Testing Alternative Record Keeping Formats Not Requiring Literacy Skills: Onchocerciasis Control at the Village Level

Keeping accurate health records at the village level is a challenge since many rural dwellers have low or no literacy skills. The African Programme for Onchocerciasis Control (APOC) is distributing the drug ivermectin at the village level by villagers themselves, and requires an accounting of drugs dispensed and villagers treated. Recently, pictorial tally sheets were developed for Community Directed Distributors (CDDs) of ivermectin. At that same time a question arose concerning indigenous record keeping methods and whether such methods could also be adapted to ivermectin distribution. This study identified two indigenous methods, counting beans/pebbles and chalk/charcoal marks on walls and compared them with the pictorial tally sheets in three clusters of onchocerciasis-endemic villages in Kajola Local Government Area (LGA) of Oyo State, Nigeria. Field staff trained the CDDs using standard APOC procedures and after distribution, collected their treatment records. A household survey was then conducted for comparison with CDD records. The tally sheet users scored the lowest mean and median percentage point difference between reported and surveyed coverage (6.6 and 4.8) compared to chalk boards (19.0, 5.6) and pebbles (15.2, 9.2), but since the village was the unit of analysis, the differences observed were of only boarderline significance ( p = 0.08). Because the tally sheets proved to be both cheaper and easier to use, they are recommended for community ivermectin programs as well as other primary health care activities at the village level.

Association between sociodemographic characteristics of female community health volunteers and their knowledge and performance on maternal and child health services in rural Nepal

Background

Engaging community health volunteers and community health workers to provide maternal and child health (MCH) care services in resource-poor settings is one of the global and widely used concepts. Despite a great role of female community health volunteers (FCHVs) in MCH services in Nepal, few research studies have been performed in this area. Our research aimed to assess the knowledge and performance of FCHVs on MCH services associated with their sociodemographic characteristics.

Methods

A cross-sectional survey was conducted to assess the knowledge and performance on selected MCH services of FCHVs using structured questionnaire in 16 village development committees of Dhanusha district, Southern Terai, Nepal, from the first of January to the end of February of 2014. A total of 138 FCHVs were selected by using multistage random sampling technique. Logistic regression was employed to examine the association between selected sociodemographic characteristics and knowledge and performance on MCH services of FCHVs after adjusting for significant variables associated with knowledge and performance and within-cluster effect.

Results

Our findings demonstrated that sociodemographic characteristics were associated independently with good knowledge of FCHVs on MCH services: education level secondary and above (adjusted odds ratio [aOR] 5.2; 95% confidence interval [CI] 2.2–12.2); residing in Mother and Infant Research Activities, nongovernmental organization working area (aOR 3.7; 95% CI 1.5–8.8); and middle caste (aOR 3.3; 95% CI 1.0–10.3). Similarly, satisfactory performance of FCHVs significantly associated with MCH services were education level secondary and above (aOR 8.9; 95% CI 3.2–24.3) and residing in Mother and Infant Research Activities working areas (aOR 9.0; 95% CI 3.5–22.6).

Conclusion

The study recommends considering education level while recruiting rural FCHVs and capacity enhancement through additional training and development programs in collaboration with developmental partner.

Village Health Worker Attrition and Function Levels in the ILE-IFE Area of Nigeria

Volunteer village health workers (VHWs) form the backbone of primary health care (PHC) from both philosophical and logistical perspectives. They represent an underlying PHC ethic of community involvement as well as a practical means for delivering health care at the grassroots. Although VHW recruitment and training does not rival the cost of training formal medical and health workers, the investment in not insubstantial. Thus when VHW dropout rates approach 50 percent in many countries, there is cause for alarm and for investigation into the possible causes of attrition. Nigeria embarked on a national PHC program in 1986, supported by national PHC policy in 1987. Nearly 1500 VHWs have been trained in model local government areas (LGAs) during the intervening years. Although there have been anecdotal reports of VHW attrition, little study into the reasons for drop-out from this large scale and expensive operation have been undertaken. This study looked at the former Oranmiyan LGA (now divided into three) where 115 VHWs had been trained. Only 79 percent of trainees took up PHC tasks, and another 7 percent left their villages shortly thereafter due to school admission or job opportunities. Two to three years after the initial training, 58 percent of the original trainees self-reported that they were still functioning as VHWs. A PHC function test, based on VHW job descriptions, was developed and administered within a questionnaire among the VHWs still living in their villages. Three factors were associated with function score: farming as an occupation, reported recent supervision and reported attendance at a continuing education activity. The results indicate two main points of intervention for preventing VHW attrition. During recruitment, effort should be made to explain the voluntary nature of the work and to encourage villagers to select people (like farmers) who will reside permanently in the village. After training, supervision and continuing education must be planned to maintain a high level of VHW functioning.

The challenges of community-directed treatment with ivermectin (CDTI) within the African Programme for Onchocerciasis Control (APOC)

The principal strategy adopted by the African Programme for Onchocerciasis Control (APOC), for the control of onchocerciasis in the 19 countries of Africa that now fall within the programme's remit, is that of community-directed treatment with ivermectin (CDTI). Halfway through its 12-year mandate, APOC has gathered enough information on the main challenges to guide its activities in Phase 2. An analysis of reports and other documents, emanating from consultants, scientists, monitors and national and project-level implementers, indicates that there are three broad categories of challenge: managerial; technical; and socio-political. Under these three categories, this review identifies the most pertinent concerns that APOC must address, during Phase 2, to enhance the prospects of establishing sustainable systems for ivermectin distribution. The major challenges include: (1) maintaining timely drug-collection mechanisms; (2) integrating CDTI with existing primary-healthcare services; (3) strengthening local health infrastructure; (4) achieving and maintaining an optimal treatment coverage; (5) establishing and up-scaling community self-monitoring; (6) designing and implementing operations research locally; (7) ensuring the adequacy of community-directed distributors; (8) increasing the involvement of local non-govemmental develop organizations in the programme; (9) achieving financial sustainability; (10) implementing equitable cost-recovery systems; and (11) engaging in effective advocacy. The implications of the challenges and suggestions about how they are being (or could be) addressed are also highlighted in this brief review, which should be of value to other programmes and agencies that may be contemplating the adoption of this unique strategy.