title: Engaging community health workers in maternal and newborn care in eastern Uganda.
abstract: BACKGROUND
  Community health workers (CHWs) have been employed in a number of low- and middle-income countries as part of primary health care strategies, but the packages vary across and even within countries. The experiences and motivations of a multipurpose CHW in providing maternal and newborn health have not been well described.
  
  
  OBJECTIVE
  This study examined the perceptions of community members and experiences of CHWs around promoting maternal and newborn care practices, and the self-identified factors that influence the performance of CHWs so as to inform future study design and programme implementation.
  
  
  METHODS
  Data were collected using in-depth interviews with six local council leaders, ten health workers/CHW supervisors, and eight mothers. We conducted four focus group discussions with CHWs. Respondents included 14 urban and 18 rural CHWs. Key themes explored included the experience of CHWs according to their various roles, and the facilitators and barriers they encounter in their work particular to provision of maternal and newborn care. Qualitative data were analysed using manifest content analysis methods.
  
  
  RESULTS
  CHWs were highly appreciated in the community and seen as important contributors to maternal and newborn health at grassroots level. Factors that positively influence CHWs included being selected by and trained in the community; being trained in problem-solving skills; being deployed immediately after training with participation of local leaders; frequent supervision; and having a strengthened and responsive supply of services to which families can be referred. CHWs made use of social networks to identify pregnant and newly delivered women, and were able to target men and the wider family during health education activities. Intrinsic motivators (e.g. community appreciation and the prestige of being 'a doctor'), monetary (such as a small transport allowance), and material incentives (e.g. bicycles, bags) were also important to varying degrees.
  
  
  CONCLUSIONS
  There is a continued role for CHWs in improving maternal and newborn care and linking families with health services. However, the process for building CHW programmes needs to be adapted to the local setting, including the process of training, deployment, supervision, and motivation within the context of a responsive and available health system.
authors.affiliation: Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda; mokugga@yahoo.com.
authors.forename: Monica
authors.initials: M
authors.lastname: Okuga
authors.affiliation: Private Consultant, Kampala, Uganda.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kemigisa
authors.affiliation: Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Sarah
authors.initials: S
authors.lastname: Namutamba
authors.affiliation: Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Gertrude
authors.initials: G
authors.lastname: Namazzi
authors.affiliation: Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.|Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|Iganga-Mayuge Health Demographic Surveillance Site, Iganga-Mayuge, Uganda.
authors.forename: Peter
authors.initials: P
authors.lastname: Waiswa
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003150:Community Health Workers / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D006293:Health Promotion / Q000458:organization & administration; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000458:organization & administration*; D007231:Infant, Newborn; D008297:Male; D000068101:Maternal-Child Health Services / Q000458:organization & administration*; D008875:Middle Aged; D011181:Postnatal Care / Q000458:organization & administration*; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D024382:Professional Role; D036301:Qualitative Research; D012424:Rural Population; D014454:Uganda; D014505:Urban Population
keywords: Uganda; community health worker; maternal health; newborn health; postnatal care; pregnancy
references.citation: Trials. 2012;13:213
references.pmid: 23153395
references.citation: Int Health. 2009 Sep;1(1):31-6
references.pmid: 24036293
references.citation: Int J Tuberc Lung Dis. 2002 Feb;6(2):104-10
references.pmid: 11931408
references.citation: Lancet. 2007 Jun 23;369(9579):2121-31
references.pmid: 17586307
references.citation: Pediatr Infect Dis J. 2009 Apr;28(4):304-10
references.pmid: 19289979
references.citation: J Perinatol. 2005 Mar;25 Suppl 1:S92-107
references.pmid: 15791283
references.citation: Glob Health Action. 2015 Mar 31;8:23969
references.pmid: 25843492
references.citation: Trop Med Int Health. 2010 Aug;15(8):964-72
references.pmid: 20636527
references.citation: Glob Health Action. 2015 Mar 31;8:24584
references.pmid: 25843498
references.citation: Soc Sci Med. 1985;20(10):1073-80
references.pmid: 4012349
references.citation: Lancet. 2005 Mar 5-11;365(9462):891-900
references.pmid: 15752534
references.citation: Cochrane Database Syst Rev. 2013;10:CD010414
references.pmid: 24101553
references.citation: Lancet. 2008 Sep 13;372(9642):917-27
references.pmid: 18790315
references.citation: Trop Med Int Health. 2013 Jul;18(7):898-906
references.pmid: 23551394
references.citation: Soc Sci Med. 2010 Jun;70(12):1920-7
references.pmid: 20382464
references.citation: Afr J Reprod Health. 2007 Apr;11(1):43-56
references.pmid: 17982947
references.citation: Soc Sci Med. 1989;29(10):1163-74
references.pmid: 2588044
references.citation: Nurse Educ Today. 2004 Feb;24(2):105-12
references.pmid: 14769454
references.citation: Lancet. 2008 Sep 27;372(9644):1151-62
references.pmid: 18926277
references.citation: Lancet. 2011 Jan 29;377(9763):403-12
references.pmid: 21239052