Health Policy Plan. 2021 Dec 18:czab151. doi: 10.1093/heapol/czab151. Online ahead of print.
ABSTRACT
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 2012-14, the Healthy Child Uganda partnership facilitated district-led CHW program scale-up. CHW retention was tracked prospectively from the start of the intervention up to two years. Additional follow up occurred at five years to confirm retention status. Database analysis assessed CHW demographic characteristics, retention rates, and exit reasons five-years post-intervention. A multivariable logistic regression model examined five-year retention-associated characteristics. Of the original cohort of 2,317 CHWs, 70% were female. The mean age was 38.8 years (SD: 10.0). Sixty-months (five 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; OR=1.53; 95% CI: 1·20-1·96) and age group (<25years, 30-59; OR=0.40; 95% CI: 0.25-0.62) were significantly associated with five-year retention in multivariable modeling. 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 program and district-wide MNCH initiative, were retained over the medium-term. Importantly, high five-year retention in this intervention counters findings from other studies suggesting high retention in government-led and volunteer CHW programs. Encouragingly, findings from our study suggest retention was low, not significantly associated with timing of external partner support, and largely not attributed to the CHW role i.e. workload, program factors. Our study showcases the potential for sustainable volunteer CHW programming at scale and can inform planners and policymakers considering program design, including selection and replacement planning for CHW networks.
PMID:34922343 | DOI:10.1093/heapol/czab151
