COMMUNITY HEALTH WORKERS’ TARGETING OF WOMEN FOR HEALTH AND NUTRITION HOME VISITS IN RURAL TANZANIA: A MIXED-METHODS STUDY

Abstract

BackgroundCommunity Health Workers (CHWs) are utilized in many health systems to provide education and messaging to families in their catchment area. However, CHWs responsible for large geographic areas often must make important decisions about whom to visit. Factors that influence these decisions are understudied. ObjectiveThis study assessed coverage and targeting for home visits by CHWs within a large Social and Behavioral Change health program in rural Tanzania. MethodsThis implementation research was a cross-sectional, mixed-methods study. Data collection included a census with households and surveys with women, surveys with CHWs, and interviews with CHWs. Survey data also included the collection of household location data for women and CHWs. Quantitative data were analyzed using linear probability models, and qualitative data were analyzed using inductive thematic analysis. ResultsOnly 13% of eligible households in our study sites reported receiving a home visit from a CHW. While CHWs were more likely to reach households with infants, other program priority populations such as poor and food insecure households were frequently missed. GPS data showed that distance was one of the greatest barriers for CHWs in providing home visits. Qualitative data indicated that while CHWs were motivated and engaged to improve maternal and child health in their communities, they faced challenges in visiting households that were further away or lacked economic resources to improve their health behaviors. CHWs also found it difficult to provide health education during home visits to mothers with no formal schooling. ConclusionsPrograms relying on community volunteers need to set realistic workloads, especially when volunteer CHWs also work full-time in their primary occupations. Implementation could also be strengthened by providing extra support for CHWs so that they can effectively provide services to community members that are more difficult to visit but may be the most in need.