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Table 2 Determinants of performance in malaria programs

From: Towards a framework for analyzing determinants of performance of community health workers in malaria prevention and control: a systematic review

S/N

Factor

Description of determinant

Studies

Community health worker (CHW) characteristics

1

Demographic factors

Female CHWs performed better than their male counterparts, married CHWs gave a higher performance than others, having fewer household duties encourages CHWs to work more actively and reduces the dropout rate, longer work experience, good educational status, availability of supporters for household chores, and appropriate sanitation practices

Kawakatsu et al. 2015; Bagonza et al. 2014; Wanduru et al. 2016

2

CHW confidence and competence

CHWs may have lacked confidence in the guidelines, particularly, the ability of CHWs to obtain an accurate history of convulsions. CHW able to do RDT confidently and effectively on the other hand

Kelly et al. 2001; Mubi et al. 2011

Community factors

1

Community factors

Mobilization of communities by the local leaders and confidence of the community in medicines used, lack of community appreciation for age restrictions of children treated, poor community participation, poor cooperation from caregivers, social prestige, community support in terms of feedback and rewards, training institute, poor performance of basic household health practices

Kalyango et al. 2012; Druetz et al. 2015; Chinbuah et al. 2013; Kawakatsu et al. 2015; Perez et al. 2009; Banek et al. 2015; Nsona et al. 2012

2

CHW service utilization

CHWs rarely use for malaria interventions and only poor household using them in mostly in rural

Druetz et al. 2015; Kisia et al. 2012; Kelly et al. 2001; Yeboah-Antwi et al. 2010

Health system factors

1

Feedback

Some CHWs did not receive timely feedback from their supervisors. Community support in the form of feedback and rewards

Bagonza et al. 2014; Kalyango et al. 2012

2

Training

Adequately continuously trained and appropriately resourced CHWs are really motivated to perform their tasks like interpreting RDTs, and give treatment for Malaria. clearly defined roles for CHAs and supervisors

Kalyango et al. 2012; Chanda et al. 2011; MOH-Rwanda 2009; Yeboah-Antwi et al. 2010; Druetz et al. 2015; Perez et al. 2009; Nsona et al. 2012; Wanduru et al. 2016

3

Stocks and supplies

The need for continuous supplies of drugs and stocks is cardinal for enhancing success of CHWs for malaria

Kelly et al. 2001; Chanda et al. 2011; Kalyango et al. 2012; Searle et al. 2016; Druetz et al. 2015; Perez et al. 2009; Chinbuah et al. 2013; Banek et al. 2015; Nsona et al. 2012

4

Job aids

Complexity of guidelines was an important reason for deficiencies managing sick children. These should be in local language possibly

Chinbuah et al. 2013; Kelly et al. 2001; Nsona et al. 2012

5

Supervision

High quality support supervision from supervisors from formal health system who should have adequate health knowledge to conduct routine supervisions to sustain a high performance is necessary to improve the performance of CHWs in malaria interventions

Bagonza et al. 2014; Kawakatsu et al. 2015; Perez et al. 2009; Kelly et al. 2001; Druetz et al. 2015; Chinbuah et al. 2013; Nsona et al. 2012; Wanduru et al. 2016

6

Funding

CHW performance is hard to achieve and to maintain without sufficient consideration for funding

Druetz et al. 2015; Banek et al. 2015; Nsona et al. 2012

7

Transport

Distance and lack of transport refund affects their performance

Kalyango et al. 2012; Perez et al. 2009

8

Remuneration/motivation

Lack of incentives demotivates them and CHWs asking for consideration

Druetz et al. 2015; Perez et al. 2009; Kalyango et al. 2012; Chinbuah et al. 2013; Banek et al. 2015; Nsona et al. 2012; Wanduru et al. 2016

9

Health professional support

CHWs work not trusted by the health professional staff

Kalyango et al. 2012

10

Workload

CHWs performed poorly due to large population coverage and multiple tasks

Yeboah-Antwi et al. 2010; Kalyango et al. 2012; Searle et al. 2016; Perez et al. 2009; Kelly et al. 2001; Bagonza et al. 2014; Wanduru et al. 2016

11

Evaluation environment

Evaluated in a different setting other than area of usual practice

Kelly et al. 2001

12

Reporting

CHW performance may have been underestimated because a failure to document was interpreted as an error—missing data

Kelly et al. 2001; Nsona et al. 2012

13

Program coordination

Poor CHW program coordination at all levels affects performance negatively

Nsona et al. 2012