Village health volunteers: key issues facing agencies in Malawi

BMJ Global Health

Since the Alma Ata Declaration in 1978, community health volunteers (CHVs) have been at the forefront, providing health services, especially to underserved communities, in low-income countries. However, consolidation of CHVs position within formal health systems has proved to be complex and continues to challenge countries, as they devise strategies to strengthen primary healthcare. Malawi’s community health strategy, launched in 2017, is a novel attempt to harmonise the multiple health service structures at the community level and strengthen service delivery through a team-based approach. The core community health team (CHT) consists of health surveillance assistants (HSAs), clinicians, environmental health officers and CHVs. This paper reviews Malawi’s strategy, with particular focus on the interface between HSAs, volunteers in community-based programmes and the community health team. Our analysis identified key challenges that may impede the strategy’s implementation: (1) inadequ...

Frontiers in Public Health, 2017

2007

Community participation in health has been an elusive concept since the days of the Alma Ata Declaration. Many faltering steps have been taken towards genuine community participation only to be retraced because the programmes were either ill-conceived or derailed by the loss of the spirit of voluntarism. In Yumbe District of north-western Uganda, Village Health Teams (VHT) have been established in line with the national strategy for community involvement in health. The Yumbe VHT programme has won an award for innovative support to strengthening decentralisation. This paper reviews aspects of the programme outlining its successes and challenges. Its success has been mainly due to integration of pre-existing volunteer cadres, intersectoral approach to the monitoring of the teams and involvement of the community in the selection of the top-up team members. Its challenges include the relatively young age of the majority of the volunteers and the likely loss of financial support for the ...

2018

Background: In many developing countries like Ghana, community volunteers assist in the provision of certain health services to rural and hard-to-reach communities. This study examined factors that influence the motivation and retention of community-based volunteers supporting with work on health-related activities at the community level in Ghana. Methods: Using a sequential mixed-method design, a cross-sectional survey was carried out among 205 selected community-based volunteers in Kintampo North Municipality (KNM) and Kintampo South District (KSD) of Ghana between December, 2014 and February, 2015. Qualitative interviews, including 12 in-depth interviews (IDIs) among health workers and community opinion leaders and 2 focus group discussion (FGD) sessions with volunteers were conducted. Results: Personal interest (32.7%) and community leaders' selection of volunteers (30.2%) were key initial reasons for volunteering. Monetary incentives such as allowance for extra duty (88.8%) and per diem (49.3%) and non-monetary incentives such as T-shirts/bags (45.4 %), food during training (52.7%), community recognition, social prestige and preferential treatment at health facilities were the facilitators of volunteers' retention. There was a weak evidence (P = .051) to suggest that per diem for their travels is a reason for volunteers' satisfaction. Conclusion: Community-based volunteers' motivation and retention were influenced by their personal interest in the form of recognition by community members and health workers, community leaders' selection and other non-monetary incentives. Volunteers were motivated by extra-duty allowance but not per diems paid for accommodation and feeding when they travel. Organizations that engage community volunteers are encouraged to strengthen the selection of volunteers in collaboration with community leaders, and to provide both non-monetary and monetary incentives to motivate volunteers. Implications for policy makers • Volunteer involving organizations should take note of monetary and non-monetary incentives among volunteers to help in their recruitment and retention. • Attention should be given to community leaders' selection of volunteers since it gives volunteers traditional authorization and also serve as an important motivation among them. • Healthcare managers and administrators should encourage the establishment of context-specific community incentive systems to motivate and retain volunteers. • There is the need for the Ministries of Health and health service managers to establish a general incentive package for volunteers in low resource settings to sustain their interest. Though the work is voluntary, volunteers work in relatively poor communities where the standard of living is relatively low. Incentives in the form of monthly honorarium (monetary) will motivate volunteers to give out their best to complement the health system. Implications for the public As part of addressing health workforce challenge particularly in developing countries community-based volunteers (CBVs) assist professional health workers to extend healthcare coverage and key health interventions to rural communities and some urban settings. The CBVs at our study site are no exception. However, our findings revealed that these volunteers do not receive salary for services rendered but volunteer to complement the staff strength of the local health system to improve on the health of their community. Understanding motivations of these volunteers is therefore important in order for healthcare managers and community/public to develop effective volunteer recruitment, motivation and retention strategies. Also community members/ public need to be sensitized that, Community-based Volunteers in Ghana are not paid as such they require community support to continue volunteering. The support could be recognition of their services through exemptions from communal labour, words of encouragement and helping volunteers to work on their farms periodically. Abstract In a recent article, Gorik Ooms has drawn attention to the normative underpinnings of the politics of global health. We claim that Ooms is indirectly submitting to a liberal conception of politics by framing the politics of global health as a question of individual morality. Drawing on the theoretical works of Chantal Mouffe, we introduce a conflictual concept of the political as an alternative to Ooms' conception. Using controversies surrounding medical treatment of AIDS patients in developing countries as a case we underline the opportunity for political changes, through political articulation of an issue, and collective mobilization based on such an articulation. Citation: Askheim C, Heggen K, Engebretsen E. Politics and power in global health: the constituting role of conflicts: Comment on " Navigating between stealth advocacy and unconscious dogmatism: the challenge of researching the norms, politics and power of global health.

