Can a community health worker and a trained traditional birth attendant work as a team to deliver child health interventions in rural Zambia?

BACKGROUND: Teaming is an accepted approach in health care settings but rarely practiced at the community level in developing countries. Save the Children trained and deployed teams of volunteer community health workers (CHWs) and trained traditional birth attendants (TBAs) to provide essential newborn and curative care for children aged 0-59 months in rural Zambia. This paper assessed whether CHWs and trained TBAs can work as teams to deliver interventions and ensure a continuum of care for all children under-five, including newborns. METHODS: We trained CHW-TBA teams in teaming concepts and assessed their level of teaming prospectively every six months for two years. The overall score was a function of both teamwork and taskwork. We also assessed personal, community and service factors likely to influence the level of teaming. RESULTS: We created forty-seven teams of predominantly younger, male CHWs and older, female trained TBAs. After two years of deployment, twenty-one teams scored "high", twelve scored "low," and fourteen were inactive. Teamwork was high for mutual trust, team cohesion, comprehension of team goals and objectives, and communication, but not for decision making/planning. Taskwork was high for joint behavior change communication and outreach services with local health workers, but not for intra-team referral. Teams with members residing within one hour's walking distance were more likely to score high. CONCLUSION: It is feasible for a CHW and a trained TBA to work as a team. This may be an approach to provide a continuum of care for children under-five including newborns.

Measuring teamwork and taskwork of community-based "teams" delivering life-saving health interventions in rural Zambia: a qualitative study.

BACKGROUND: The use of teams is a well-known approach in a variety of settings, including health care, in both developed and developing countries. Team performance is comprised of teamwork and task work, and ascertaining whether a team is performing as expected to achieve the desired outcome has rarely been done in health care settings in resource-limited countries. Measuring teamwork requires identifying dimensions of teamwork or processes that comprise the teamwork construct, while taskwork requires identifying specific team functions. Since 2008 a community-based project in rural Zambia has teamed community health workers (CHWs) and traditional birth attendants (TBAs), supported by Neighborhood Health Committees (NHCs), to provide essential newborn and continuous curative care for children 0-59 months. This paper describes the process of developing a measure of teamwork and taskwork for community-based health teams in rural Zambia. METHODS: Six group discussions and pile-sorting sessions were conducted with three NHCs and three groups of CHW-TBA teams. Each session comprised six individuals. RESULTS: We selected 17 factors identified by participants as relevant for measuring teamwork in this rural setting. Participants endorsed seven functions as important to measure taskwork. To explain team performance, we assigned 20 factors into three sub-groups: personal, community-related and service-related. CONCLUSION: Community and culturally relevant processes, functions and factors were used to develop a tool for measuring teamwork and taskwork in this rural community and the tool was quite unique from tools used in developed countries.