Assessing performance of village health team (VHT) members in promoting maternal and neonatal health programmes in Soroti District Uganda
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Background: Maternal mortality is still unacceptably high in Uganda at 438 per 100,000 live births (UDHS 2011).Uganda adopted the Village Health Teams (VHTs) strategy in 2001 as a bridge in health service delivery between communities and health facilities. This study sought to assess the performance of VHT members in promoting maternal and neonatal health programmes in Soroti district and factors affecting this performance to guide strategies towards strengthening their work. This was prompted by the lack of adequate information regarding VHTs performance in supporting the promotion of maternal and neonatal health programmes in Soroti District under the VHT national strategy. Methodology: This was a cross-sectional study conducted between April and June 2015 among 384 VHT members supporting maternal and neonatal health programmes in Soroti district. Only VHTs who had worked for more than 6 months by the time of the study, supporting maternal and neonatal health programmes were considered to participate in this study. Performance of VHTs was assessed using composite scores based on the nine core MNH activities supported by VHTs as stated in the MoH VHT national strategy. These included; registration of pregnant women in their villages, preparing pregnant women for delivery, encouraging women to attend all the four ANC visits, support deliveries at the HC, support outreach for tetanus immunization for IPT2, home visiting for new born babies, conducting community sensitization meetings on MNH, promoting use of ITN or LLIN and referral of mothers for routine postnatal care. Four focus group discussions and four Key Informant Interviews were conducted and qualitative data was analyzed with thematic content analysis. Performance in this study was classified as good when a VHT member scored 75% and above and poor performance when the score was below 75%. Descriptive and inferential statistics using odds ratios were done to determine association between community and health systems factors with VHTs performance in supporting MNH programmes in Soroti district. 2 Results: Out of the 384 respondents, 243 were males (63.3%). Overall good performance was 11.2% (n= 43, 95% CI = 8.03-14.37%). Factors significantly associated with good performance included; Frequency of supervision (OR = 0.22, 95% CI = 0.07-0.68) and the employment status (being a peasant) (OR = 0.62, 95% CI = 0.62- 2.79). Conclusion: The performance of VHTs was poor, only 1 in every 9 VHTs interviewed, performed optimally as per VHTs MNH core functions. Recommendations: The frequency of support supervision to VHTs needs to be increased so as to improve their performance. During the selection process of VHTs by community members, people who have time to work such as peasants should be highly considered since it was associated with good performance.