Determinants of Utilization and Community Experiences with Community Health Volunteers for Treatment of Childhood Illnesses in Rural Sierra Leone.
In 2010, at the same time as the national roll out of the Free Health Care Initiative (FHCI), which removed user fees for facility based health care, trained community health volunteers (CHVs) were deployed to provide integrated community case management of diarrhea, malaria and pneumonia to children under 5 years of age (U5) in Kambia and Pujehun districts, Sierra Leone. After 2 years of implementation and in the context of FHCI, CHV utilization rate was 14.0 %. In this study, we examine the factors associated with this level of CHV utilization. A cross-sectional household-cluster survey of 1590 caregivers of 2279 children U5 was conducted in 2012; with CHV utilization assessed using a multiple logistic regression model. Focus groups and in-depth interviews were also conducted to understand communities' experiences with CHVs. Children with diarrhea (OR = 3.17, 95 % CI: 1.17-8.60), from female-headed households (OR = 4.55, 95 % CI: 1.88-11.00), and whose caregivers reported poor quality of care as a barrier to facility care-seeking (OR = 8.53, 95 % CI: 3.13-23.16) were more likely to receive treatment from a CHV. Despite low utilization, caregivers were highly familiar and appreciative of CHVs, but were concerned about the lack of financial remuneration for CHVs. CHVs remained an important source of care for children from female-headed households and whose caregivers reported poor quality of care at health facilities. CHVs are an important strategy for certain populations even when facility utilization is high or when facility services are compromised, as has happened with the recent Ebola epidemic in Sierra Leone.
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615N. Wolfe Street, Baltimore, MD, 21205, USA. aisha.yansaneh@gmail.com.
Aisha I
http://orcid.org/0000-0002-2610-6079
AI
Yansaneh
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615N. Wolfe Street, Baltimore, MD, 21205, USA.
Asha S
AS
George
Knowledge Management and Implementation Research Unit, Programme Division, Health Section, UNICEF, 3 UN Plaza, New York, NY, 10017, USA.
Alyssa
A
Sharkey
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615N. Wolfe Street, Baltimore, MD, 21205, USA.
William R
WR
Brieger
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615N. Wolfe Street, Baltimore, MD, 21205, USA.
Lawrence H
LH
Moulton
Dalan Development Consultants, Maze Area off Marcus Jones, King Street, Wilberforce, Freetown, Sierra Leone.
Fatu
F
Yumkella
Statistics Sierra Leone, A.J. Momoh Street, Tower Hill, PMB 595, Freetown, Sierra Leone.
Peter
P
Bangura
Health Section, Child Survival Division, UNICEF Sierra Leone, Jomo Kenyatta Road, Freetown, Sierra Leone.
Augustin
A
Kabano
Knowledge Management and Implementation Research Unit, Programme Division, Health Section, UNICEF, 3 UN Plaza, New York, NY, 10017, USA.
Theresa
T
Diaz
D000293:Adolescent; D000328:Adult; D000067576:Child Health; D002675:Child, Preschool; D003150:Community Health Workers; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000628:therapy; D005260:Female; D017144:Focus Groups; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008288:Malaria / Q000628:therapy; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012807:Sierra Leone; D014838:Volunteers; D055815:Young Adult
Children under five; Community health workers/volunteers; Integrated community case management; Sierra Leone; Utilization