The Johns Hopkins Bloomberg School of Public Health, MD, Baltimore, USA.
Makerere University School of Public Health, Kampala, Uganda.
Trials. 2023 Jun 23;24(1):428. doi: 10.1186/s13063-023-07426-6.
Uganda's community health worker (CHW), or village health team (VHT), program faces significant challenges with poor retention and insufficient financial and program investment. Adequate compensation comprising financial and non-financial components is critical to retaining any workforce, including CHWs. This study evaluates the impact of a recognition-based non-financial incentives package on the motivation, performance, and retention of VHTs, as well as on the utilization of health services by the community. The incentive package and intervention were developed in collaboration with the district-level leadership and award VHTs who have met predetermined performance thresholds with a certificate and a government-branded jacket in a public ceremony.
A two-armed cluster randomized controlled trial (RCT), conducted at the parish level in Uganda's Masindi District, will evaluate the effects of the 12-month intervention. The cluster-RCT will use a mixed-methods approach, which includes a baseline/endline VHT survey to assess the impact of the intervention on key outcomes, with an expected sample of 240 VHTs per study arm; our primary outcome is the total number of household visits per VHT and our multiple secondary outcomes include other performance indicators, motivation, and retention; VHT performance and retention data will be validated using monthly phone surveys tracking key performance indicators and through abstraction of VHT-submitted health facility reports; and focus group discussions will be conducted with VHTs and community members to understand how the intervention was received. Data collection activities will be administered in local languages. To assess the impact of the intervention, the study will conduct a regression analysis using Generalized Estimating Equations adjusting for cluster effect. Further, a difference-in-differences analysis will be conducted.
This study utilized a cluster-RCT design to assess the impact of a recognition-based incentives intervention on the motivation, performance, and retention of VHTs in Uganda's Masindi District. Utilizing a mixed-methods approach, the study will provide insights on the effectiveness and limitations of the intervention, VHT perspectives on perceived value, and critical insights on how non-financial incentives might support the strengthening of the community health workforce.
ClinicalTrials.gov NCT05176106. Retrospectively registered on 4 January 2022.
乌干达的社区卫生工作者（CHW）或村级卫生小组（VHT）计划面临着人员保留率低、财务和项目投资不足等重大挑战。充分的薪酬包括财务和非财务部分，对于留住任何劳动力，包括 CHW 都是至关重要的。本研究评估了基于认可的非财务激励方案对 VHT 的激励、绩效和保留率以及社区对卫生服务的利用的影响。该激励方案和干预措施是与地区一级的领导合作制定的，并为达到预定绩效门槛的 VHT 颁发证书和政府品牌的夹克，在公开仪式上予以奖励。
一项在乌干达马辛迪区的堂区一级进行的双臂群组随机对照试验（RCT）将评估该 12 个月干预措施的效果。群组 RCT 将采用混合方法，包括基线/终线 VHT 调查，以评估干预对关键结果的影响，每个研究臂预计有 240 名 VHT 参与；我们的主要结果是每名 VHT 的家访总数，我们的多个次要结果包括其他绩效指标、激励和保留率；VHT 的绩效和保留数据将通过每月跟踪关键绩效指标的电话调查和对 VHT 提交的卫生机构报告的摘录进行验证；并将与 VHT 和社区成员进行焦点小组讨论，以了解干预措施的接受情况。数据收集活动将用当地语言进行。为了评估干预措施的影响，研究将使用广义估计方程进行回归分析，调整群组效应。此外，还将进行差分分析。
本研究采用群组 RCT 设计，评估了乌干达马辛迪区基于认可的激励干预对 VHT 的激励、绩效和保留率的影响。该研究采用混合方法，将提供有关该干预措施的有效性和局限性、VHT 对感知价值的看法以及非财务激励措施如何支持加强社区卫生工作者队伍的重要见解。
ClinicalTrials.gov NCT05176106. 2022 年 1 月 4 日回顾性注册。
