Factors affecting community health worker’s services delivery in Okwerodot Subcounty, Kole District, Uganda

Abstract

Background: Community Health Workers (CHWs) in Uganda have a vital role in improving access to essential healthcare services and expanding their coverage. Their efforts have significantly contributed to reducing the prevalence of malaria and diarrheal diseases, particularly among children under the age of five. Despite their valuable contributions, the factors influencing the effectiveness of CHWs in Okwerodot Sub-County, Kole District remain unknown. Objective: The objective of the study was to determine factors affecting Community Health Workers (CHWs) in delivering health services in Okwerodot Sub County, Kole district. Method: A descriptive cross-sectional study was conducted to collect quantitative data, involving 176 Community Health Workers (CHWs) in Okwerodot Sub County, Kole District. A simple random sampling was used to determine respondents before data collection. The questionnaire was pretested with CHWs in Aduku Sub County, Kwania District. The selected CHWs were then interviewed using the pretested questionnaire, with the assistance of a trained research assistant, using Kobo-collect tool. Additionally, qualitative data were collected from the District Health Office, District Senior Health Educator, Health Inspector and Health Assistant through key informant interviews with the aid of a voice recorder. Quantitative data was exported to Stata version 15 for descriptive analysis. The results were presented using frequency tables and graphs. On the other hand, the qualitative data was transcribed verbatim and analyzed thematically. Results: Among the 173 Community Health Workers (CHWs) surveyed, the average age was 43.63 years (SD 10.79). The majority of the CHWs were male, 107 (61.9%), married 163 CHWs (94.2%). Most CHWs had only completed primary-level education, 108 (62.4%). Additionally, a significant number of CHWs had been working as CHWs for more than three years, 192 (93.6%). Family members were the primary source of support for the CHWs, 171 (98.8%). Friends also played a significant role, providing support to 142 (82.1%) CHWs. The majority of the CHWs expressed being appreciated and reported receiving contributions from community members, 162 (93.6%) and 159 (91.9%), respectively. However, the CHWs highlighted limited institutional support in terms of acquiring useful skills, 99 (57.2%). Additionally, 96 CHWs (55.5%) reported a lack of supervision and peer-to-peer support. This is in agreement with qualitative findings which revealed that, “the exit of UNICEF from the district in 2019, paralyzed activities that included; refresher trainings, support supervision and peer-to-peer support that was aimed at strengthening CHWs” ……Health Worker 1 Conclusion: The results reveal challenges related to limited institutional support. CHWs reported a lack of support in terms of learning useful skills, supervision, and peer-to-peer support. The findings suggest the need for interventions to enhance institutional support for CHWs, including training programs, improved supervision mechanisms, and the establishment of peer support networks. Strengthening these areas can contribute to the overall effectiveness and success of CHWs in Okwerodot Sub-County, Kole District, Uganda.