads and CHWs need community members to participate in establishment of selection criteria. Socio-cultural beliefs call for community sensitization on how they affect maternal and neonatal health. Lack of community appreciation on the role of CHWs, irregular working schedule implied poor supervision and defined age limit would overcome challenges related to old age.

Highlights

Shortage of human resource for health in maternal and child health has led to increasing Community Health Workers (CHWs) in middle and low-income countries.[1]
Shortage of health workers threatens the achievement of Sustainable Development Goal number 3 that encompasses good health and well-being of all people, including reduction of maternal and neonatal mortality by less than 70 per 100,000 births and 12 per 1,000 births, respectively in 2030.2 The reported global maternal mortality rate is 211 per 100,000 live births in 2017 and high in Sub-Saharan African countries with a rate of 542 deaths per 100,000 live births.[3]
Results were organized into social-demographic characteristics and the reported challenges facing CHWs

Summary

Introduction

Shortage of human resource for health in maternal and child health has led to increasing Community Health Workers (CHWs) in middle and low-income countries.[1]. The program declined in 1990s due to poor performance and donor influence on adoption of disease-specific programs.[8] In 2007-2017, Tanzania launched “Mpango wa Maendeleo wa Afya ya Msingi” (MMAM) to increase community-based health care where the importance of using CHWs surfaced for the second time.[9] Health actors, including non-governmental organization, the President’s Emergency Plan for AIDS Relief (PEPFAR) and African Medical and Research Foundation (AMREF), launched CHWs programs.[8, 10] In addition, the National Health Policy of 2017 endorsed use of CHWs to promote maternal and neonatal health at the community level.[11] Likewise, the Ministry of Health, through their Health Sector Strategic Plan of July 2015 to June 2020 have categorically stated that mobilization and training of CHWs is among six initiatives launched to realize a 20% reduction of maternal and neonatal mortality by 2017/18.12

Objectives

Methods

Results

Discussion

Conclusion