Assessment of the performance and its determinants of community health workers who use digital methods in Kyaka II Refugee Settlement, Kyegegwa District, Western Uganda

Abstract

Background: Community Health Workers (CHWs) often provide healthcare in under-served communities, including refugee settlements, however, various challenges hinder their performance. Both digital and paper-based methods have been adopted to improve their performance. We assessed the performance and associated factors with the use of digital and paper-based methods by CHWs in the Kyaka II refugee settlement. Methods: This was a cross-sectional study. Quantitative and qualitative methods of data collection were used. Data was collected from the implementing partners and health facility databases, from a total of 300 CHWs. Nine focus group discussions (FGDs) with the CHWs and community members, two In-depth (IDIs) with CHW leaders and eight key informant interviews (KIIs) with six implementing partners and two local leaders were conducted. The qualitative data were analysed thematically using Atlas. Ti.9 software while the quantitative data were analysed at the univariate, bivariate and multivariable levels using Stata.14 software. Results: The study found that the performance of CHWs was sub-optimal (17%). The factors that significantly influenced CHW performance included education level: secondary and above (APR: 1.83, 95% CI: 1.02-3.30), having another occupation (APR: 2.02, 95%CI: 1.16- 3.52) and mHealth use (APR: 0.06, 95%CI: 0.02-.0.30). Other key factors that influence performance included the number of households assigned to CHWs, personal conviction and devotion, monetary incentives, community and family support and discrimination based on nationality and ethnicity. However, most stakeholders preferred using mHealth, while digital payments were unpopular. Conclusion and recommendations: The performance of CHWs in the refugee settlement was sub-optimal. The main factors that influence performance include the level of education, use of mHealth, having another occupation, workload, incentivisation, CHWs’ devotion, and coordination of the CHW program. Implementing partners should work collaboratively to improve refugee settlement context-specific working conditions for the CHWs and adopt digital methods toward improved CHW performance.