Abstract
Abstract
Introduction
Uganda’s community health worker (CHW), or village health team (VHT), program faces significant challenges with poor retention and insufficient financial and program investment. Adequate compensation comprising financial and non-financial components is critical to retaining any workforce, including CHWs. This study evaluates the impact of a recognition-based non-financial incentives package on the motivation, performance, and retention of VHTs, as well as on the utilization of health services by the community. The incentive package and intervention were developed in collaboration with the district-level leadership and award VHTs who have met predetermined performance thresholds with a certificate and a government-branded jacket in a public ceremony.
Methods
A two-armed cluster randomized controlled trial (RCT), conducted at the parish level in Uganda’s Masindi District, will evaluate the effects of the 12-month intervention. The cluster-RCT will use a mixed-methods approach, which includes a baseline/endline VHT survey to assess the impact of the intervention on key outcomes, with an expected sample of 240 VHTs per study arm; our primary outcome is the total number of household visits per VHT and our multiple secondary outcomes include other performance indicators, motivation, and retention; VHT performance and retention data will be validated using monthly phone surveys tracking key performance indicators and through abstraction of VHT-submitted health facility reports; and focus group discussions will be conducted with VHTs and community members to understand how the intervention was received. Data collection activities will be administered in local languages. To assess the impact of the intervention, the study will conduct a regression analysis using Generalized Estimating Equations adjusting for cluster effect. Further, a difference-in-differences analysis will be conducted.
Discussion
This study utilized a cluster-RCT design to assess the impact of a recognition-based incentives intervention on the motivation, performance, and retention of VHTs in Uganda’s Masindi District. Utilizing a mixed-methods approach, the study will provide insights on the effectiveness and limitations of the intervention, VHT perspectives on perceived value, and critical insights on how non-financial incentives might support the strengthening of the community health workforce.
Trial registration
ClinicalTrials.gov NCT05176106. Retrospectively registered on 4 January 2022.
Funder
Alliance for a Healthier World, Johns Hopkins University
Publisher
Springer Science and Business Media LLC
Subject
Pharmacology (medical),Medicine (miscellaneous)
Reference28 articles.
1. Dowhaniuk N. Exploring country-wide equitable government health care facility access in Uganda. Int J Equity Health. 2021;20(1):38.
2. Republic of Uganda, Ministry of Health. Village Health Team Strategy and Operational Guidelines. Republic of Uganda, Ministry of Health. Available from: http://library.health.go.ug/publications/health-education/village-health-team-strategy-and-operational-guidelines. Cited 2021 Mar 18.
3. Mays DC, O’Neil EJ, Mworozi EA, Lough BJ, Tabb ZJ, Whitlock AE, et al. Supporting and retaining Village Health Teams: an assessment of a community health worker program in two Ugandan districts. Int J Equity Health. 2017;16(1):129.
4. Kayemba C, Sengendo H, Ssekitooleko J, Kerber K, Kallander K, Waiswa P, et al. Introduction of newborn care within integrated community case management in Uganda. Am J Trop Med Hyg. 2012;87(Issue 5_Suppl):46–53.
5. Brenner J, Kabakyenga J, Kyomuhangi T, Wotton K, Pim C, Ntaro M, et al. Can volunteer community health workers decrease child morbidity and mortality in southwestern Uganda? An impact evaluation. PLoS One. 2011;6(12):e27997–e27997.