In a study by Malaria Consortium’s Agnes Nanyonjo et.al (2013) caregivers of children under five in mid-Western Uganda were found to perceive the quality of care provided by community health workers significantly higher than that by public health facility workers.
In the eight districts of mid-Western Uganda where the study was conducted it is estimated that there are almost 400,000 children under the age of five. In this region there are 6,674 CHWs active in integrated community case management (ICCM), trained to diagnose and treat malaria, pneumonia and diarrhoea in children under five.
ICCM is associated with improved financial and geographical access and previous studies have shown that accessibility, affordability and availability of medicines are associated with better perceived quality of care.
Caregivers in this study were asked to rate their perceived quality of care in the areas of accessibility, continuity, comprehensiveness, integration, clinical interaction, interpersonal treatment and trust between CHWs and PHFWs. Overall and in all individual categories, except continuity, CHWs were perceived to provide a higher quality of care.
The study, published in PLOS ONE has important implications for community health worker (CHW) policies extending past Uganda. A high level of perceived quality of care is likely to impact on service uptake and adherence to recommendations and treatment advice. This study is the first to establish the perceived quality of care for CHW and the effect this can have on caregiver demand and utlisation. An increase in the uptake of the CHW services is expected to lead to more timely treatment of uncomplicated cases in the community and an increase in the quality of care provided at the health facilities for severe cases due to a decreased staff workload.
“We are very pleased to see that caregivers believe they are receiving a high quality of care from their CHWs,” says Dr. Nanyonjo. “This shows that there is demand and need for trained and equipped CHWs. Now is the time to scale up such life-saving interventions.”