Health Behavior, Health Care Utilization, Incentives
Conditions
Keywords
Community Health Workers, Incentives, Uganda, Motivation, Retention, Performance
Brief summary
The overarching goal of this study is to improve the health of women and children in rural areas of Uganda through strengthening of the community health workforce, which provides critical health services to the rural poor.
Detailed description
Uganda, like several countries in Sub-Saharan Africa, faces a shortage of skilled healthcare workers, and a disproportionate concentration of workers in urban areas. This disparity has dire consequences for rural populations, who have higher fertility rates, lower utilization of maternal and child health services, lower levels of access to safe drinking water and sanitation services, and poorer vaccination coverage. Women and children in rural and remote communities bear the disproportionate brunt of poor access to and poor quality of health care. Village Health Teams (VHTs), Uganda's community health workers (CHW), were introduced to address some of these inequities by providing basic health services to the rural poor. However, like many CHW programs globally, the VHT program has high levels of attrition, owing to inadequate systems and financial support. The objectives of this study are to understand: 1. What structure and group of incentives is best suited to motivate VHTs, improve their performance in the delivery of services, and increase their retention in the health workforce? 2. What is the behavioral mechanisms through which new incentives may work or fail to work? 3. How do the changes in the national VHT program impact utilization of maternal and child health services, sanitary practices, and perception of quality of health services at the community-level? What is the impact of COVID-19 on VHT practices on community health? This study will evaluate a 1-year incentives intervention provided to VHTs in Uganda's Masindi District. It is a two-armed clinical trial, where parishes will be randomized to the incentives intervention (i.e., an incentives package will be provided to VHTs practicing in the intervention parishes; control parishes VHTs will not receive an incentives package). The primary outcomes include assessing VHT performance, VHT motivation, VHT retention, trends in utilization of maternal and child health services, and trends in the adoption of sanitary practices. Outcomes for VHT performance, VHT retention, trends in utilization of maternal and child health services, and trends in adoption of sanitary practices will be measured monthly. Outcomes for VHT motivation will be measured twice, at baseline (Month 1) and endline (Month 12).
Interventions
BEHAVIORALCHW Incentives Intervention
The intervention comprises of an incentives package provided to VHTs who are active in the intervention-randomized parishes. It will comprise of items that will motivate them and support their work as VHTs in the community.
Sponsors
Makerere University
Johns Hopkins Bloomberg School of Public Health
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Parishes will be randomized to intervention or control. VHTs in the intervention parishes will receive the incentives package as part of the intervention.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Must be an active VHT in Uganda's Masindi district.
Exclusion criteria
* Anyone who fails to meet the inclusion criteria specified above will be excluded.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in VHT Performance | Measured monthly for 12 months | Measure change in average number of VHT visits made over the course of the 1-year intervention. Types of VHT visits include: average number of home visits, antenatal care visits, postnatal care visits, visits to support immunization of children, visits to talk about safe drinking water, visits to examine latrines and observe handwashing, and number of referrals made to the health facility over the last month. |
| Change in VHT Motivation | Baseline (Month 1) and Endline (Month 12) | Measure the percentage of VHTs who have improved motivation during the course of the 1-year intervention through use of the Close-To-Community (CTC) Provider Motivational Indicator Scale, which measures satisfaction, organizational commitment, community commitment, and work conscientiousness. |
| Change in VHT Retention | Measured monthly for 12 months | Measure the percentage of VHTs who report to the health facility over the course of the 1-year intervention. |
| Change in Maternal and Child Health Services Utilization | Measured monthly for 12 months | Measure change in maternal and child health services utilization, which includes proportion of antenatal care coverage, proportion of immunization coverage, and proportion of children under 5 who have been visited by a VHT, over the course of the 1-year intervention. |
| Change in Adoption of Sanitary Practices | Measured monthly for 12 months | Measure changes in the adoption of sanitary practices, which includes assessing the average number of households with latrines, improved latrines, handwashing facilities, safe drinking water, and are open defecation free over the course of the 1-year intervention. |
Countries
Uganda
Outcome results
None listed