Use of Lot quality assurance sampling surveys to evaluate community health worker performance in rural Zambia: a case of Luangwa district

Moses Mwanza, Japhet Zulu, Stephanie M Topp, Patrick Musonda, Wilbroad Mutale, Roma Chilengi, Moses Mwanza, Japhet Zulu, Stephanie M Topp, Patrick Musonda, Wilbroad Mutale, Roma Chilengi

Abstract

Background: The Better Health Outcomes through Mentoring and Assessment (BHOMA) project is a cluster randomized controlled trial aimed at reducing age-standardized mortality rates in three rural districts through involvement of Community Health Workers (CHWs), Traditional Birth Attendants (TBAs), and Neighborhood Health Committees (NHCs). CHWs conduct quarterly surveys on all households using a questionnaire that captures key health events occurring within their catchment population. In order to validate contact with households, we utilize the Lot Quality Assurance Sampling (LQAS) methodology. In this study, we report experiences of applying the LQAS approach to monitor performance of CHWs in Luangwa District.

Methods: Between April 2011 and December 2013, seven health facilities in Luangwa district were enrolled into the BHOMA project. The health facility catchment areas were divided into 33 geographic zones. Quality assurance was performed each quarter by randomly selecting zones representing about 90% of enrolled catchment areas from which 19 households per zone where also randomly identified. The surveys were conducted by CHW supervisors who had been trained on using the LQAS questionnaire. Information collected included household identity number (ID), whether the CHW visited the household, duration of the most recent visit, and what health information was discussed during the CHW visit. The threshold for success was set at 75% household outreach by CHWs in each zone.

Results: There are 4,616 total households in the 33 zones. This yielded a target of 32,212 household visits by community health workers during the 7 survey rounds. Based on the set cutoff point for passing the surveys (at least 75% households confirmed as visited), only one team of CHWs at Luangwa high school failed to reach the target during round 1 of the surveys; all the teams otherwise registered successful visits in all the surveys.

Conclusions: We have employed the LQAS methodology for assurance that quarterly surveys were successfully done. This methodology proved helpful in identifying poorly performing CHWs and could be useful for evaluating CHW performance in other areas.

Trial registration: Identifier: NCT01942278 . Date of Registration: September 2013.

Keywords: Community Health Worker performance; Lot quality assurance sampling; Quarterly surveys; Rural Zambia.

