Factors affecting the performance of family planning workers: Importance of geographical information systems in empirical analysis

An intensive family planning intervention based on community health workers (CHWs) has been in place in the Matlab area of rural Bangladesh for over a decade. Despite the programme's relative success, considerable variations in the performances of CHWs remain a concern. The purpose of this paper is to explore the determinants of CHWs performances by introducing geographical factors in addition to the conventional socioeconomic and other related variables. The attribute data on the study area were obtained from a longitudinal surveillance system, and the spatial data came from a geographical information system (GIS) database. The catchment areas for all 80 CHWs were defined by using GIS technology and spatially referenced data. A cross-sectional time-series regression model was employed on the longitudinal data of 16 years for the 80 CHWs. One significant finding of the empirical analysis is that the size of catchment area influences the performance of CHWs significantly. Geographical barriers to movement in the catchment area also affect performance of the CHW. The exercise implies that the performance of the CHWs can be improved significantly by defining their catchment areas using GIS techniques.