Abstract
Zimbabwe, like most low-income countries, faces health worker shortages. Community health workers (CHWs) bridge this gap by delivering essential health services and nutrition interventions to communities. However, as workloads increase, CHWs' ability to provide quality services may be compromised. We studied influences upon CHWs' performance related to pregnancy surveillance and nutrition and hygiene education in rural Zimbabwe. In the context of a cluster-randomized trial conducted in 2 rural districts between November 2012 and March 2015, 342 government-employed CHWs identified and referred pregnant women for early antenatal care and delivered household-level behavior change lessons about infant feeding and hygiene to more than 5,000 women. In 2013, we conducted a survey among 322 of the CHWs to assess the association between demographic and work characteristics and task performance. Exploratory factor analyses of the Likert-type survey questions produced 8 distinct and reliable constructs of job satisfaction and motivation, supervision, peer support, and feedback (Cronbach α range, 0.68 to 0.92). Pregnancy surveillance performance was assessed from pregnancy referrals, and nutrition and hygiene education performance was assessed by taking the average summative score (range, 5 to 30) of lesson delivery observations completed by a nurse supervisor using a 6-item Likert-type checklist. Poisson and multiple linear regressions were used to test associations between CHW demographic and work characteristics and performance. CHWs who referred more pregnant women were female, unmarried, under 40 years old, from larger households, and of longer tenure. They also perceived work resources to be adequate and received positive feedback from supervisors and the community, but they were less satisfied with remuneration. CHWs with high scores on behavior change lesson delivery were from smaller households, and they received more supportive supervision but less operational supervision. Measures of job satisfaction and motivation were not associated with either task. Among CHWs responsible for multiple tasks in rural Zimbabwe, factors associated with performance of one task were not the same as those associated with performance of another task. Our methods and findings illustrate ways to examine heterogeneity in CHW performance and to identify organizational factors associated with quality of program delivery.
Highlights
Among community health worker (CHW) responsible for multiple tasks in rural Zimbabwe, factors associated with performance of one task were not the same as those associated with performance of another task
Our methods and findings illustrate ways to examine heterogeneity in CHW performance and to identify organizational factors associated with quality of program delivery
CHW services are important in ensuring the delivery of primary health care services in many low-income settings
Summary
Community health workers (CHWs) are an effective part of the workforce for delivering essential maternal and child health and nutrition services.[1,2]CHW Performance in a Multi-Tasked Setting in Zimbabwe www.ghspjournal.orgMany sub-Saharan African countries such as Zimbabwe face critical health worker shortages, driving the continued expansion of the role of CHWs in these health systems.[3,4] CHWs’ scope of practice varies substantially among and within countries; as CHW workload and task complexity increase, concern exists about the quality of services provided by CHWs.[5,6]In Zimbabwe, CHWs have been the front line of the national health system since the 1980s.7 They provide basic health care treatment and health promotion education on a broad range of topics and report monthly to the head nurse at their nearest primary health care facility. Community health workers (CHWs) are an effective part of the workforce for delivering essential maternal and child health and nutrition services.[1,2]. Many sub-Saharan African countries such as Zimbabwe face critical health worker shortages, driving the continued expansion of the role of CHWs in these health systems.[3,4] CHWs’ scope of practice varies substantially among and within countries; as CHW workload and task complexity increase, concern exists about the quality of services provided by CHWs.[5,6]. In Zimbabwe, CHWs have been the front line of the national health system since the 1980s.7. Community health workers (CHWs) bridge this gap by delivering essential health services and nutrition interventions to communities. We studied influences upon CHWs’ performance related to pregnancy surveillance and nutrition and hygiene education in rural Zimbabwe
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