Self-Efficacy and Delivery Service Provision among Community Health Workers: Lessons from Rural Ethiopia Öffentlichkeit
Handley, Anna Lynn (2011)
Published
Abstract
Background: Efforts to reduce maternal and newborn
mortality in Ethiopia have been slow moving, in part because of
limited health infrastructure. In response to the inaccessiblity of
services, the Health Extension Program was created in 2003, and has
deployed nearly 30,000 community health workers. Mothers and
newborns are at greatest risk for negative health outcomes
during birth and accordingly, most community health workers
received training in the
delivery of normal births. The training is primarily theoretical,
and few CHWs are provided with delivery experience. Due to limited
monitoring, it is unclear how prepared CHWs are to attend delivery
amidst competing health responsibilities.
Objective: This study explores the factors than enable
community health workers to
provide delivery care in Amhara region, particularly emphasizing
the
association between self-efficacy and the prioritization and
self-marketing of delivery
services.
Methods: Twenty-six in-depth interviews and 162 surveys were
conducted with Health
Extension Workers, voluntary Community Health Workers, and
traditional birth
attendants in Amhara region, Ethiopia to assess current patterns of
delivery care
provision and factors that enable the provision of delivery
care.
Results: The survey reveals that despite formal training in
delivery, many
community health workers are not providing delivery services.
Self-efficacy was found
to be strongly associated with the provision of delivery care.
Formative interviews indicate that experience with delivery
promoted
a sense of self-efficacy among community health workers, which
prompted self-
marketing of services, and increased the number of notification
pathways for labor or
pregnancy-related complications. Self-efficacy, when coupled with
regular interaction
with TBAs further increased the number of notification
pathways.
Discussion: Community health workers in rural Ethiopia have
life saving
knowledge and skills, but are often not in the right place at the
right time to fully utilize
their abilities. Mechanisms to get community health workers into
the homes of women in
labor or with complications need urgent exploration. This study
offers emerging evidence
that building self-efficacy through experience with delivery is
critical for health workers
to prioritize and self-market of delivery services. Furthermore,
regular interaction with
traditional birth attendants enhances the probability that
community health workers will
be notified of labor or pregnancy-related
complications.
Table of Contents
1 -
INTRODUCTION...............................................................................................
1
Problem Statement
...............................................................................................
1
Objectives and Aims
..............................................................................................
3
Background of Ethiopia
..........................................................................................
3
Ethiopia's Health System
........................................................................................
5
Host Organization
.................................................................................................
11
Summary..............................................................................................................
13
2 - LITERATURE
REVIEW.........................................................................................
14
Community-based Maternal and Newborn Health Interventions
................................... 14
Elements of Success and
Failure...............................................................................
17
Theoretical Frameworks and Community Health Worker
Training................................... 28
3 - METHODS
........................................................................................................
34
Program Background
..............................................................................................
34
Study Setting
........................................................................................................
36
Research Design
....................................................................................................
37
Data
Analysis.........................................................................................................
42
Reflections on Data Quality
......................................................................................
43
4 - RESULTS (Qualitative)
........................................................................................
45
Descriptive Statistics
...............................................................................................
45
Frontline Health Worker Roles and
Responsibilities........................................................
45
Determinants and Implications of FLW Team Identity
.................................................... 52
Determinants of Delivery Care Among
CHWs................................................................
59
Additional considerations
...........................................................................................
66
Limitations
..............................................................................................................
67
5 - RESULTS (Quantitative)
.......................................................................................
68
Introduction and Data Quality
....................................................................................
68
Population Characteristics
..........................................................................................
68
Patterns and Prioritization of Community-based MNH Service
Provision............................. 71
Patterns of Community-based Delivery Service
Provision................................................. 73
The Association between Confidence and Delivery Service Provision
................................. 74
Associations with Confidence in and Provision of Delivery Care
........................................ 78
Key Components of Confidence
...................................................................................
83
Summary..................................................................................................................
90
6 -
DISCUSSION........................................................................................................
92
Summary of
Results...................................................................................................
92
Relationship to the Literature
......................................................................................
95
New Findings
............................................................................................................
99
Public Health Recommendations
..................................................................................
103
Training
...................................................................................................................
103
Post-training strategies
..............................................................................................
104
Involvement of
TBAs..................................................................................................
105
Quality improvement
frameworks.................................................................................
105
Conclusion
................................................................................................................
107
About this Master's Thesis
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