Assessment of community health workers incentives on maternal and newborn health services performance

Level of Community Health Workers incentives

In results as indicated in Table 4 in this study involved three sub variables which are both monetary and non-monetary incentives grouped in three categories such as: first the community performance based financing (CPBF) and incentives which they receive every after quarterly evaluation by sector steering committee.

Secondly, the provision of equipment and materials for facilitating the accomplishment of their assigned duties, and thirdly, membership in community health workers cooperatives for income generation with mentorship for capacity building.

Table 4: Level of Community Health Workers incentives

Item	Mean	SD	Interpretation
Community financial incentives
Receiving sufficient salary after monthly target visits	1.55	0.79	Low
Receiving incentive of monthly bonus	1.93	1.05	Low
Receiving quarterly incentive of BPF	1.94	0.73	Low
I receive a bag	1.63	0.90	Low
I receive umbrella	1.79	1.14	Very low
I receive rain coat	3.35	0.98	High
Register book for monthly reporting	1.95	1.25	Low
Register book for pregnant women/productive age	1.03	0.22	Very low
Register of follow up for pregnancy women	1.05	0.32	Very low
Receiving training and follow-up	1.28	0.71	Very low
Conducting monthly inventory based on my store card	2.39	1.35	Low
Advice to clients (referral) to use health facility services	1.06	0.37	Very low
Aggregate mean and SD	1.75	0.82	Low
CHWs' non-financial incentives (equipment and materials)
Timer equipment for respiration count	1.19	0.65	Very low
Mobile Phone equipment	1.24	0.74	Very low
Thermometer equipment	1.20	0.69	Very low
Weighing scale equipment	1.09	0.48	Very low
Measurement of upper arm circumference equipment	2.35	1.48	Low
Aggregate mean and SD	1.41	0.81	Very low
Membership in CHW's cooperatives
Receive quarterly supervision from health facility	1.45	0.78	Very low
Receive per-diem during the monthly meetings	2.71	1.08	Moderate
Member of community health workers' cooperative	1.09	0.40	Very low
Receive 30% of quarterly PBF from my cooperative	1.45	0.79	Very low
Access loans from my cooperative	3.14	1.18	Moderate
Aggregate mean and SD	1.97	0.85	Low
Grand Mean	1.71	0.82	Low

Source: Primary data

Legend: 1.00-1.49 (Very low); 1, 50-2.49 (Low); 2.50-3.49 (Moderate); 3.50-4.49 (High); 4.50-5.00 (Very high)

Table 4 therefore, shows the study results on the community performance based financing (CPBF) and incentives showed that there was low mean and standard deviation (= 1.75; SD = 0.82) well as on CHWs' equipment and materials the results showed a very low mean and standard deviation (=1.41; SD = 0.81) lastly, membership in community health workers cooperatives for income generation with mentorship for capacity building the result showed a low mean and standard deviation (=1.97; SD=0.85) . The general result on community performance based financing and other incentives showed also a low mean and standard deviation (=1.71; SD=0.82).

This is in line with the research findings of WHO Regional office for Africa (2013), which shows that the total catchment population for the 31 health centers in 2010 was 720 40814. Of these, 4.1% (29 537) were expected to be women in need of maternal health services per annum.

The antenatal care indicator (visit before or during 4th month of pregnancy) was targeted to reach at least 30% of women in 2010 or 738 women per month.

The indicator on delivery was targeted to achieve 85% of women delivering in health facilities. The postnatal indicator was targeted to reach 15% of women in 2010.

Level of Maternal and Newborn Health Service performance

Furthermore, the third object research objective showed in table 5 was to determine the findings on level of maternal and newborn health in Rwinkwavu district hospital in Rwanda.

Table 5: Level of Maternal and Newborn Health Service

Item	Mean	SD	Interpretation
Census of women in reproductive age	1.57	0.92	Low
Visit 3 times all pregnancy women in the village	1.55	0.99	Low
Women visited in first prenatal care visits to homes	2.86	1.58	Moderate
Women visited by CHWs during pregnancy	2.47	1.43	Low
Women who completed 4 standards ANC	3.42	1.44	Moderate
Deliveries at health facilities by health professionals	2.60	1.68	Moderate
Home deliveries	4.63	0.91	Very high
Home deliveries referred to health facility	4.91	1.95	Very high
Women presented in postpartum consultation within	4.28	1.24	High
Women vaccinated against tetanus during pregnancy	1.72	1.14	Low
Women receive iron for anemia to prevention	1.61	1.15	Low
At risk pregnancies referred to health facility	4.85	0.69	Very high
Grand mean and SD	3.04	1.26	Moderate

Source: Primary data

Legend: 1.00-1.49 (Very low); 1,50-2.49 (Low); 2.50-3.49 (Moderate);3.50-4.49 (High);4.50-5.00 (Very high)

The result revealed a moderate mean and standard deviation of (=3.04; SD = 1.26). In the article, `Rwanda's Success in Improving Maternal Health', strategies that were used to reach the success story of maternal mortality (a decrease of 77% between 2000 and 2013 in Rwanda's maternal mortality ratio currently at 320 deaths per 100,000 live births, under-5 child mortality reduced by more than 70 percent), Worley (2015), identified the factors that created this story. Among them were maternal health as a priority in postwar rebuilding, maternal and child health core of community-based health insurance, and family planning key to sustained success in maternal health. However, some challenges were identified among which was the need for 586 more midwives to reach 95 percent skilled birth attendance.

Midwives are the ones who train, supervise, and help in monitoring and the evaluation process of the community health workers, if such a big number is still lacking in the rural areas, not so different from the current study, then it could one of the reasons why there was a weak positive relationship between community performance based financing and other incentives and maternal and newborne health services in this study.

More so, rural areas are still underserved (Worley, 2015). Forty percent of women live more than an hour away from a health facility. Even with the increase in family planning and decline in the total fertility rate, contraception remains unavailable to or underused by many Rwandans. And nearly one in every two children under 5 are stunted. The researcher recommends that rural areas be staffed with the necessary incentives like increase in the number of midwives to help in the training, supervision and monitoring of community health workers.