Village Health Team Functionality in Uganda: Implications for Community System Effectiveness

Babughirana Geoffrey; Muhirwe Barungi Lorna; Kimurahebwe Clare

doi:doi:10.11648/j.sjph.20160402.16

| Peer-Reviewed

Village Health Team Functionality in Uganda: Implications for Community System Effectiveness

Babughirana Geoffrey, Muhirwe Barungi Lorna, Kimurahebwe Clare

Published in Science Journal of Public Health (Volume 4, Issue 2)

Received: 28 February 2016 Accepted: 9 March 2016 Published: 22 March 2016

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Community health workers have long been recognized as a critical cadre for the timely delivery of basic primary health care packages in low resource settings. In most countries, community health workers are semi-skilled workers who receive in-service training without structured curricula, mentorship approaches and clear opportunities for career advancement which affects their functionality. Several other external issues may affect community health worker functionality including availability of equipment and supplies, community involvement, country ownership and health system performance. Assessment of village health team (VHT) functionality was conducted in 24 districts in Uganda and involved 2369 village health workers. The study utilized guided self-assessments and participatory performance improvement processes based on the Community Health Worker Assessment and Improvement Matrix (CHWAIM) toolkit. Functionality assessment focused on 15 programmatic components regarded as essential for effective CHW programs. Data collection and functionality scoring was done at district level with the involvement of district leaders and VHTs themselves. Data from study districts was pooled into one national data set and aggregated to provide an aggregate representation of the national VHT functionality situation in Uganda. VHT functionality is affected by various programmatic components interacting at various levels. Our findings indicate that the four operational regions of the country are at different levels of VHT functionality with Karamoja region having the highest functionality level (52%) and Central region having the lowest functionality (38%). At an aggregate level, the national VHT functionality stood at 46%. In all the regions; supervision, individual performance evaluation and referral linkages registered a functionality score of 1 or 0 indicating either partial or non-functionality. This was the same finding for reporting and availability of equipment and supplies which obtained a score of 1 in all the regions except Karamoja. Overall program evaluation and country ownership scores were both 1 which has implications for achieving optimum VHT functionality levels in Uganda. As Uganda looks towards re-engineering its health system to meet the sustainable development goals, sufficient attention must be paid to strategies that support routine monitoring of the functionality of village health teams for overall program excellence.

Published in	Science Journal of Public Health (Volume 4, Issue 2)
DOI	10.11648/j.sjph.20160402.16
Page(s)	117-126
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2016. Published by Science Publishing Group

