Abstract
ABSTRACTBackground: Preventable maternal and newborn deaths can be averted through simple evidence-based interventions, such as the use of community health workers (CHWs), also known in Uganda as village health teams. However, the CHW strategy faces implementation challenges regarding training packages, supervision, and motivation.Objectives: This paper explores knowledge levels of CHWs, describes the coverage of home visits, and shares lessons learnt from setting up and implementing the CHW strategy.Methods: The CHWs were trained to conduct four home visits: two during pregnancy and two after delivery. The aim of the visits was to promote birth preparedness and utilization of maternal and newborn health (MNH) services. Mixed methods of data collection were employed. Quantitative data were analyzed using Stata version 13.0 to determine the level and predictors of CHW knowledge of MNH. Qualitative data from 10 key informants and 15 CHW interviews were thematically analyzed to assess the implementation experiences.Results: CHWs’ knowledge of MNH improved from 41.3% to 77.4% after training, and to 79.9% 1 year post-training. However, knowledge of newborn danger signs declined from 85.5% after training to 58.9% 1 year later. The main predictors of CHW knowledge were age (≥ 35 years) and post-primary level of education. The level of coverage of at least one CHW visit to pregnant and newly delivered mothers was 57.3%. Notably, CHW reports complemented the facility-based health information. CHWs formed associations, which improved teamwork, reporting, and general performance, and thus maintained low dropout rates at 3.6%. Challenges included dissatisfaction with the quarterly transport refund of 6 USD and lack of means of transportation such as bicycles.Conclusions: CHWs are an important resource in community-based health information and improving demand for MNH services. However, the CHW training and supervision models require strengthening for improved performance. Local solutions regarding CHW motivation are necessary for sustainability.
Highlights
Preventable maternal and newborn deaths can be averted through simple evidence-based interventions, such as the use of community health workers (CHWs), known in Uganda as village health teams
Despite substantial progress and a decline in global maternal and child mortality by 44% and 53%, respectively, the targeted 75% and 66% drops in the Millennium Development Goals (MDGs) were not achieved [1]
This paper explores the knowledge levels of the CHWs, describes the coverage of home visits, and shares lessons learnt from the setting up and implementation of the CHW strategy
Summary
Preventable maternal and newborn deaths can be averted through simple evidence-based interventions, such as the use of community health workers (CHWs), known in Uganda as village health teams. Maternal and newborn mortality contribute greatly to the burden of preventable deaths, most of which occur in sub-Saharan Africa. Building upon the MDGs, the even more ambitious Sustainable Development Goals (SDGs), which call for major reductions in maternal, neonatal, and child mortality, and universal access to sexual and reproductive health services by 2030, were developed. These ambitious goals aim to reduce the maternal mortality ratio to less than 70 per 100,000 live births, end all preventable newborn deaths, and reduce neonatal mortality and still births to less than 12 per 1000 births by 2030 [1]. While 95% of women attend antenatal care at least once, only 57% of births occur in health facilities, and just 59% of births are attended by a skilled attendant [2]
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