title: A time-use study of community health worker service activities in three rural districts of Tanzania (Rufiji, Ulanga and Kilombero).
abstract: Despite expanding international commitment to community health worker (CHW) deployment, little is known about how such workers actually use their time. This paper investigates this issue for paid CHWs named "Community Health Agents," which in Swahili is "Wawezeshaji wa Afya ya Jamii" ("WAJA"), trained for 9 months in primary health care service delivery and deployed to villages as subjects of a randomized trial of their impact on childhood survival in three rural districts of Tanzania.
  
  
  
  To capture information about time allocation, 30 WAJA were observed during conventional working hours by research assistants for 5 days each over a period of 4 weeks. Results were presented in term of percentage time allocation for direct client treatment, documentation activities, health education, health promotion non-work-related activities and personal activities.
  
  
  
  During routine 8-h workdays, 59.5 % of WAJA time was spent on the provision of health services and other work-related activities. Overall, WAJA spent 27.8 % of their work on traveling from home to home, 33.1 % on health education, 9.9 % of health promotion and only 12.3 % on direct patient care. Other activities related to documentation (7.8 %) and supervision (2.5 %).
  
  
  
  Results reflect the pressing obligations of WAJA to engage in activities other than direct work responsibilities during routine work hours. Time spent on work activities is primarily used for health education, promotion, moving between households, and direct patient care. However, greater effort should be directed to strengthening supervisory systems and follow-up of challenges WAJAs facing in order to increase proportion of working hours.
authors: Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania. ktani@ihi.or.tz.
authors: Kassimu
authors: K
authors: Tani
authors: Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA.
authors: Allison
authors: A
authors: Stone
authors: Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania.
authors: Amon
authors: A
authors: Exavery
authors: Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania.
authors: Mustafa
authors: M
authors: Njozi
authors: Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA.
authors: Colin D
authors: CD
authors: Baynes
authors: Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA.
authors: James F
authors: JF
authors: Phillips
authors: Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania.|Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA.
authors: Almamy Malick
authors: AM
authors: Kanté
mesh_terms: D000328:Adult; D003153:Community Health Services / Q000706:statistics & numerical data*; D003150:Community Health Workers / Q000193:education / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D006266:Health Education / Q000379:methods; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007318:Inservice Training; D008297:Male; D011364:Professional Practice / Q000706:statistics & numerical data; D012423:Rural Health; D013636:Tanzania; D016526:Workload / Q000706:statistics & numerical data
keywords: Community health worker; Connect project; Tanzania; Time use