Keywords

Community Health Worker, Village Health Team, Functionality, Uganda

References

[1]	Sachs, J & Singh, P (2013). 1 million community health workers in Africa by 2015. http://dx.doi.org/10.1016/S0140-6736(12)62002-9.
[2]	Bhutta ZA, Lassi ZS, Pariyo G, Huicho L. Global experience of community health workers for delivery of health related millennium development goals: a systematic review, country case studies, and recommendations for integration into national health systems. http://www.who.int/workforcealliance/knowledge/publications/CHW_FullReport_2010.pdf
[3]	Lewin S, Munabi-Babiqumira S, Glenton C, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases (review). Cochrane Database Syst Rev 2010. 3: CD004015.
[4]	Lehmann U, Sanders D, for WHO. Community health workers: what do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. http://www.who.int/hrh/documents/community_health_workers.
[5]	Bhutta ZA, Darmstadt GL Hasan BS, Haws RA. Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: A review of the evidence. Peadiatrics 2005: 115(Suppl): 519–617, PMID: 15866863.
[6]	USAID Healthcare Improvement Project; 2010. Community Health Worker Programs: A Review of Recent Literature. www.hciproject.org
[7]	WHO (1989). Strengthening the performance of community health workers in primary health care. Report of a WHO Study Group. Geneva, World Health Organization WHO Technical Report Series No 780.
[8]	Ministry of Health Uganda; VHT A Handbook to improve health in communities; 2009. https://www.k4health.org/sites/default/files/VHT%20BOOK.pdf
[9]	Draft National VHT assessment report, Ministry of Health Uganda 2014.
[10]	Naimoli JF, Frymus DE, Wuliji T, Franco LM and Newsome MH. A Community Health Worker “logic model”: towards a theory of enhanced performance in low- and middle-income countries. Human Resources for Health 2014, 12:56 Http://www.human-resources-health.com/content/12/1/56
[11]	Gilson L, Walt G, Heggenhougen K, Owuor-Omondi L, Perera M, Ross D, and Salazar L. 1989. 11 USAID Health Care Improvement Project. National Community Health Worker Programs: How Can They Be Strengthened? Journal of Public Health Policy 10(4): 518-532.
[12]	Brunie A, Wamala-Mucheri P, Otterness C, Akol A, Chen M, Bufumbo L, et al. Keeping community health workers in Uganda motivated: key challenges, facilitators, and preferred program inputs. Glob Health Sci Pract. 2014; 2(1): 103-116. http://dx.doi.org/10.9745/GHSP-D-13-00140.
[13]	Battacharyya K, Winch P, LeBan K, Tien M. Community Health Worker Incentives and Disencentives: How They Affect Motivation, Retention and Sustainability. Arlington, VA: Basic Support for Institutionalizing Child Survival Project (BASICS II) for the United States Agency for International Development; 2001.
[14]	Robinson SA, Larsen DE. The relative influence of the community and the health system on work performance: a case study of community health workers in Colombia. Soc Sci Med. 1990; 30(10): 1041-8.
[15]	Stekelenburg J, Kyanamina SS, Wolffers I. Poor performance of community health workers in Kalabo District, Zambia. Health Policy. 2003; 65(2): 109-18.
[16]	Berman P, Franco L. Formal Health System Support Activities and Community Health Worker Performance. Global Health Evidence Summit: Community and Formal Health System Support for Enhanced Community Health Worker Performance. Washington, DC; 2012.
[17]	Perry H, Townsend J. Community Support Activities and Community Health Worker Performance. Global Health Evidence Summit: Community and Formal Health System Support for Enhanced Community Health Worker Performance. Washington, DC; 2012.
[18]	Frehywot S, Wuliji T. Community and Formal Health System Support Activities and Their Impact on Community Health Worker Performance. Global Health Evidence Summit: Community and Formal Health System Support for Enhanced Community Health Worker Performance. Washington, DC; 2012.
[19]	USAID. Global Health Evidence Summit: Community and Formal Health System Support for Enhanced Community Health Worker Performance. 2012 [cited 17 July 2012]; Available from: http://www.who.int/workforcealliance/media/events/2012/Community_Health_Worker_Evidence_Summit_Concept_Note.pdf
[20]	Gilson L, Walt G, Heggenhougen K, Owuor-Omondi L, Perera M, Ross D, et al. National community health worker programs: how can they be strengthened? J Public Health Policy. 1989; 10(4): 518-32.
[21]	Crigler L, Hill K, Furth R, Bjerregaard D., Community Health Worker Assessment and Improvement Matrix (CHW AIM): A Toolkit for Improving Community Health Worker Programs and Services. (2011), http://www.who.int/workforcealliance/knowledge/toolkit/50.pdf

Cite This Article

Plain Text BibTeX RIS

APA Style

Babughirana Geoffrey, Muhirwe Barungi Lorna, Kimurahebwe Clare. (2016). Village Health Team Functionality in Uganda: Implications for Community System Effectiveness. Science Journal of Public Health, 4(2), 117-126. https://doi.org/10.11648/j.sjph.20160402.16

Copy | Download

ACS Style

Babughirana Geoffrey; Muhirwe Barungi Lorna; Kimurahebwe Clare. Village Health Team Functionality in Uganda: Implications for Community System Effectiveness. Sci. J. Public Health 2016, 4(2), 117-126. doi: 10.11648/j.sjph.20160402.16

Copy | Download

AMA Style

Babughirana Geoffrey, Muhirwe Barungi Lorna, Kimurahebwe Clare. Village Health Team Functionality in Uganda: Implications for Community System Effectiveness. Sci J Public Health. 2016;4(2):117-126. doi: 10.11648/j.sjph.20160402.16

Copy | Download

@article{10.11648/j.sjph.20160402.16,
  author = {Babughirana Geoffrey and Muhirwe Barungi Lorna and Kimurahebwe Clare},
  title = {Village Health Team Functionality in Uganda: Implications for Community System Effectiveness},
  journal = {Science Journal of Public Health},
  volume = {4},
  number = {2},
  pages = {117-126},
  doi = {10.11648/j.sjph.20160402.16},
  url = {https://doi.org/10.11648/j.sjph.20160402.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjph.20160402.16},
  abstract = {Community health workers have long been recognized as a critical cadre for the timely delivery of basic primary health care packages in low resource settings. In most countries, community health workers are semi-skilled workers who receive in-service training without structured curricula, mentorship approaches and clear opportunities for career advancement which affects their functionality. Several other external issues may affect community health worker functionality including availability of equipment and supplies, community involvement, country ownership and health system performance. Assessment of village health team (VHT) functionality was conducted in 24 districts in Uganda and involved 2369 village health workers. The study utilized guided self-assessments and participatory performance improvement processes based on the Community Health Worker Assessment and Improvement Matrix (CHWAIM) toolkit. Functionality assessment focused on 15 programmatic components regarded as essential for effective CHW programs. Data collection and functionality scoring was done at district level with the involvement of district leaders and VHTs themselves. Data from study districts was pooled into one national data set and aggregated to provide an aggregate representation of the national VHT functionality situation in Uganda. VHT functionality is affected by various programmatic components interacting at various levels. Our findings indicate that the four operational regions of the country are at different levels of VHT functionality with Karamoja region having the highest functionality level (52%) and Central region having the lowest functionality (38%). At an aggregate level, the national VHT functionality stood at 46%. In all the regions; supervision, individual performance evaluation and referral linkages registered a functionality score of 1 or 0 indicating either partial or non-functionality. This was the same finding for reporting and availability of equipment and supplies which obtained a score of 1 in all the regions except Karamoja. Overall program evaluation and country ownership scores were both 1 which has implications for achieving optimum VHT functionality levels in Uganda. As Uganda looks towards re-engineering its health system to meet the sustainable development goals, sufficient attention must be paid to strategies that support routine monitoring of the functionality of village health teams for overall program excellence.},
 year = {2016}
}