Research Square (Research Square), 2024

Background Community health workers continue to function vitally in assisting in the provision of health care, thereby contributing to the attainment of sustainable development goals and universal health coverage. Several community health worker programmes around the globe encounter signi cant obstacles that impact their engagement in providing community-based healthcare services. Objectives This study assessed the level of participation of Village Health Teams in community-based health care in Mitooma district, western Uganda. Methods This was a cross-sectional study that used a structured questionnaire to collect quantitative data from 341 Village Health Teams in Mitooma district. The main study variable was Village Health Teams' participation based on the many programmatic functions Village Health Teams perform. Multivariable logistic regression in STATA was used to establish the predictors of Village Health Teams' participation. Results The majority 231 (67.7%) VHTs participated heavily in health care initiatives. Majority 264 (77.4%) were female and had the occupation of crop agriculture. The Adjusted R Square was less that 70% implying the goodness of t and signi cantly high association [95% CI: p = 0.0000; <0.05]. Logistic regression revealed that female VHTs [AOR = 3.8 (95% CI: 1.18-16.67), p = 0.03] were over three times more likely to participate with impact in community-based healthcare than their male counterparts. VHTs aged above 40 years [AOR = 4.43 (95% CI: (1.18-16.67), p = 0.03] were over four times more likely to participate with impact in community-based healthcare than those aged 40 years and below. VHTs who were engaged in business [AOR = 3.78 (95% CI: 1.21-11.74), p = 0.02] were over three times more likely to participate with impact in community-based healthcare than those engaged in agriculture. Conclusion We draw the conclusion from the study that gender, age, and employment play a vital role in the high involvement rate of village health teams in community-based healthcare. It is however necessary to support a long-term incentive system for VHTs by offering su cient monetary and non-monetary rewards.

Open Journal of Preventive Medicine, 2014

Primary health care provision through innovative community level interventions such as the Village Health Team (VHT) concept in Uganda can be a rational way of achieving universal access to healthcare. This cross-sectional study interviewed 150 VHT members and 16 key informants in three districts in Northern Uganda to establish the roles of VHTs, the service gaps encountered and the measures in place to address these gaps. Quantitative data were analyzed using SPSS 16.0. Direct content analysis of themes of transcribed qualitative data was conducted manually for common codes. The majority of the respondents 64.29% (n = 72) reported to have been VHT volunteers for more than 5 years. Among the roles were community mobilization reported by 99.1% (n = 111) and home visiting of individuals reported by 97.3% (n = 109). Lack of transport, motivation, adequate skills and community appreciation with nearly no measures in place to counteract the challenges was reported by almost all respondents. Although the VHT concept can be a significant means of achieving universal access to primary health care, extensive community involvement and motivation of the volunteers are highly needed for a maximum benefit.

