Factors affecting performance of village health team members implementing the integrated community case management program in Wakiso District, Uganda.

Abstract

Background: Optimal performance of Village Health Team (VHT) members implementing community based interventions is desired if a reduction in childhood morbidity and mortality is to be achieved. Little documentation existed regarding the performance of VHT members who are involved in the management of malaria, pneumonia and diarrhea in Wakiso district under the Integrated Community Case Management (ICCM) policy. We assessed the performance of VHT members implementing the ICCM program and the associated factors in Wakiso district.

Methods: We conducted a cross sectional study between March and June 2012 among 336 VHT members managing malaria, pneumonia and diarrhea in children under five years in Wakiso district. Only VHT members who had worked under the ICCM strategy for more than 6 months by the time of the study were included. Performance was assessed using mixed methods (interviews and record reviews) and composite scores based on the core activities of VHTs under the ICCM program were calculated. Core activities included: treating children under five years, referring severely sick children and newborns, home visiting, counseling caregivers on home care, recording keeping and community sensitization. We classified performance as good when a VHT member scored 75% and above and poor when the score was below 75%. Four focus group discussions with VHT members were conducted and data was analyzed manually for content. Descriptive and inferential statistics using odds ratios were done to determine factors influencing performance of VHT members under the ICCM policy.

Results: Out of 336 respondents, 242 (72%) were females and the overall level of good performance was 21.7% (n= 73, 95% CI = 17.3 – 26.1%). Factors significantly associated with good performance were; being female (AOR= 2.65, 95% CI=1.29 – 5.43), community support (AOR = 2.29, 95% CI= 1.27 – 4.14), receiving timely feedback from supervisors (AOR = 4.9, 95% CI = 2.52 – 9.27) and drug availability in the previous three months (AOR=2.99, 95% CI=1.64 – 5.42). Amoxicillin was the drug mostly out of stock 64.2% (147/229). Perceived motivators of performance were: financial incentives, bicycles, certificates, gumboots and T shirts.

Conclusion: Only one in every five VHT members performed optimally under the ICCM program in Wakiso district. Strategies to improve drug supply, community support and feedback provision from the formal health system are necessary to improve the performance of VHT members.