Abstract
BackgroundImproving the performance of community health workers (CHWs) is a global issue. The relationship between CHWs and their community may impact their performance. In Lao People’s Democratic Republic (Lao PDR), CHW are called village health volunteers (VHV). Lao PDR has a problem with VHV inactivity, especially in rural areas. This study focused on which aspects of social capital are related to VHV performance.MethodsThis research represents a cross-sectional study with a quantitative survey based primarily on interviews using a semi-structured questionnaire. Interviews were conducted with 149 VHVs living and working in the Sepon District. VHV performance evaluation was measured with scores on a 5-point scale, and the cutoff point for designating performance as good or poor was set at the median score. This evaluation of VHV performance was conducted as a self-evaluation by VHVs and by health center staff who were supervisors of the VHVs. Measurement of social capital was accomplished using the short version of the Adapted Social Capital Assessment Tool (SASCAT). For statistical analyses, logistic regression was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI).ResultsThe results of multiple logistic regression adjusted by moderator variables showed that citizenship activities in the structural social capital component of SASCAT were significantly related to performance in self-evaluation by VHVs (adjusted OR: 2.10, 95% CI: 1.19-3.71) and the evaluations by health center staff (adjusted OR: 1.67, 95% CI: 1.01-2.77). Support from groups (adjusted OR: 1.87, 95% CI: 1.27-2.76) and cognitive social capital (adjusted OR: 7.48, 95% CI: 2.14-26.10) were found to be significantly associated but only for VHV self-evaluation.ConclusionsThe results suggest that individuals who interact with important figures in the community and who cooperate with other villagers whenever problems arise, i.e., have social capital, exhibit good performance as VHVs. These findings suggest that increasing citizenship activities could increase the retention rate of CHWs and help improve their performance. Citizenship activities could also be used as a predictive indicator when selecting new CHWs.
Highlights
Improving the performance of community health workers (CHWs) is a global issue
The “citizenship activities” item includes two questions regarding “joining together with other village members” and “talking with a local authority or government organization.”. It appears that individuals who have connections with important figures in the community and who cooperate with other villagers whenever problems arise exhibit good performance as village health volunteers (VHV)
We can conclude that the results of this research are useful, if only for the reason that they represent a first attempt to study the relationship between social capital and VHV performance in Lao People’s Democratic Republic (Lao PDR) and have led to the proposal of effective methods to improve VHV performance
Summary
Improving the performance of community health workers (CHWs) is a global issue. The relationship between CHWs and their community may impact their performance. According to documents issued by the WHO [1], the term community health worker (CHW) refers to local healthcare workers who are not medical professionals such as doctors or nurses but who provide some form of healthcare service to the public after receiving required training. A review of the literature concluded that CHWs did not consistently provide services that are likely to have substantial effects on health and that quality was usually poor [7]. Such ineffective performance has variously been attributed to the lack of monetary incentives, appropriate supervision, or ongoing training [8,9,10]
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