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.

Amnesty Lefevre ,Harriet Lutale,Dereck Chitama,Helen Semu,Diwakar Mohan,Japhet Killewo,Shivam Gupta,Abdullah H Baqui,Isabelle Feldhaus,Audrey Pereira,Rose Mpembeni,Giulia Besana,Emmanuel Mtete,Charles Kilewo,Asha George ,Chad J Cooper ,Joy J Chebet ,Dunstan R Bishanga ,David P Urassa ,Peter J Winch

doi:10.1186/s12960-015-0086-3

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.

Highlights

Despite impressive decreases in under-five mortality, progress in reducing maternal and neonatal mortality in Tanzania has been slow
While we explore the implications of these social characteristics elsewhere (Intersectionality implications of scaling up MNCH CHVs in Tanzania: examining how gender, age and educational determinants combine to influence CHV experience, to be submitted.), further analyses found no significant differences in the mean number of households visited monthly and in the mean composite scores for overall knowledge by community health worker (CHW) education, gender, or age, qualitative data indicated that CHW education, gender, and age did influence CHW communication and visits with community members [19]
Further research is required to understand the balance of CHW performance, CHW to population ratio, and incentives before scale up at the national level

Summary

Introduction

Despite impressive decreases in under-five mortality, progress in reducing maternal and neonatal mortality in Tanzania has been slow. Key contributors to the slow progress in reducing neonatal and maternal mortality have been (1) stagnant levels of facility deliveries, (2) poor quality of care, (3) lack of contact of health services with children during their first 28 days of life, and (4) breaks in the continuity of care from preconception through antenatal, intra-partum, and postpartum periods. Critical shortages of health workers underpin these contributing factors, impeding efforts to improve timely and continuous access to high-quality health services in Tanzania and many other low-resource settings. The difficulties in addressing the challenges underpinning human resources for health in Tanzania, including inadequate training and recruitment, uneven workforce distributions, and retention, coupled with the desire to extend the reach of health services, have led to a proliferation of community health worker (CHW) programs [4]

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Discussion

Conclusion