Factors affecting performance of community health workers implementing water, sanitation and hygiene activities in Kawempe Division, Kampala, Uganda

Abstract

Background Community Health Workers (CHWs) play an important role in the delivery of community based health services especially where access to health care facilities is difficult. Although substantial evidence on the performance of CHWs implementing various community based programs in Uganda exists, there is limited knowledge about the performance of CHWs implementing Water, Sanitation and Hygiene (WASH) activities. The objective of this study was to assess factors affecting performance of CHWs implementing WASH activities in Kawempe Division, Kampala Capital City Authority (KCCA). Methodology This was a cross sectional study that used mixed methods. The study population was made up of CHWs implementing WASH activities in Kawempe Division of KCCA. Face to face interviews were conducted among a total of 261 respondents. Two Focus Group Discussions among community members who had previously utilized services of CHWs; 6 Key Informant Interviews among health workers, local leaders and program officers of implementing NGOs; and 6 In-depth Interviews among selected CHWs were conducted. Univariate, bivariate and multivariate data analysis were done using STATA Version 12 to determine the performance of CHWs implementing WASH activities and the associated factors. Qualitative data was analyzed manually using the thematic approach. Results Overall, 39.5% of the CHWs implementing WASH activities were assessed as good performers. Good performance of CHWs was significantly associated with refresher training (APR=1.74, C.I=1.19-2.56, P value = 0.005) and frequency of supervision visits (APR=2.46, C.I=1.30-4.63, P value = 0.005). CHWs were perceived by community leaders, health workers and program officers to be useful in community mobilization, health education and awareness creation for WASH activities. Enablers for good performance included support from health workers and community leaders; and community recognition and appreciation while the barriers to good performance included uncooperative community members; political interference and lack of equipment to implement WASH activities. Conclusion and Recommendations Overall, the level of performance among CHWs implementing WASH activities in Kawempe Division was generally poor. Refresher trainings and supervision were positively associated with good performance. CHWs should be adequately motivated with refresher trainings; and frequent but quality supervision in order to improve their performance.