Evaluating the effect of village health workers on hospital admission rates and their economic impact in the Kingdom of Bhutan.

BACKGROUND: Village health workers (VHWs) in Bhutan play an all-encompassing role in supporting the health of their communities. Recent reports from the Bhutan Ministry of Health have indicated a sharp reduction in the number of working VHWs. As such, our work attempts to estimate the cost saved and the number of averted hospital admissions onto the Bhutanese healthcare system and the individuals who are served by these health workers. METHODS: We utilized a dataset from the Bhutan Ministry of Health which encompassed over 95% of all reported disease cases within the nation. We examined the impact that VHWs have on hospital admission rates for eight diseases of interest by using multiple multivariate logistic regression models. Our model allowed us to estimate the potential disease cases averted when the average number of VHWs per health center is increased by one unit. Lastly, we utilized the 2011 "A Costing of Healthcare Services in Bhutan" to estimate the cost saved attributed to VHWs. RESULTS: An average one unit increase of VHWs per health center is associated with a decrease in hospital and clinic admission for diarrhea, dysentery, wound care, depression/anxiety, dental caries, and skin infection, while a non-significant increase was observed for scabies and conjunctivitis. These findings translate to 4604 outpatient visits averted, with $28,637 saved, and 78 inpatient visits averted, with $10,711 saved. These values sum to a total of 4682 yearly averted admissions at health centers, with a total cost savings of $39,348 yearly. Additionally, we estimated a yearly savings of $13,348 in transportation costs and a total of $20,960 saved in wages to the community members that VHWs serve. CONCLUSIONS: VHWs serve as a source of cost-savings for the Kingdom of Bhutan and also act as an economic buffer for more vulnerable communities. The cost-savings associated with these health workers is likely to become more pertinent as the nation begins to develop and healthcare costs increase. It is imperative that proper action be taken to retain these health workers as every VHW who leaves the program increases healthcare costs onto the Bhutanese government.

Identifying and confirming demotivating factors for village health workers in rural communities of Bhutan.

BACKGROUND: Bhutan achieved over 95% of health coverage through its primary health care network and geared towards achieving and ensuring Universal Health Coverage. About 62.2% of the Bhutanese people are rural dwellers, living in villages. Village health workers (VHWs) are essential for primary health care delivery at the community level in order to bridge the gap between the health care system and the communities. However, increasing numbers of VHWs leaving the health care system remain a challenge for Bhutan. This study intends to find existing problems of motivation and retention among VHWs in Bhutan and to devise appropriate strategies for making effective policy interventions. METHODS: This quantitative study with a cross-sectional survey design aims to determine demotivating factors. One stage cluster sampling technique was applied for VHWs from 12 districts in three regions. Data were collected by the trained enumerators using a pre-tested semi-structured questionnaire. RESULTS: The Confirmatory factor analysis identified and confirmed a four-factor model of demotivation among VHWs in Bhutan. Among the four factors, the social factor was the main factor for VHWs leaving the health care system. However, the holistic combination of both financial and non-financial motivator needs to be taken into consideration. The content analysis revealed six areas of recommendation for improving motivation and retention among VHWs. CONCLUSION: The study concluded that managers and policymakers must give more emphasis to non-financial motivators through the holistic approach to existing altruism and intrinsic needs.

A Cross-Sectional Survey Analyzing Community Perception and Utilization of Village Health Workers Stratified by the Urban-Rural Divide Within the Kingdom of Bhutan.

Village health workers (VHWs) serve as an integral health resource for many resource limited nations, including the Kingdom of Bhutan. As such, we aimed to identify community perceptions as well as utilization rates and types with relation to VHWs based on the urban-rural divide. Our team conducted a randomized survey of 429 community members in 14 villages within the Western region of Bhutan. Our findings indicate VHWs in rural communities are requested for their services twice as much as their urban counterparts. More specifically, urban VHWs are utilized 2.5 times more for general community services, while rural VHWs are utilized more for accessing medications. Additionally, our research indicates a need to increase training of VHWs as well as overall program promotion relating to the specific services that VHWs can provide. These investigations indicate the importance of differentially allocating resources, programming, and training based on the urban-rural divide.

Motivational Factors Influencing Retention of Village Health Workers in Rural Communities of Bhutan.

Village health workers (VHWs) are the first contact extending vital health services to unreached and underserved communities in Bhutan. VHWs truly embody the principles of primary health care and are effective catalysts in promoting community health. This study identifies and confirms factors motivating VHWs to remain in the health care system. This is a quantitative study with a cross-sectional survey design. Two-stage cluster sampling was used with VHWs from 12 districts representing 3 regions of Bhutan. Data were collected using pretested semistructured questionnaires. Confirmatory factor analysis was used for data analysis. Findings reveal a 4-factor model of motivations among VHWs that includes social, personal, job related, and organizational factors. Among these, the social factor most significantly motivates VHWs to remain in the health care system. VHW motivation can be further fostered by providing a holistic combination of financial and nonfinancial incentives that recognize intrinsic needs and empower innate altruism.

Prevalence of Exclusive Breastfeeding and Factors Associated With Exclusive Breastfeeding of Children in Trongsa District, Bhutan.

The World Health Organization estimated that about 800 000 infant deaths could be prevented annually by exclusively breastfeeding infants for the first 6 months of life. This study aimed to examine the prevalence of exclusive breastfeeding and its associated factors. A total of 192 mothers participated. The prevalence of exclusive breastfeeding practice in Trongsa district was 97% at 1 month, declining to 58% at 6 months. Mothers who returned to formal work were less likely to exclusively breastfeed than those who were farmers or housewives. The main reasons stated by the mothers for not exclusively breastfeeding were lack of the mother's self-confidence that the child is getting enough breastmilk and mothers having to return to work, 59% and 22%, respectively. The rate of exclusive breastfeeding in Trongsa district of Bhutan is high, and every effort should be made to maintain and improve this rate.