At an online webinar on Wednesday, members of the inSCALE project team spoke about community health worker (CHW) motivation and performance. The webinar outlined some of the main obstacles that CHWs face in their work and what is being done to address them through the project which is being implemented in Mozambique and Uganda.
The inSCALE project, run by Malaria Consortium and funded by the Bill & Melinda Gates Foundation, aims to improve CHW motivation and performance in order to provide better treatment for sick children and demonstrate that coverage and impact of government-led CHW programmes can be extended if innovative solutions can be found regarding motivation and retention. Once solutions are identified, these can be used to increase the coverage of CHW programmes and improve their quality so that more children under five have prompt access to appropriate treatment.
Dr Karin Källander, Malaria Consortium Senior Research Advisor and inSCALE project manager opened the webinar with an overview of the project, its objectives and goals and a brief introduction to the two innovative interventions being implemented.
Dr Källander was joined by two other speakers.
Daniel Strachan, Senior Research Associate at the UCL Institute for Global Health, focused on the extensive formative research conducted as part of the project in order to design effective interventions. His presentation highlighted the participatory nature of the research as well as the importance of ensuring that all interventions are feasible and acceptable to key stakeholders. The presentation also showed how the findings from the formative research were used in practice to create interventions that were in line with the inSCALE conceptual framework. A Malaria Consortium learning paper goes into more detail on the research and intervention development stages of the project - you can find it here
Maureen Nakirunda, inSCALE Research Officer - Social Sciences, shared some preliminary findings from the process evaluation of a mobile technology intervention in eight districts of mid-western Uganda. The presentation focused on findings from 24 key informant interviews and how the provision of mobile phones, solar lamps and chargers has impacted on CHW supportive supervision, performance and other aspects which could influence motivation such as recognition and affirmation, cost savings, income generation and social status and respect. The presentation also highlighted some key challenges which the project has faced during implementation.
Following the presentations there was a Q&A session with presenters answering questions on issues such as costing, programme sustainability and barriers to setting up mHealth projects in Africa.
Questions came from a variety of audience members and focused on different aspects of the presentations such as implementation, relationship to the Government and Ministry of Health, costing and date use. There were questions about the different types of supervision, technical and non-technical, which are both being addressed by the inSCALE projects through supporting the supervision of CHWs from the health facility supervisors (technical) and their communities (non-technical). Presenters also answered questions about cost; the project is costing the intervention as a whole as well as each component separately and assessing the impact of each of these components on the motivation, performance and retention of CHWs. The interventions are currently being paid for by the project but as the evidence on impact and cost are collected, recommendations will be made to Governments and mobile phone operators on scaling up the intervention (or its individual components) and supporting the associated costs. Dr. Källander also explained how the inSCALE project will be measuring performance through a mix of questionnaires which walk CHWs through case scenarios to assess how they respond as well as observations.
The inSCALE project’s intervention in Mozambique was also mentioned, where Malaria Consortium is working with Dimagi to provide more interactive software to the CHWs who have been given Android enabled phones. In Mozambique, CHWs use their phones to support their consultations as there based on a step by step algorithm which has been developed. In addition, the software also contains audio and visual messages for the CHW and the caregiver to explain the diagnosis as well as provide health education messages.
You can download the slides for all three presentations, or watch the online Q&A session here.
For more information on the inSCALE project and Malaria Consortium’s CHW programmes please visit www.malariaconsortium.org/inscale