Copy | Download

TY  - JOUR
T1  - Village Health Team Functionality in Uganda: Implications for Community System Effectiveness
AU  - Babughirana Geoffrey
AU  - Muhirwe Barungi Lorna
AU  - Kimurahebwe Clare
Y1  - 2016/03/22
PY  - 2016
N1  - https://doi.org/10.11648/j.sjph.20160402.16
DO  - 10.11648/j.sjph.20160402.16
T2  - Science Journal of Public Health
JF  - Science Journal of Public Health
JO  - Science Journal of Public Health
SP  - 117
EP  - 126
PB  - Science Publishing Group
SN  - 2328-7950
UR  - https://doi.org/10.11648/j.sjph.20160402.16
AB  - Community health workers have long been recognized as a critical cadre for the timely delivery of basic primary health care packages in low resource settings. In most countries, community health workers are semi-skilled workers who receive in-service training without structured curricula, mentorship approaches and clear opportunities for career advancement which affects their functionality. Several other external issues may affect community health worker functionality including availability of equipment and supplies, community involvement, country ownership and health system performance. Assessment of village health team (VHT) functionality was conducted in 24 districts in Uganda and involved 2369 village health workers. The study utilized guided self-assessments and participatory performance improvement processes based on the Community Health Worker Assessment and Improvement Matrix (CHWAIM) toolkit. Functionality assessment focused on 15 programmatic components regarded as essential for effective CHW programs. Data collection and functionality scoring was done at district level with the involvement of district leaders and VHTs themselves. Data from study districts was pooled into one national data set and aggregated to provide an aggregate representation of the national VHT functionality situation in Uganda. VHT functionality is affected by various programmatic components interacting at various levels. Our findings indicate that the four operational regions of the country are at different levels of VHT functionality with Karamoja region having the highest functionality level (52%) and Central region having the lowest functionality (38%). At an aggregate level, the national VHT functionality stood at 46%. In all the regions; supervision, individual performance evaluation and referral linkages registered a functionality score of 1 or 0 indicating either partial or non-functionality. This was the same finding for reporting and availability of equipment and supplies which obtained a score of 1 in all the regions except Karamoja. Overall program evaluation and country ownership scores were both 1 which has implications for achieving optimum VHT functionality levels in Uganda. As Uganda looks towards re-engineering its health system to meet the sustainable development goals, sufficient attention must be paid to strategies that support routine monitoring of the functionality of village health teams for overall program excellence.
VL  - 4
IS  - 2
ER  -

Copy | Download

Author Information

Babughirana Geoffrey

World Vision, Kampala, Uganda
Muhirwe Barungi Lorna

World Vision, Kampala, Uganda
Kimurahebwe Clare

Independent Consultant, Kampala, Uganda

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Babughirana Geoffrey, Muhirwe Barungi Lorna, Kimurahebwe Clare. (2016). Village Health Team Functionality in Uganda: Implications for Community System Effectiveness. Science Journal of Public Health, 4(2), 117-126. https://doi.org/10.11648/j.sjph.20160402.16

Copy | Download

ACS Style

Babughirana Geoffrey; Muhirwe Barungi Lorna; Kimurahebwe Clare. Village Health Team Functionality in Uganda: Implications for Community System Effectiveness. Sci. J. Public Health 2016, 4(2), 117-126. doi: 10.11648/j.sjph.20160402.16

Copy | Download

AMA Style

Babughirana Geoffrey, Muhirwe Barungi Lorna, Kimurahebwe Clare. Village Health Team Functionality in Uganda: Implications for Community System Effectiveness. Sci J Public Health. 2016;4(2):117-126. doi: 10.11648/j.sjph.20160402.16