of Alma-Ata, with many initiatives established in developing countries. However, CHW programmes often suffer high attrition once the initial enthusiasm of volunteers wanes. In 2002, Uganda began implementing a national CHW programme called the village health teams (VHTs), but their performance has been poor in many communities. It is argued that poor community involvement in the selection of the CHWs affects their embeddedness in communities and success. The question of how selection can be implemented creatively to sustain CHW programmes has not been sufficiently explored. In this paper, our aim was to examine the process of the introduction of the VHT strategy in one rural community, including the selection of VHT members and how these processes may have influenced their work in relation to the ideals of the natural helper model of health promotion. Methods: As part of a broader research project, an ethnographic study was carried out in Luwero district. Data collection involved participant observation, 12 focus group discussions (FGDs), 14 in-depth interviews with community members and members of the VHTs and four key informant interviews. Interviews and FGD were recorded, transcribed and coded in NVivo. Emerging themes were further explored and developed using text query searches. Interpretations were confirmed by comparison with findings of other team members. Results: The VHT selection process created distrust, damaging the programme’s legitimacy. While the Luwero community initially had high expectations of the programme, local leaders selected VHTs in a way that sidelined the majority of the community’s members. Community members questioned the credentials of those who were selected, not seeing the VHTs as those to whom they would go to for help and support. Resentment grew, and as a result, the ways in which the VHTs operated alienated them further from the community. Without the support of the community, the VHTs soon lost morale and stopped their work. Conclusion: As the natural helper model recommends, in order for CHW programmes to gain and maintain community support, it is necessary to utilize naturally existing informal helping networks by drawing on volunteers already trusted by the people being served. That way, the community will be more inclined to trust the advice of volunteers and offer them support in return, increasing the likelihood of the sustainability of their service in the community. Keywords: Community health workers, Village health teams, Natural helpers

Human Resources for Health, 2007

In this paper, we aim to quantify the contribution of international health volunteers to the health workforce in sub-Saharan Africa and to explore the perceptions of health service managers regarding these volunteers.

International Journal for Equity in Health

Background: Uganda's national community health worker program involves volunteer Village Health Teams (VHTs) delivering basic health services and education. Evidence demonstrates their positive impact on health outcomes, particularly for Ugandans who would otherwise lack access to health services. Despite their impact, VHTs are not optimally supported and attrition is a growing problem. In this study, we examined the support needs and existing challenges of VHTs in two Ugandan districts and evaluated specific factors associated with long-term retention. We report on findings from a standardized survey of VHTs and exploratory interviews with key stakeholders and draw conclusions that inform efforts to strengthen and sustain community health care delivery in Uganda. Methods: A mixed-methods approach was employed through a survey of 134 individual VHT members and semi-structured interviews with six key stakeholders. Descriptive and bivariate regression analysis of quantitative survey data was performed along with thematic analysis of qualitative data from surveys and interviews. In the regression analysis, the dependent variable is 10-year anticipated longevity among VHTs, which asked respondents if they anticipate continuing to volunteer as VHTs for at least 10 more years if their current situation remains unchanged. Results: VHTs desire additional support primarily in the forms of money (e.g. transportation allowance) and material supplies (e.g. rubber boots). VHTs commonly report difficult working conditions and describe a lack of respect from their communities and other health workers. If their current situation remains unchanged, 57% of VHTs anticipate remaining in their posts for at least 10 years. Anticipated 10-year longevity was positively associated with stronger partnerships with local health center staff and greater ease in home visiting. Conclusions: Supporting and retaining Uganda's VHTs would be enhanced by building stronger partnerships between VHTs and other health workers and regularly providing supplies and transportation allowances. Pursuing such measures would likely improve equity in access to healthcare for all Ugandans.

Shortage of health staff is a global problem and this is more pronounced in Sub Saharan Africa. Realizing this challenge, World Health Organization recommended the use of Community Health Workers to provide primary health care in these countries with weak health systems and high demand for health services (WHO 2008). This study therefore focused on the role of the Village Health Workers (VHWs) and challenges faced in providing primary health care in Zimbabwe. An exploratory qualitative research study was conducted in two districts using focus group discussions, in-depth and key informant interviews, and observations. The study revealed that after undergoing a formal training VHWs performed the following roles; preventative, promotional, surveillance, referral and supportive. Challenges associated with inadequate support of VHWs as a result of limited resources were noted. These challenges however had implications on VHW programme’s efficacy in the country.