Five-year retention of volunteer community health workers in rural Uganda: a population-based retrospective cohort.

Autor:	Hobbs AJ, Manalili K; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW., Calgary, AB T2N 4Z6, Canada., Turyakira E; Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda., Kabakyenga J; Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda., Kyomuhangi T; Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda., Nettel-Aguirre A; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW., Calgary, AB T2N 4Z6, Canada.; Centre for Health and Social Analytics, National Institute for Applied Statistics Research Australia, University of Wollongong, NSW 2522, NIASRA Administration Office, Room 263, Level 2, Building 39C, Australia., Kyokushaba C; Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda., Rwandekeye P; Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda., Brenner JL; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW., Calgary, AB T2N 4Z6, Canada.; Department of Paediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW., Calgary, AB T3B 6A8, Canada.
Jazyk:	angličtina
Zdroj:	Health policy and planning [Health Policy Plan] 2022 Apr 12; Vol. 37 (4), pp. 483-491.
DOI:	10.1093/heapol/czab151
Abstrakt:	Community health workers (CHWs) effectively improve maternal, newborn and child health (MNCH) outcomes in low-to-middle-income countries. However, CHW retention remains a challenge. This retrospective registry analysis evaluated medium-term retention of volunteer CHWs in two rural Ugandan districts, trained during a district-wide MNCH initiative. From 2012 to 2014, the Healthy Child Uganda partnership facilitated district-led CHW programme scale-up. CHW retention was tracked prospectively from the start of the intervention up to 2 years. Additional follow-up occurred at 5 years to confirm retention status. Database analysis assessed CHW demographic characteristics, retention rates and exit reasons 5 years post-intervention. A multivariable logistic regression model examined 5-year retention-associated characteristics. Of the original cohort of 2317 CHWs, 70% were female. The mean age was 38.8 years (standard deviation, SD: 10.0). Sixty months (5 years) after the start of the intervention, 84% of CHWs remained active. Of those exiting (n = 377), 63% reported a 'logistical' reason, such as relocation (n = 96), new job (n = 51) or death (n = 30). Sex [male, female; odds ratio (OR) = 1.53; 95% confidence interval (CI): 1 · 20-1 · 96] and age group (<25 years, 30-59; OR = 0.40; 95% CI: 0.25-0.62) were significantly associated with 5-year retention in multivariable modelling. Education completion (secondary school, primary) was not significantly associated with retention in adjusted analyses. CHWs in this relatively large cohort, trained and supervised within a national CHW programme and district-wide MNCH initiative, were retained over the medium term. Importantly, high 5-year retention in this intervention counters findings from other studies suggesting low retention in government-led and volunteer CHW programmes. Encouragingly, findings from our study suggest that retention was high, not significantly associated with timing of external partner support and largely not attributed to the CHW role i.e. workload and programme factors. Our study showcases the potential for sustainable volunteer CHW programming at scale and can inform planners and policymakers considering programme design, including selection and replacement planning for CHW networks. (© The Author(s) 2021. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)
Databáze:	MEDLINE
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