Copy | Download

@article{10.11648/j.sjph.20160402.16,
  author = {Babughirana Geoffrey and Muhirwe Barungi Lorna and Kimurahebwe Clare},
  title = {Village Health Team Functionality in Uganda: Implications for Community System Effectiveness},
  journal = {Science Journal of Public Health},
  volume = {4},
  number = {2},
  pages = {117-126},
  doi = {10.11648/j.sjph.20160402.16},
  url = {https://doi.org/10.11648/j.sjph.20160402.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjph.20160402.16},
  abstract = {Community health workers have long been recognized as a critical cadre for the timely delivery of basic primary health care packages in low resource settings. In most countries, community health workers are semi-skilled workers who receive in-service training without structured curricula, mentorship approaches and clear opportunities for career advancement which affects their functionality. Several other external issues may affect community health worker functionality including availability of equipment and supplies, community involvement, country ownership and health system performance. Assessment of village health team (VHT) functionality was conducted in 24 districts in Uganda and involved 2369 village health workers. The study utilized guided self-assessments and participatory performance improvement processes based on the Community Health Worker Assessment and Improvement Matrix (CHWAIM) toolkit. Functionality assessment focused on 15 programmatic components regarded as essential for effective CHW programs. Data collection and functionality scoring was done at district level with the involvement of district leaders and VHTs themselves. Data from study districts was pooled into one national data set and aggregated to provide an aggregate representation of the national VHT functionality situation in Uganda. VHT functionality is affected by various programmatic components interacting at various levels. Our findings indicate that the four operational regions of the country are at different levels of VHT functionality with Karamoja region having the highest functionality level (52%) and Central region having the lowest functionality (38%). At an aggregate level, the national VHT functionality stood at 46%. In all the regions; supervision, individual performance evaluation and referral linkages registered a functionality score of 1 or 0 indicating either partial or non-functionality. This was the same finding for reporting and availability of equipment and supplies which obtained a score of 1 in all the regions except Karamoja. Overall program evaluation and country ownership scores were both 1 which has implications for achieving optimum VHT functionality levels in Uganda. As Uganda looks towards re-engineering its health system to meet the sustainable development goals, sufficient attention must be paid to strategies that support routine monitoring of the functionality of village health teams for overall program excellence.},
 year = {2016}
}

Copy | Download

TY  - JOUR
T1  - Village Health Team Functionality in Uganda: Implications for Community System Effectiveness
AU  - Babughirana Geoffrey
AU  - Muhirwe Barungi Lorna
AU  - Kimurahebwe Clare
Y1  - 2016/03/22
PY  - 2016
N1  - https://doi.org/10.11648/j.sjph.20160402.16
DO  - 10.11648/j.sjph.20160402.16
T2  - Science Journal of Public Health
JF  - Science Journal of Public Health
JO  - Science Journal of Public Health
SP  - 117
EP  - 126
PB  - Science Publishing Group
SN  - 2328-7950
UR  - https://doi.org/10.11648/j.sjph.20160402.16
AB  - Community health workers have long been recognized as a critical cadre for the timely delivery of basic primary health care packages in low resource settings. In most countries, community health workers are semi-skilled workers who receive in-service training without structured curricula, mentorship approaches and clear opportunities for career advancement which affects their functionality. Several other external issues may affect community health worker functionality including availability of equipment and supplies, community involvement, country ownership and health system performance. Assessment of village health team (VHT) functionality was conducted in 24 districts in Uganda and involved 2369 village health workers. The study utilized guided self-assessments and participatory performance improvement processes based on the Community Health Worker Assessment and Improvement Matrix (CHWAIM) toolkit. Functionality assessment focused on 15 programmatic components regarded as essential for effective CHW programs. Data collection and functionality scoring was done at district level with the involvement of district leaders and VHTs themselves. Data from study districts was pooled into one national data set and aggregated to provide an aggregate representation of the national VHT functionality situation in Uganda. VHT functionality is affected by various programmatic components interacting at various levels. Our findings indicate that the four operational regions of the country are at different levels of VHT functionality with Karamoja region having the highest functionality level (52%) and Central region having the lowest functionality (38%). At an aggregate level, the national VHT functionality stood at 46%. In all the regions; supervision, individual performance evaluation and referral linkages registered a functionality score of 1 or 0 indicating either partial or non-functionality. This was the same finding for reporting and availability of equipment and supplies which obtained a score of 1 in all the regions except Karamoja. Overall program evaluation and country ownership scores were both 1 which has implications for achieving optimum VHT functionality levels in Uganda. As Uganda looks towards re-engineering its health system to meet the sustainable development goals, sufficient attention must be paid to strategies that support routine monitoring of the functionality of village health teams for overall program excellence.
VL  - 4
IS  - 2
ER  -

Copy | Download