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| Name | Class |
|---|---|
| Makerere University | OTHER |
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The overarching goal of this study is to improve the health of women and children in rural areas of Uganda through strengthening of the community health workforce, which provides critical health services to the rural poor.
Uganda, like several countries in Sub-Saharan Africa, faces a shortage of skilled healthcare workers, and a disproportionate concentration of workers in urban areas. This disparity has dire consequences for rural populations, who have higher fertility rates, lower utilization of maternal and child health services, lower levels of access to safe drinking water and sanitation services, and poorer vaccination coverage. Women and children in rural and remote communities bear the disproportionate brunt of poor access to and poor quality of health care. Village Health Teams (VHTs), Uganda's community health workers (CHW), were introduced to address some of these inequities by providing basic health services to the rural poor. However, like many CHW programs globally, the VHT program has high levels of attrition, owing to inadequate systems and financial support.
The objectives of this study are to understand:
This study will evaluate a 1-year incentives intervention provided to VHTs in Uganda's Masindi District. It is a two-armed clinical trial, where parishes will be randomized to the incentives intervention (i.e., an incentives package will be provided to VHTs practicing in the intervention parishes; control parishes VHTs will not receive an incentives package). The primary outcomes include assessing VHT performance, VHT motivation, VHT retention, trends in utilization of maternal and child health services, and trends in the adoption of sanitary practices. Outcomes for VHT performance, VHT retention, trends in utilization of maternal and child health services, and trends in adoption of sanitary practices will be measured monthly. Outcomes for VHT motivation will be measured twice, at baseline (Month 1) and endline (Month 12).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention-Randomized Parishes | Experimental | Parishes will be randomized in Masindi District to receive the intervention (i.e., an incentives package). VHTs who are active in that parish will thereby receive the incentives intervention. |
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| Control-Randomized Parishes | No Intervention | Non-intervention randomized parishes will be the control parishes. Active VHTs in the control parishes will not receive the incentives intervention. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CHW Incentives Intervention | Behavioral | The intervention comprises of an incentives package provided to VHTs who are active in the intervention-randomized parishes. It will comprise of items that will motivate them and support their work as VHTs in the community. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in VHT Performance | Measure change in average number of VHT visits made over the course of the 1-year intervention. Types of VHT visits include: average number of home visits, antenatal care visits, postnatal care visits, visits to support immunization of children, visits to talk about safe drinking water, visits to examine latrines and observe handwashing, and number of referrals made to the health facility over the last month. | Measured monthly for 12 months |
| Change in VHT Motivation | Measure the percentage of VHTs who have improved motivation during the course of the 1-year intervention through use of the Close-To-Community (CTC) Provider Motivational Indicator Scale, which measures satisfaction, organizational commitment, community commitment, and work conscientiousness. | Baseline (Month 1) and Endline (Month 12) |
| Change in VHT Retention | Measure the percentage of VHTs who report to the health facility over the course of the 1-year intervention. | Measured monthly for 12 months |
| Change in Maternal and Child Health Services Utilization | Measure change in maternal and child health services utilization, which includes proportion of antenatal care coverage, proportion of immunization coverage, and proportion of children under 5 who have been visited by a VHT, over the course of the 1-year intervention. | Measured monthly for 12 months |
| Change in Adoption of Sanitary Practices | Measure changes in the adoption of sanitary practices, which includes assessing the average number of households with latrines, improved latrines, handwashing facilities, safe drinking water, and are open defecation free over the course of the 1-year intervention. | Measured monthly for 12 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Makerere University School of Public Health | Kampala | Uganda |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37353798 | Derived | Agarwal S, Tweheyo R, Pandya S, Obuya E, Kiyomoto A, Mitra P, Schleiff M, Nagpal T, Macis M, Rutebemberwa E. Impact of a recognition package as an incentive to strengthen the motivation, performance, and retention of village health teams in Uganda: a study protocol for a cluster randomized controlled trial. Trials. 2023 Jun 23;24(1):428. doi: 10.1186/s13063-023-07426-6. |
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We will not be sharing individual participant data. All data that will be shared will be at the aggregate-level so that any identifying information is not identifiable and does not place the participant at additional risk.
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| ID | Term |
|---|---|
| D015438 | Health Behavior |
| D010342 | Patient Acceptance of Health Care |
| ID | Term |
|---|---|
| D001519 | Behavior |
| D000074822 | Treatment Adherence and Compliance |
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Parishes will be randomized to intervention or control. VHTs in the intervention parishes will receive the incentives package as part of the intervention.
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