TY - JOUR
T1 - “Because even the person living with HIV/AIDS might need to make babies” – Perspectives on the drivers of feasibility and acceptability of an integrated community health worker model in Iringa, Tanzania
AU - Shelley, Katharine D.
AU - Frumence, Gasto
AU - Mpembeni, Rose
AU - Mwinnyaa, George
AU - Joachim, Juliana
AU - Kisusi, Hawa Kadria
AU - Killewo, Japhet
AU - Baqui, Abdullah H.
AU - Peters, David H.
AU - George, Asha S.
N1 - Funding Information:
Asha George serves as the Vice Chair of Health Systems Global. Asha George is supported by the South African Research Chair’s Initiative of the Department of Science and Technology and National Research Foundation (NRF) of South Africa (Grant No 82769). Any opinion, finding and conclusion or recommendation expressed in this material is that of the author and the NRF does not accept any liability in this regard. Hawa Kadria Kisusi served as a Senior Technical Officer – Home Based Care at Christian Social Services Commission, the Technical Partner for TUNAJALI II. All other authors declare no competing interests.
Funding Information:
USAID through the Health Research Challenge for Impact (HRCI) Cooperative Agreement (#GHS-A-00-09-00004-00) with the Johns Hopkins Bloomberg School of Public Health (JHSPH), Baltimore, MD, USA. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government.
Publisher Copyright:
© 2019 The Author(s); Published by Kerman University of Medical Sciences.
PY - 2019/9
Y1 - 2019/9
N2 - Background: Countries with health workforce shortages are increasingly turning to multipurpose community health workers (CHWs) to extend integrated services to the community-level. However, there may be tradeoffs with the number of tasks a CHW can effectively perform before quality and/or productivity decline. This qualitative study was conducted within an existing program in Iringa, Tanzania where HIV-focused CHWs working as volunteers received additional training on maternal, newborn, and child health (MNCH) promotion, thereby establishing a dual role CHW model. Methods: To evaluate the feasibility and acceptability of the combined HIV/MNCH CHW model, qualitative in-depth interviews (IDIs) with 36 CHWs, 21 supervisors, and 10 program managers were conducted following integration of HIV and MNCH responsibilities (n = 67). Thematic analysis explored perspectives on task planning, prioritization and integration, workload, and the feasibility and acceptability of the dual role model. Interview data and field observations were also used to describe implementation differences between HIV and MNCH roles as a basis for further contextualizing the qualitative findings. Results: Perspectives from a diverse set of stakeholders suggested provision of both HIV and MNCH health promotion by CHWs was feasible. Most CHWs attempted to balance HIV/MNCH responsibilities, although some prioritized MNCH tasks. An increased workload from MNCH did not appear to interfere with HIV responsibilities but drew time away from other income-generating activities on which volunteer CHWs rely. Satisfaction with the dual role model hinged on increased community respect, gaining new knowledge/skills, and improving community health, while the remuneration-level caused dissatisfaction, a complaint that could challenge sustainability. Conclusions: Despite extensive literature on integration, little research at the community level exists. This study demonstrated CHWs can feasibly balance HIV and MNCH roles, but not without some challenges related to the heavier workload. Further research is necessary to determine the quality of health promotion in both HIV and MNCH domains, and whether the dual role model can be maintained over time among these volunteers.
AB - Background: Countries with health workforce shortages are increasingly turning to multipurpose community health workers (CHWs) to extend integrated services to the community-level. However, there may be tradeoffs with the number of tasks a CHW can effectively perform before quality and/or productivity decline. This qualitative study was conducted within an existing program in Iringa, Tanzania where HIV-focused CHWs working as volunteers received additional training on maternal, newborn, and child health (MNCH) promotion, thereby establishing a dual role CHW model. Methods: To evaluate the feasibility and acceptability of the combined HIV/MNCH CHW model, qualitative in-depth interviews (IDIs) with 36 CHWs, 21 supervisors, and 10 program managers were conducted following integration of HIV and MNCH responsibilities (n = 67). Thematic analysis explored perspectives on task planning, prioritization and integration, workload, and the feasibility and acceptability of the dual role model. Interview data and field observations were also used to describe implementation differences between HIV and MNCH roles as a basis for further contextualizing the qualitative findings. Results: Perspectives from a diverse set of stakeholders suggested provision of both HIV and MNCH health promotion by CHWs was feasible. Most CHWs attempted to balance HIV/MNCH responsibilities, although some prioritized MNCH tasks. An increased workload from MNCH did not appear to interfere with HIV responsibilities but drew time away from other income-generating activities on which volunteer CHWs rely. Satisfaction with the dual role model hinged on increased community respect, gaining new knowledge/skills, and improving community health, while the remuneration-level caused dissatisfaction, a complaint that could challenge sustainability. Conclusions: Despite extensive literature on integration, little research at the community level exists. This study demonstrated CHWs can feasibly balance HIV and MNCH roles, but not without some challenges related to the heavier workload. Further research is necessary to determine the quality of health promotion in both HIV and MNCH domains, and whether the dual role model can be maintained over time among these volunteers.
KW - Community Health Workers
KW - Implementation Research
KW - Integration
KW - Tanzania
KW - Workload
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U2 - 10.15171/ijhpm.2019.38
DO - 10.15171/ijhpm.2019.38
M3 - Article
C2 - 31657176
AN - SCOPUS:85068147820
SN - 2322-5939
VL - 8
SP - 538
EP - 549
JO - International Journal of Health Policy and Management
JF - International Journal of Health Policy and Management
IS - 9
ER -