Factors related to retention of community health workers in a trial on community-based management of fever in children under 5 years in the Dangme West District of Ghana
Factors related to retention of community health workers in a trial on community-based management of fever in children under 5 years in the Dangme West District of Ghana
复制标题
DOI：
10.1093/inthealth/ihu007
复制
发表时间：
2014-06-01
影响因子：
2.5
通讯作者：
van den Borne, Bart
中科院分区：
文献类型：
--
作者：
Abbey, Mercy;Bartholomew, L. Kay;van den Borne, Bart
在资源有限的发展中国家，通过社区卫生工作者（CHW）促进以社区为基础的卫生干预措施是改善儿童健康的一项重要战略。然而，由于社区保健妇女的流失率很高，人们对这些方案的可持续性感到关切。本研究探讨了影响志愿者CHWs保留在加纳农村地区的5岁以下发烧社区管理的随机分组试验中的因素，数据来自结构化访谈（n=520）和焦点小组讨论（n=5）与CHWs。本研究以概率单位模式分析影响社区工作者去留的因素，并以焦点小组讨论的结果解释研究结果，社区工作者的流失率为21.2%。年轻组中的Attide相对较高（15-25岁组为25.9%，26-45岁组为18.2%，46岁组为16.5%）。社区（p < 0.001）和社区卫生工作者直系亲属（p < 0.05）对社区卫生工作者的认可对留在方案中的可能性有显著影响。保留的动机与服务社区的愿望以及人道主义和宗教原因有关，相对温和的自然减员率可归因于社区高度参与甄选过程以及其他方面的干预措施，导致社区高度认可和支持。对这些方面的关注有助于提高加纳社区卫生干预措施中CHW的保留率，这些经验教训可以应用于类似环境中的国家。
In resource-constrained settings of developing countries, promotion of community-based health interventions through community health workers (CHWs) is an important strategy to improve child health. However, there are concerns about the sustainability of such programmes owing to the high rate of CHW attrition. This study examined factors influencing retention of volunteer CHWs in a cluster randomised trial on community management of under-5 fever in a rural Ghanaian district.Data were obtained from structured interviews (n=520) and focus group discussions (n=5) with CHWs. Factors influencing CHWs' decisions to remain or leave the programme were analysed using a probit model, and focus group discussion results were used to elucidate the findings.The attrition rate among CHWs was 21.2%. Attrition was comparatively higher in younger age groups (25.9% in 15-25 years group, 18.2% in 26-45 years group and 16.5% in a parts per thousand yen46 years group). Approval of a CHW by the community (p < 0.001) and the CHW's immediate family (p < 0.05) were significant in influencing the probability of remaining in the programme. Motivation for retention was related to the desire to serve their communities as well as humanitarian and religious reasons.The relatively moderate rate of attrition could be attributed to the high level of community involvement in the selection process as well as other aspects of the intervention leading to high community approval and support. Attention for these aspects could help improve CHW retention in community-based health interventions in Ghana, and the lessons could be applied to countries within similar settings.