Figures & Tables
Tables
Program Inputs Level 1 Level 2 Level 3 Training 5-day initial training and 3-day supervised practicum at health center Same as Level 1 + 3-day refresher training once a year N/A Supervision Monthly CHW meetings at health center Same as Level 1 + quarterly visit by health center staff in the community N/A Incentives CHW kit with gumboots, raincoat, job aids, and stationery CHW kit + T-shirt + badge CHW kit + T-shirt + badge + bicycle Transportation refund 5,000 UGX for each meeting 10,000 UGX for each meeting N/A Communication No mobile phone Mobile phone without airtime N/A Abbreviations: CHW, community health worker; N/A, not applicable; UGX, Ugandan Shilling.
Active CHWs Former CHWs Program Type No. of Surveysa No. of IDIs Total No. Interviewed/ Total No. in Program No. of IDIs Public sector (2 districts) 35 13 48/48 3 Former NGO (3 districts) 82 14 96/112 0 NGO (2 districts) 66 16 82/203 2 Total 183 43 226/363 5 Abbreviations: CHWs, community health workers; IDIs, in-depth interviews; NGO, nongovernmental organization.
↵a Surveys included a Discrete Choice Experiment (DCE).
Total (N = 183) Highly Active (n = 88) Less Active (n = 69) Motivational Outcomes Overall, I am very satisfied with being an FP CHW. 3.78 3.73 3.85 I would recommend to my children that they become CHWs. 3.50 3.57 3.48 I am glad to be working as an FP CHW rather than in some other volunteer position in the community. 3.20 3.13 3.40 I feel very little commitment to the FP CHW program.a 1.35 1.39 1.33 I enjoy working in my community to make it better, even if it is without pay. 3.77 3.81 3.74 I do not think that it makes good sense to spend any time working in my community without payment.a 1.55 1.46 1.57 I have no intention to keep doing my FP CHW work without pay.a 1.42 1.36 1.40 Motivational Determinants Barriers My FP CHW work takes so much time that I am worried about how to support myself and my family.a 2.13 2.03 2.07 My family complains about the demands of my FP CHW work.a 1.53 1.65 1.39 Serving as an FP CHW will not help my chances of getting a better job in the future.a 1.45 1.51 1.47 Talking about FP with my clients is very embarrassing.a 1.27 1.24 1.33 It is difficult to help clients find the method that is right for them.a 1.54 1.37 1.59 Contraceptive use often makes people sick.a 2.16 2.21 2.05 Facilitators Overall, my supervisors provide helpful feedback and support. 3.77 3.72 3.74 I can probably perform most of my activities without additional training. 2.51 2.50 2.58 The FP CHW program provides all the equipment and material I need to do my job well. 3.19 3.12 3.35 It is easy to find women who are interested in receiving an FP method in this community. 3.67 3.64 3.75 Abbreviations: CHW, community health worker; FP, family planning.
Level of activity of CHWs was based on data from service statistics, which were available for 157 CHWs.
Items were scored from 1 = “Disagree a lot” to 4 = “Agree a lot.” Nonresponses varied across items. Weighted means are reported.
↵a Item was reverse-scored before factor analysis.
Characteristics Total Highly Active Less Active P Value (N = 183) (n = 88) (n = 69) Age, y, mean (SE) 41.3 (0.8) 41.1 (1.1) 40.9 (1.2) .89 No. of living children, mean (SE) 5.5 (0.2) 5.2 (0.2) 6.0 (0.5) .23 Education, % Primary 27.4 26.1 37.4 .17 Secondary or higher 72.6 73.9 62.6 Sex, % Female 49.8 59.1 48.8 .47 Male 50.2 40.9 51.2 No. of years as an FP CHW, mean (SE) 5.6 (0.4) 5.5 (0.4) 5.3 (0.4) .83 Provides other services besides FP, % No 7.3 4.8 9.4 .31 Yes 92.7 95.2 90.6 Prior volunteer experience, % No 10.9 12.2 5.3 .05 Yes 89.1 87.8 94.7 Received refresher training in past year, % No 26.1 27.2 32.9 .50 Yes 73.9 72.8 67.1 Ever received supervision from HC staff, % Never 34.0 39.4 36.7 .82 Ever 66.0 60.9 63.3 Received supervisory visits in community in the past year, % No 41.3 36.0 50.8 .23 Yes 58.7 64.0 49.2 Problems with supplies, % No 36.1 26.7 41.2 .01 Yes 63.9 73.3 58.8 Received recognition/support from community in the past year, % No 10.9 10.0 12.0 .75 Yes 89.1 90.0 88.0 Received incentive from NGO or district in the past year, % No 46.2 45.2 47.4 .81 Yes 53.8 54.8 52.3 Collaboration with other CHWs, % No 37.1 46.8 24.7 .03 Yes 62.9 53.2 75.3 Time to HC, h, mean (SE) 1.2 (0.1) 1.3 (0.1) 1.3 (0.1) .88 Motivation, mean (SE) -0.08 (0.1) -0.05 (0.1) -0.04 (0.1) .95 Barriers, mean (SE) -0.05 (0.1) -0.04 (0.1) -0.04 (0.1) .96 Facilitators, mean (SE) -0.02 (0.1) -0.05 (0.1) 0.07 (0.1) .41 Abbreviations: CHW, community health worker; FP, family planning; HC, health center; NGO, nongovernmental organization; SE, standard error.
Level of activity of CHWs was based on data from service statistics, which were available for 157 CHWs.
Nonresponses varied across items. Weighted percentages and means are reported.
- TABLE 5. Factors Associated With CHW Level of Activity in Logistic Regression Analysis (N = 156)
Characteristicsa Odds Ratio (95% CI) Demographic Maleb 0.63 (0.23–1.76) Secondary or higher educationb 2.30 (0.75–7.01) Age, y 1.04 (0.99–1.08) Situational Prior volunteer experienceb 0.67 (0.26–1.72) Travel time to health center, h 0.98 (0.68–1.43) Work Problems with suppliesb 2.22 (1.32–3.75) Collaboration with other CHWsb 0.33 (0.13–0.86) Motivational outcomes and determinants Motivation 1.25 (0.70–2.23) Barriers 1.07 (0.67–1.72) Facilitators 0.67 (0.40–1.14) Abbreviations: CHW, community health worker; CI, confidence interval.
↵a Control variables were education, sex, age, time to health center, motivation, barriers, and facilitators.
↵b Indicator variable. For male/sex, the reference is female. For education, the reference is primary education. Other variables are yes/no binary variables, with “no” as the reference level.
- TABLE 6. Mixed Logit Model Results for Program Inputs Influencing CHW Preferences in the Discrete Choice Experiment (N = 182)
Program Input Model Coefficients Mean Estimate (SE) Standard Deviation Estimate (SE) T-shirt, badge, and bicycle 3.90a (1.41) 1.24 (1.45) Mobile phone, no airtime 0.99b (0.41) … 10,000 UGX transport refund 0.77b (0.35) 1.06 (0.77) Yearly refresher training 0.73b (0.34) 1.22 (0.63) T-shirt and badge 1.97 (1.02) 1.51 (0.86) Quarterly supervisory visits in community 0.70 (0.38) 1.15 (0.70)
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