Article

Task-shifting to community health workers: evaluation of the performance of a peer-led model in an antiretroviral program in Uganda.

1 Executive Directors Office, Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda.
AIDS patient care and STDs (Impact Factor: 2.68). 02/2012; 26(2):101-7. DOI: 10.1089/apc.2011.0279
Source: PubMed

ABSTRACT Task shifting to community health workers (CHW) has received recognition. We examined the performance of community antiretroviral therapy and tuberculosis treatment supporters (CATTS) in scaling up antiretroviral therapy (ART) in Reach Out, a community-based ART program in Uganda. Retrospective data on home visits made by CATTS were analyzed to examine the CATTS ability to perform home visits to patients based on the model's standard procedures. Qualitative interviews conducted with 347 randomly selected patients and 47 CATTS explored their satisfaction with the model. The CATTS ability to follow-up with patients worsened from patients requiring daily, weekly, monthly, to three-monthly home visits. Only 26% and 15% of them correctly home visited patients with drug side effects and a missed clinic appointment, respectively. Additionally, 83% visited stable pre-ART and ART patients (96%) more frequently than required. Six hundred eighty of the 3650 (18%) patients were lost to follow-up (LTFU) during the study period. The mean number of patients LTFU per CATTS was 40.5. Male (p = 0.005), worked for longer durations (p = 0.02), and had lower education (p = 0.005). An increased number of patients (p = 0.01) were associated with increased LTFU. Ninety-two percent of the CATTS felt the model could be improved by reducing the workload. CATTS who were HIV positive, female, not residing in the same village as their patients, more educated, married, on ART, and spent less time with the patients were rated better by their patients. The Reach-Out CHW model is labor-intensive. Triaged home visits could improve performance and allow CATTS time to focus on patients requiring more intensive follow-up.

1 Bookmark
 · 
131 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Community health workers (CHWs) have long played an important role in the management of complex health problems, especially in resource-poor settings. Although there is a large literature regarding the use of CHWs around the world, there is little detail about how these workers are selected, trained and utilized in the field. Lesotho has one of the highest rates of HIV in the world, with an estimated 25% of the general population infected with the disease; at the same time, there is a significant health human resources shortage in Lesotho with an estimated 60% of health posts left vacant. Community health workers have the potential to play a major role in HIV treatment scale-up in the country, and in 2006, a CWH-based project called "The Rural Initiative" was started in the remote mountain regions of the country. More than 1000 CHWs were trained and employed through this program between June 2006 and December 2008. This paper will review the CHW program in detail, with a focus on recruitment, training, ongoing supervision and support, and the larger public health implications of the CHW program in Lesotho. It is hoped this program can serve as a practical model for other programs working with or in need of CHWs.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors intersect to influence CHW performance. A systematic review with a narrative analysis was conducted to identify contextual factors influencing performance of CHWs. We searched six databases for quantitative, qualitative, and mixed-methods studies that included CHWs working in promotional, preventive or curative primary health care services in LMICs. We differentiated CHW performance outcome measures at two levels: CHW level and end-user level. Ninety-four studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programmes. Thematic coding was conducted and evidence on five main categories of contextual factors influencing CHW performance was synthesized. Few studies had the influence of contextual factors on CHW performance as their primary research focus. Contextual factors related to community (most prominently), economy, environment, and health system policy and practice were found to influence CHW performance. Socio-cultural factors (including gender norms and values and disease related stigma), safety and security and education and knowledge level of the target group were community factors that influenced CHW performance. Existence of a CHW policy, human resource policy legislation related to CHWs and political commitment were found to be influencing factors within the health system policy context. Health system practice factors included health service functionality, human resources provisions, level of decision-making, costs of health services, and the governance and coordination structure. All contextual factors can interact to shape CHW performance and affect the performance of CHW interventions or programmes. Research on CHW programmes often does not capture or explicitly discuss the context in which CHW interventions take place. This synthesis situates and discusses the influence of context on CHW and programme performance. Future health policy and systems research should better address the complexity of contextual influences on programmes. This insight can help policy makers and programme managers to develop CHW interventions that adequately address and respond to context to optimise performance.
    Health Research Policy and Systems 12/2015; 13(1):1. DOI:10.1186/s12961-015-0001-3 · 1.86 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors influence CHW performance. A systematic review was conducted to identify intervention design related factors influencing performance of CHWs. We systematically searched six databases for quantitative and qualitative studies that included CHWs working in promotional, preventive or curative primary health services in LMICs. One hundred and forty studies met the inclusion criteria, were quality assessed and double read to extract data relevant to the design of CHW programmes. A preliminary framework containing factors influencing CHW performance and characteristics of CHW performance (such as motivation and competencies) guided the literature search and review. A mix of financial and non-financial incentives, predictable for the CHWs, was found to be an effective strategy to enhance performance, especially of those CHWs with multiple tasks. Performance-based financial incentives sometimes resulted in neglect of unpaid tasks. Intervention designs which involved frequent supervision and continuous training led to better CHW performance in certain settings. Supervision and training were often mentioned as facilitating factors, but few studies tested which approach worked best or how these were best implemented. Embedment of CHWs in community and health systems was found to diminish workload and increase CHW credibility. Clearly defined CHW roles and introduction of clear processes for communication among different levels of the health system could strengthen CHW performance. When designing community-based health programmes, factors that increased CHW performance in comparable settings should be taken into account. Additional intervention research to develop a better evidence base for the most effective training and supervision mechanisms and qualitative research to inform policymakers in development of CHW interventions are needed. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014.

Full-text (2 Sources)

Download
17 Downloads
Available from
May 21, 2014