Kuule Yusufu, Dobson Andrew Eric, Woldeyohannes Desalegn, Zolfo Maria, Najjemba Robinah, Edwin Birungi Mutahunga R, Haven Nahabwe, Verdonck Kristien, Owiti Philip, Wilkinson Ewan
Church of Uganda Bwindi Community Hospital, Kinkizi Diocese, Kanungu, Uganda.
Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
Front Public Health. 2017 Mar 29;5:62. doi: 10.3389/fpubh.2017.00062. eCollection 2017.
Community health volunteers (CHVs) play an integral role in primary healthcare. Several countries rely on CHV programs as a major element in improving access to care and attaining universal health coverage. However, their performance has been heterogeneous and at times context-specific, and influenced by multiple factors. We describe the socio-demographic and workplace characteristics affecting CHVs' performance in a public health program in rural western Uganda.
This was a cross-sectional study based on routine program data of CHVs serving the catchment of Bwindi Community Hospital, Kanungu District, South Western Uganda, in 2014 and 2015. Information was collected on individual socio-demographic and workplace characteristics of the CHVs. To assess their work output, we defined study-specific targets in terms of attendance at monthly CHVs' meetings with community health nurses, households followed-up and reported, children screened for malnutrition, immunization coverage, and health facility deliveries. Frequencies and proportions are reported for characteristics and outputs and odds ratios for study-specific factors associated with overall performance.
Of the 508 CHVs, 65% were women, 48% were aged 35 years and below, and 37% took care of more than the recommended 20-30 households. Seventy-eight percent of the CHVs had ≥80% of pregnant women under their care delivering in health units, 71% had ≥95% of the children on schedule for routine immunization, while 27% screened ≥75% of the children under 5 years for malnutrition. More refresher trainings was associated with better overall performance [adjusted odds ratio (aOR): 12.2, 95% confidence interval (CI): 1.6-93.6, = 0.02] while overseeing more than the recommended 20-30 households reduced overall performance (aOR: 0.6, 95% CI: 0.4-0.9, = 0.02).
Being in-charge of more than the recommended households was associated with reduced performance of CHVs, while more refresher trainings were associated with improved performance. If the CHVs are to remain a strategic pillar in universal health coverage, it is imperative to address those factors known to impact on their performance.
社区卫生志愿者在初级卫生保健中发挥着不可或缺的作用。一些国家将社区卫生志愿者项目作为改善医疗服务可及性和实现全民健康覆盖的主要要素。然而，他们的表现参差不齐，有时因具体情况而异，并受到多种因素的影响。我们描述了影响乌干达西部农村地区一个公共卫生项目中社区卫生志愿者表现的社会人口学和工作场所特征。
这是一项横断面研究，基于2014年和2015年在乌干达西南部卡农古区布温迪社区医院服务范围内的社区卫生志愿者的常规项目数据。收集了社区卫生志愿者的个人社会人口学和工作场所特征信息。为了评估他们的工作产出，我们根据参加每月与社区卫生护士的会议、随访和报告的家庭、筛查营养不良的儿童、免疫接种覆盖率以及医疗机构分娩情况等确定了特定研究目标。报告了特征和产出的频率及比例，以及与总体表现相关的特定研究因素的比值比。
在508名社区卫生志愿者中，65%为女性，48%年龄在35岁及以下，37%负责照顾超过推荐的20 - 30户家庭。78%的社区卫生志愿者所照顾的孕妇中有≥80%在卫生机构分娩，71%的社区卫生志愿者所负责的儿童中有≥95%按时进行常规免疫接种，而27%的社区卫生志愿者对≥75%的5岁以下儿童进行了营养不良筛查。更多的进修培训与更好的总体表现相关[调整后的比值比（aOR）：12.2，95%置信区间（CI）：1.6 - 93.6，P = 0.02]，而负责照顾超过推荐的20 - 30户家庭则降低了总体表现（aOR：0.6，95% CI：0.4 - 0.9，P = 0.02）。
负责照顾超过推荐数量的家庭与社区卫生志愿者表现下降相关，而更多的进修培训与表现改善相关。如果社区卫生志愿者要继续作为全民健康覆盖的战略支柱，必须解决那些已知会影响其表现的因素。
