Rapid Assessment of Community Health Worker Knowledge Compared with Knowledge of Doctors and Nurses

摘要

United States Agency for International Development (USAID) funding through the Rural Expansion of Afghanistans Community-based Healthcare (REACH) Program has supported the selection and training of 6036 Community Health Workers (3204 females and 2832 males). The CHW training includes three phases, and CHWs can start working after concluding Phase I; however, they do not acquire the full spectrum of skills, including treatment of pneumonia and malaria, until Phase III. After final testing and fielding of the CHWs, the challenge remains to monitor their actual performance. According to the grants agreements signed with the nongovernmental organizations (NGO) that are implementing the Basic Package of Health Services (BPHS) in 14 provinces of Afghanistan, regular supervision and monitoring is part of the NGO responsibility. In addition, REACH performs independent monitoring of the working status of the CHWs. Taking advantage of the regular REACH monitoring schedule, a 10% sample of the 2571 CHWs who had completed the third phase of training by December 2005, and who were scheduled for monitoring in December 2005 and January 2006, was selected to be tested on their knowledge of how to manage the prime health conditions that are part of the CHW job description. Between December 2005 and March 2006, 295 CHWs were interviewed in 11 provinces. Of these, 292 interview records were retained for analysis. In May 2006, a sample of 52 nurses and medical doctors, selected from among the 726 doctors and nurses posted in 6 provinces by NGO grantees, were asked to respond to the same questionnaires. The latter interviews were undertaken to provide a basis for comparing the results of the CHW knowledge assessment with the knowledge of other health workers on the same topics. Because of time and budget constraints, the selection of provinces was limited to those provinces initially visited for the CHW interviews that were also easily accessible from Kabul.