Mwanza Moses, Zulu Japhet, Topp Stephanie M, Musonda Patrick, Mutale Wilbroad, Chilengi Roma
Centre for Infectious Disease Research in Zambia, Plot No. 5032, Great North Road, P.O. Box 34681, Lusaka, Zambia.
University of Alabama at Birmingham, Birmingham, AL, USA.
BMC Health Serv Res. 2017 Apr 17;17(1):279. doi: 10.1186/s12913-017-2229-9.
The Better Health Outcomes through Mentoring and Assessment (BHOMA) project is a cluster randomized controlled trial aimed at reducing age-standardized mortality rates in three rural districts through involvement of Community Health Workers (CHWs), Traditional Birth Attendants (TBAs), and Neighborhood Health Committees (NHCs). CHWs conduct quarterly surveys on all households using a questionnaire that captures key health events occurring within their catchment population. In order to validate contact with households, we utilize the Lot Quality Assurance Sampling (LQAS) methodology. In this study, we report experiences of applying the LQAS approach to monitor performance of CHWs in Luangwa District.
Between April 2011 and December 2013, seven health facilities in Luangwa district were enrolled into the BHOMA project. The health facility catchment areas were divided into 33 geographic zones. Quality assurance was performed each quarter by randomly selecting zones representing about 90% of enrolled catchment areas from which 19 households per zone where also randomly identified. The surveys were conducted by CHW supervisors who had been trained on using the LQAS questionnaire. Information collected included household identity number (ID), whether the CHW visited the household, duration of the most recent visit, and what health information was discussed during the CHW visit. The threshold for success was set at 75% household outreach by CHWs in each zone.
There are 4,616 total households in the 33 zones. This yielded a target of 32,212 household visits by community health workers during the 7 survey rounds. Based on the set cutoff point for passing the surveys (at least 75% households confirmed as visited), only one team of CHWs at Luangwa high school failed to reach the target during round 1 of the surveys; all the teams otherwise registered successful visits in all the surveys.
We have employed the LQAS methodology for assurance that quarterly surveys were successfully done. This methodology proved helpful in identifying poorly performing CHWs and could be useful for evaluating CHW performance in other areas.
Identifier: NCT01942278 . Date of Registration: September 2013.
通过指导与评估改善健康结果（BHOMA）项目是一项整群随机对照试验，旨在通过社区卫生工作者（CHW）、传统接生员（TBA）和社区卫生委员会（NHC）的参与，降低三个农村地区的年龄标准化死亡率。社区卫生工作者每季度使用一份问卷对所有家庭进行调查，该问卷记录了其服务人群中发生的关键健康事件。为了验证与家庭的联系，我们采用了批质量保证抽样（LQAS）方法。在本研究中，我们报告了应用LQAS方法监测卢安瓜区社区卫生工作者绩效的经验。
2011年4月至2013年12月期间，卢安瓜区的七家卫生设施纳入了BHOMA项目。卫生设施的服务区域被划分为33个地理区域。每季度进行质量保证，随机选择代表约90%登记服务区域的区域，每个区域再随机确定19户家庭。调查由接受过LQAS问卷使用培训的社区卫生工作者监督员进行。收集的信息包括家庭身份号码（ID）、社区卫生工作者是否访问过该家庭、最近一次访问的持续时间以及在社区卫生工作者访问期间讨论了哪些健康信息。成功的阈值设定为每个区域的社区卫生工作者覆盖75%的家庭。
33个区域共有4616户家庭。这使得社区卫生工作者在7轮调查期间的家访目标为32212次。根据设定的通过调查的临界点（至少75%的家庭确认被访问），在第一轮调查中，只有卢安瓜高中的一组社区卫生工作者未达到目标；其他所有团队在所有调查中均登记了成功的访问。
我们采用了LQAS方法来确保季度调查成功完成。该方法被证明有助于识别表现不佳的社区卫生工作者，并且可能有助于评估其他地区社区卫生工作者的绩效。
标识符：NCT01942278。注册日期：2013年9月。
