Department of Health Policy and Management, School of Public Health, University of Zambia, P. O. Box 50110, Lusaka, Zambia.
Department of Environmental Health, School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia.
BMC Health Serv Res. 2020 Jul 2;20(1):612. doi: 10.1186/s12913-020-05458-1.
Community Health Workers (CHWs) are an important human resource in improving community malaria intervention coverages and success in reducing malaria incidence has been attributed to them. However, despite this attribution, malaria resurgence cases have been reported in various countries including Zambia. This study aims to evaluate the implementation fidelity of CHW roles in malaria prevention and control programs in Livingstone through performance and service quality assessment.
A mixed method concurrent cross-sectional study based on quantitative and qualitative approaches was used to evaluate performance and service quality of the CHW roles for selected catchments areas in Livingstone district. For the quantitative approach, (34) CHWs were interviewed and a community survey was also done with 464 community participants. For qualitative approach, two focused group discussions with CHWs and three key informant interviews from the CHW supervisors were done.
Overall implementation fidelity to the CHW roles was low with only 5(14.7%) of the CHWs having good performance and least good quality service while 29 (85.3%) performed poorly with substandard service. About 30% of house-holds reported having experienced malaria cases but CHWs had low coverage in testing with RDT (27%) for malaria index case service response with treatment at 14% coverage and provision of health education at 23%. For other households without malaria cases, only 27% had received malaria health education and 15% were screened for malaria. However, ITN distribution, sensitization for IRS were among other CHW services received by the community but were not documented in CHW registers for evaluation. Factors that shaped fidelity were being married, record for reports, supervision, and work experience as significant factors associated with performance. Lack of supplies, insufficient remuneration and lack of ownership by the supervising district were reported to hinder ideal implementation of the CHW strategy.
Fidelity to the malaria CHW roles was low as performance and quality of service was poor. A systems approach for malaria CHW facilitation considering supervision, stock supply and recruiting more CHWs on a more standardized level of recognition and remuneration would render an effective quality implementation of the CHW roles in malaria.
社区卫生工作者（CHWs）是改善社区疟疾干预覆盖率的重要人力资源，他们在降低疟疾发病率方面取得了成功。然而，尽管有这种归因，包括赞比亚在内的许多国家仍报告了疟疾死灰复燃的病例。本研究旨在通过绩效和服务质量评估，评估利文斯顿社区疟疾预防和控制项目中 CHW 角色的实施保真度。
采用基于定量和定性方法的混合方法同期横断面研究，评估利文斯顿区选定集水区的 CHW 角色的绩效和服务质量。对于定量方法，对 34 名 CHW 进行了访谈，并对 464 名社区参与者进行了社区调查。对于定性方法，对 CHW 进行了两次焦点小组讨论，并对 CHW 主管进行了三次关键人物访谈。
CHW 角色的总体实施保真度较低，只有 5（14.7%）名 CHW 表现良好，服务质量最差，而 29（85.3%）名表现不佳，服务质量不达标。约 30%的家庭报告曾经历过疟疾病例，但 CHW 进行疟疾检测的覆盖率较低，用于疟疾索引病例服务响应的 RDT（27%），治疗覆盖率为 14%，提供健康教育覆盖率为 23%。对于其他没有疟疾病例的家庭，只有 27%接受了疟疾健康教育，15%接受了疟疾筛查。然而，社区还获得了 ITN 分发、IRS 宣传等其他 CHW 服务，但这些服务并未在 CHW 登记册中记录以供评估。影响保真度的因素包括已婚、报告记录、监督和工作经验是与绩效相关的重要因素。缺乏供应品、薪酬不足以及监督地区缺乏所有权被报告为阻碍 CHW 战略理想实施的因素。
CHW 对疟疾角色的保真度较低，绩效和服务质量较差。考虑到监督、供应品以及以更标准化的认可和薪酬水平招募更多 CHW 的系统方法，将使疟疾 CHW 角色的有效质量实施成为可能。