Figures

Fig. 1
Fig. 1
Frequency of topics discussed for each round

References

    1. Lehmann U, Damme WV, Barten F, Sanders D. Task shifting: the answer to the human resources crisis in Africa. Hum Resour Health. 2009;7:49. doi: 10.1186/1478-4491-7-49.
    1. Lindsey E, Sheilds L, Stajduhar K. Creating effective nursing partnerships: An approach to community based action. Nurs Outlook. 1999;45(1):23–6.
    1. Kane SS, Gerretsen B, Scherpbier R, Poz MD, Dieleman M. A realist synthesis of randomized control trials involving use of community health workers for delivering child health interventions in low and middle income countries. BMC Health Serv Res. 2010;10:286. doi: 10.1186/1472-6963-10-286.
    1. Javanparast S, Baum F, Labonte R, Sanders D, Rajabi Z, Heidari G. The experience of community health workers training in Iran: a qualitative study. BMC Health Serv Res. 2012;12:291. doi: 10.1186/1472-6963-12-291.
    1. National Health Strategic Plan: 2011–2015. .
    1. Zulu JM, Kinsman J, Michelo C, Hurtig A. Developing the national community health assistant strategy in Zambia: a policy analysis. Health Res Policy Syst. 2013;11:24. doi: 10.1186/1478-4505-11-24.
    1. Braun R, Catalani C, Wimbush J, Israelski D. Community Health Workers and Mobile Technology: A Systematic Review of the Literature. PLoS One. 2013;8(6):e65772. doi: 10.1371/journal.pone.0065772.
    1. Gilmore B, McAuliffe E. Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review. BMC Public Health. 2013;13:847. doi: 10.1186/1471-2458-13-847.
    1. Makaula P, Bloch P, Banda HT, Mbera GB, Mangani C, Sousa A, et al. Primary health care in rural Malawi - a qualitative assessment exploring the relevance of the community-directed intervention approach. BMC Health Serv Res. 2012;12:328. doi: 10.1186/1472-6963-12-328.
    1. Stringer JSA, Taylor-Chisembele A, Chibwesha CJ, Chi HF, Ayles H, Manda H, et al. Protocol-driven primary care and community linkages to improve population health in rural Zambia: the Better Health Outcomes through Mentoring and Assessment (BHOMA) project. BMC Health Serv Res. 2013;13(Suppl 2):S7. doi: 10.1186/1472-6963-13-S2-S7.
    1. Schutter L, Sindano N, Theis M, Zue C, Joseph J, Chilengi R, et al. A mobile phone-based, community health worker program for referral, follow-up and service outreach in rural Zambia: outcomes and overview. Telemed E Health. 2014;20(8):721–8. doi: 10.1089/tmj.2013.0240.
    1. Tumusiime DK, Agaba G, Kyomuhangi T, Finch J, Kabakyenga J, Macleod S. Introduction of mobile phones for use by volunteer community health workers in support of integrated community case management in Bushenyi District, Uganda: development and implementation process. BMC Health Serv Res. 2014;14(Suppl 1):S2. doi: 10.1186/1472-6963-14-S1-S2.
    1. Lanata CF, Black RE. Lot quality assurance sampling techniques in health surveys in developing countries: advantages and current constraints. Health Serv Res. 1991;44(3):133–9.
    1. Mushtaq MU, Majrooh MA, Ullah ZMS, Akram J, Siddiqui AM, Shad MA, et al. Are we doing enough? Evaluation of the Polio Eradication Initiative in a district of Pakistan’s Punjab province: LQAS study. BMC Public Health. 2010;10:60. doi: 10.1186/1471-2458-10-60.
    1. Pezzoli L, Conteh I, Kamara W, Gacic-Dobo M, Ronveaux O, Perea WA, et al. Intervene before leaving: Clustered lot quality assurance sampling to monitor vaccination coverage at health district level before the end of a yellow fever and measles vaccination campaign in Sierra Leone in 2009. BMC Public Health. 2012;12:415. doi: 10.1186/1471-2458-12-415.
    1. Valadaz JJ, Diprete Brown L, Varges WV, Morley D. Using lot quality assurance sampling to assess measurements for growth monitoring in a developing country’s primary health care system. Int J Epidemiol. 1996;25:381–7. doi: 10.1093/ije/25.2.381.
    1. National LQAS conference . Enhancing Evidence Based Planning at District Level: The LQAS Experience in Uganda Sheraton Hotel Kampala. 2006.
    1. Hedt-Gauthier BL, Mitsunaga T, Hund L, Olives C, Pagano M. The effect of clustering on lot quality assurance sampling: a probabilistic model to calculate sample sizes for quality assessments. Emerg Themes Epidemiol. 2013;10:1. doi: 10.1186/1742-7622-10-11.
    1. Perez F, Ba H, Dastagire SG, Altmann The role of community health workers in improving child health programmes in Mali. BMC Int Health Hum Rights. 2009;9:28. doi: 10.1186/1472-698X-9-28.
    1. Biedron C, Pagano M, Hedt BL, Killian A, Ratcliffe, Mabunda S, Valadez JJ, et al. An assessment of Lot Quality Assurance Sampling to evaluate malaria outcome indicators: extending malaria indicator surveys. Int J Epidemiol. 2010;39:72–9. doi: 10.1093/ije/dyp363.
    1. Gigante J, Dell M, Sharkey A. “Getting Beyond”: How to Give Effective Feedback. Pediatrics. 2011;127:205. doi: 10.1542/peds.2010-3351.
    1. Valadez JJ, Devkota B, Pradhan MM, Meherda P, Sonal GS, Dhariwal A, et al. Improving malaria treatment and prevention in India by aiding district managers to manage their programmes with local information: a trial assessing the impact of Lot Quality Assurance Sampling on programme outcomes. Trop Med Int Health. 2014;19(10):1226–36. doi: 10.1111/tmi.12354.
    1. Oladele EA, Ormond L, Adeyemi O, Patrick D, Okoh F, Oresanya O, et al. Tracking the Quality of Care for Sick Children Using Lot Quality Assurance Sampling: Targeting Improvements of Health Services in Jigawa, Nigeria. PLoS One. 2012;7(9):e44319. doi: 10.1371/journal.pone.0044319.
    1. Gupte MD, Murthy BN, Mahmood K, Meeralakshmi S, Nagaraju B, Prabhakaran R. Application of lot quality assurance sampling for Leprosy elimination monitoring- examination of some critical factors. Int J Epidemiol. 2004;33:344–8. doi: 10.1093/ije/dyh024.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir