Table 4 Thematic analysis on Domain 3: accountability: mechanisms of responsibility within and outside the health system
Pre-intervention | Post-intervention | ||
|---|---|---|---|
Sub-themes | Quotes (barriers) | Sub-themes | Quotes (enablers, impacts) |
Barriers • Community accountability generally good, reports of trust mixed | “The community still gives us support; however, we are not in contact with them like we used to since now we spend a lot of our time working at the clinic.” Participant, clinic 3 | Enablers • Stable platform for building trust and action alliances in response to local needs, e.g., patient support groups dealing with stigma/loss to follow-up • Process to convene and mobilise community stakeholders to raise awareness and address stigma over COVID-19 and other communicable diseases • Better quality relationships between CHWs | “The VAPAR training was good; it met my expectations. I learned a lot about respect, communication and how to use all the tools … Most importantly I learnt the power of working together as CHWs, communities and traditional authorities. If the communities can master this approach of working together, we can solve a lot of issues that our communities come across every day.” Participant clinic 2 |
“Personally, I had challenges with public speaking but since I attended the training my presentation skills have improved. Now I can confidently facilitate any workshop at any given time. I learned from how you were engaging with us, it was the first time we met but you made us feel free to talk around you and that is something I want to practice with my patients in the community, making people feel free and welcomed.” Participant, clinic 3 | |||
“The training exceeded my expectation; I learnt a lot more than I expected …. I will use the skills I leant during the training to identify issues faced by chronic patients and work with them to address these issues.” Participant, clinic 1 | |||
“Our relationship is good with the community; they are starting to see the importance of our work. Others will also tell you they miss seeing us in the village, when they see us they get very happy.” Participant, clinic 1 | “I will use a problem tree to help my patient understand their medical condition better, to understand the cause of the complications and the impact of not adhering to their medications.” Participant, clinic 2 | ||
“Our relationship [with the community] is well except that other people still don’t know what our roles are in the community, as a result some are still reluctant to our services… Communities need to be educated more about our roles” Participant, clinic 3 | Impacts • Strengthened trust relationships between CHWs and communities • Development of shared mindsets | “The training … helped me to understand public engagement more, how to be patient when working with the local people and to understand deeper issues around defaulting of HIV/TB.” Participant, clinic 3 | |
Barriers • Supervision generally adequate | “I currently report to sister [name], we have a good working relationship where we can ask anything anytime, we want. She gives us feedback in a professional manner.” Participant, clinic 1 | Enablers • Increased understanding of alliance-building and collaboration | “VAPAR training played a huge role to me as an individual because I did not know how to approach problems that we encounter as Community Health Workers but now I know. The training taught me ways of identifying challenges and addressing them, I understand challenges better than I used to. I'm confident that now I know even how to identify people who can assist us in dealing with various issues.” Participant, clinic 2 |
“I hardly get feedback or communication regarding my performance; I think it's because [clinic name] has a lot of CHWs so it’s difficult to keep track of each of us.” Participant, clinic 1 | “…my confidence and communication skills have improved. I am communication better with the nurses and community people. My thinking has improved because I know how to identify problems and finding solutions for them.” Participant, clinic 3 | ||
“We used to get proper supervision where we're still allowed to work but not anymore, since we were told to stop working. Suddenly, even the nurses do not care about our existence. Now, no communication at all such that we do not even know whether we are needed at the clinic or not but back then they used to communicate very well with us.” Participant, clinic 2 | Impacts • Opportunities to build dialogue at higher levels of system, supporting more effective relationships including supervision | “The VAPAR training exposed me to things that I didn’t know such as identifying various problem within our community and how we can collectively solve them. I learned that before one can start thinking about solution of a problem, they should start by understanding the problem, what are the causes of these problems and its impact. I have also learned about how we can identify stakeholders at different levels to engage with them in solving community issues.” Participant, clinic 2 |