Improving Quality Performance among Community Health Workers Providing Integrated Community Management of Febrile Illnesses in Nigeria
A Poster Presentation at the 60th ASTMH meeting by Bright C. Orji, William R. Brieger, Emmanuel O. Otolorin, Jones Nwadike, Enobong Ndekhedehe, Olugbenga Ishola, Godfrey Akro, Nancy Ali
Efforts to improve access to quality case management of febrile illness include the engagement of Community Health Workers (CHWs) to use Rapid Diagnostic Tests (RDTs), dispense ACTs and manage pneumonia and diarrhea. Use of CHWs reduces challenges like a weak public sector, human resource constraints, and variable quality of the private sector.
Studies have suggested that CHWs are able to perform case management services in a training setting, but not much has been done to measure quality performance among CHWs in the field. Jhpiego and the Akwa Ibom State, Nigeria health authorities trained CHWs and developed simple quality performance standards (one-page tool) for CHWs providing community services in Akwa Ibom State, Nigeria.
All 131 trained CHWs in two local government areas providing malaria, pneumonia and diarrhea case management were assessed using the standards. The tool has 37 performance criteria (PC) to measure CHW knowledge, skills and competence in 3 sections:
- History taking and Examination
- Conducting RDTs for Malaria and
- Illness Management
Trained assessors observed CHWs providing services. Each correctly performed criterion was scored 1 point. Three rounds of assessments were conducted at an interval of two months from May-November, 2011.
At the end of each round assessors provided feedback and refresher training for CHWs during their monthly meetings. During Round 1 CHWs achieved an average of 19 (52.2%) PC. This rose to 25 (67.5%) PC at Round 2 and 28 (75.6%).
PC that needed most improvement included checking signs and symptoms to distinguish among the illnesses. CHWs also needed reinforcement on checking RDT expiry date, entering results on records, safe disposing of sharps, and counseling on preventive measures.
In conclusion feedback after Rounds 1 and 2 helped CHWs improve their performance. Additional quarterly assessments and feedback sessions are planned. CHW supervisors can use this tool to enhance the quality of services provided by the CHWs and improve CHW training.