Relationship between CHWs
Incentive and Improve Maternal and Newborn Health
Working with the community gives
health workers a platform from which to strengthen their relationship with the
community and receive community feedback, as well as a structure for regular
interaction with health facility staff. Community participation is an integral
part of CHWs' incentives. Without involvement, communities lack interest and
expectations, leaving CHWs without a support system we can't achieve MDGs 4 and
for improving maternal and child health (MOH, Malawi, 2014).
The rate of decline in child mortality is too slow in most
African countries to achieve the Millennium Development Goal of reducing
under-five mortality by two-thirds between 1990 and 2015. Effective strategies
to monitor child mortality are needed where accurate vital registration data
are lacking to help governments assess and report on progress in child
survival. They present results from a test of a mortality monitoring approach
based on recording of births and deaths by specially trained community health
workers in Malawi (MOH, Malawi, 2014).
Results from systematic reviews of CHW program confirm that
CHWs provide critical links between rural communities and the formal health
system and have been shown to reduce child morbidity and mortality when
compared to the usual healthcare services (MOH, Sierra Leone 2013).
With appropriate support and sufficient training, CHWs can
potentially play a pivotal role in strengthening health systems in areas with
poor human resources for health. More specifically, they are an important
resource for implementing interventions targeting reductions in neonatal
mortality and tracking women throughout their pregnancy while simultaneously
promoting appropriate maternal and newborn care practices (MOH, Sierra Leone
2013)..
Their potential however, is hampered by inadequate
supervision, lack of locally relevant incentive systems, loss of motivation,
insufficient recognition and community support, poor connectivity to health
facilities, and knowledge retention problems. Moreover, higher attrition rates
are often observed in programs where CHWs are asked to volunteer.
The motivation of CHWs and the risk of high attrition rates
therefore have important implications for the effectiveness, success, cost,
credibility and continuity of CHW-based programs, (MOH, Sierra Leone 2013).
Summary of Identified
Gaps
We now know that CHWs can play a crucial role in broadening
access and coverage of health services in remote areas and can undertake
actions that lead to improved health outcomes, especially, but not exclusively
in the field of child and maternal health. CHWs represent an important health
resource whose potential in providing and extending a basic health care to
underserved populations must be fully tapped. Despite the experience with
community health workers worldwide, the research gap remains in community
health worker literature especially in terms of Incentives strategies
and maternal and infant mortality improvement (MOH, Rwanda
2011).
Despite the availability of Rwandan community health policy
and strategies there is no study conducted on contribution of CHWs' incentives
on the improvement of maternal and infant health services. The evaluation done
by MOH, Rwanda (2011), where the main objective was to assess the quality of
services provided by the CHWs and their access to necessary supplies. This was
mainly assessing what CHWs do and how they give services but this didn't relate
to the quality of services provided in terms of maternal and infant health with
incentives they get. The study was conducted in the district of Djenné,
Mali by Perez in 2009, concerning the role of community health workers in
improving child health programs which mainly compared the knowledge and
practice between households with and without community health workers.
The researcher mentioned the results in terms of
knowledge/practices the family with CHWs might have but didn't relate the
incentives given to CHWs to their contribution on infant and maternal health
(MOH, Rwanda 2011).
The study conducted by Winch et al., (2001) was assessing the
contribution of CHWs on improvement of health system including drug
availability and the skills of Community Health Workers to assess, classify,
and treat children accurately. This included the three following elements:
improving partnerships between health facilities and services and the
communities they serve, increasing appropriate and accessible care and
information from community-based providers, integrating promotion of key family
practices critical for child health and nutrition but they didn't asses the
relationship between CHWs' incentives and maternal and infant health
improvement.
In all the literature above there is no specific research,
which explains well the assessment of incentives given to CHWs to their
contribution on improving maternal & newborn health. Hence, for the purpose
of this study, the research intends to assess the relationship between CHWs' in
charge of maternal and newborn health incentives on improvement of maternal and
newborn health services. Child health intervention
that warrants considerably more attention, particularly in Africa and South
Asia. (Oxford University Press, 2005).
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