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Evaluating the effect of innovative motivation and supervision approaches on community health worker performance and retention in Uganda and Mozambique: study protocol for a randomised controlled…

Overview of attention for article published in Trials, April 2015
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Title
Evaluating the effect of innovative motivation and supervision approaches on community health worker performance and retention in Uganda and Mozambique: study protocol for a randomised controlled trial
Published in
Trials, April 2015
DOI 10.1186/s13063-015-0657-6
Pubmed ID
Authors

Karin Källander, Daniel Strachan, Seyi Soremekun, Zelee Hill, Raghu Lingam, James Tibenderana, Frida Kasteng, Anna Vassall, Sylvia Meek, Betty Kirkwood

Abstract

If trained, equipped and utilised, community health workers (CHWs) delivering integrated community case management for sick children can potentially reduce child deaths by 60%. However, it is essential to maintain CHW motivation and performance. The inSCALE project aims to evaluate, using a cluster randomised controlled trial, the effect of interventions to increase CHW supervision and performance on the coverage of appropriate treatment for children with diarrhoea, pneumonia and malaria. Participatory methods were used to identify best practices and innovative solutions. Quantitative community based baseline surveys were conducted to allow restricted randomisation of clusters into intervention and control arms. Individual informed consent was obtained from all respondents. Following formative research and stakeholder consultations, two intervention packages were developed in Uganda and one in Mozambique. In Uganda, approximately 3,500 CHWs in 39 clusters were randomised into a mobile health (mHealth) arm, a participatory community engagement arm and a control arm. In Mozambique, 275 CHWs in 12 clusters were randomised into a mHealth arm and a control arm. The mHealth interventions encompass three components: 1) free phone communication between users; 2) data submission using phones with automated feedback, messages to supervisors for targeted supervision, and online data access for district statisticians; and 3) motivational messages. The community engagement arm in Uganda established village health clubs seeking to 1) improve the status and standing of CHWs, 2) increase demand for health services and 3) communicate that CHWs' work is important. Process evaluation was conducted after 10 months and end-line surveys will establish impact after 12 months in Uganda and 18 months in Mozambique. Main outcomes include proportion of sick children appropriately treated, CHW performance and motivation, and cost effectiveness of interventions. Study strengths include a user-centred design to the innovations, while weaknesses include the lack of a robust measurement of coverage of appropriate treatment. Evidence of cost-effective innovations that increase motivation and performance of CHWs can potentially increase sustainable coverage of iCCM at scale. (identifier NCT01972321 ) on 22 April 22 2013.

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Geographical breakdown

Country Count As %
United Kingdom 2 <1%
Tanzania, United Republic of 1 <1%
Netherlands 1 <1%
Mozambique 1 <1%
South Africa 1 <1%
Spain 1 <1%
Unknown 443 98%

Demographic breakdown

Readers by professional status Count As %
Student > Master 86 19%
Researcher 61 14%
Student > Ph. D. Student 49 11%
Student > Bachelor 49 11%
Student > Postgraduate 29 6%
Other 80 18%
Unknown 96 21%
Readers by discipline Count As %
Medicine and Dentistry 119 26%
Social Sciences 55 12%
Nursing and Health Professions 54 12%
Psychology 20 4%
Agricultural and Biological Sciences 12 3%
Other 78 17%
Unknown 112 25%