An evaluation of a peer supervision pilot project among community health workers in rural Uganda.

Background: Living Goods operates a Community Health Worker (CHW) program in 19 districts of Uganda, where CHWs are supervised by full time Community Health Supervisors. This model is effective, but expensive. Evidence indicates that peer supervision can be a substitute and cheaper model for CHW supervision. We describe our experience and outcomes while implementing peer supervision among CHWs in Mayuge district. Objectives: 1. To compare health services delivery outcomes between the two supervision models. 2. To compare costs of the two supervision models.. Methods: Internal organizational records from January to December 2019 were reviewed. Focus group discussions and in-depth interviews with participating CHWs were also conducted. Qualitative analysis was performed using thematic content analysis. Quantitative data was summarized to generate averages, percentages and graphs. Findings: CHWs under the peer supervision performed better than those under standard supervision against all key performance indicators. The total cost to maintain the peer supervision model for 1 year was USD $176 per CHW versus USD $273 among CHWs under the standard supervision model. Peer supervision thus resulted in overall cost savings of 36%. There was lower attrition among CHWs under peer supervision compared to standard supervision (10% versus 17%). Conclusions: Peer supervision is a feasible and more affordable model of supervising CHWs.

Lessons from an eight-country community health data harmonization collaborative.

BACKGROUND: Community health workers (CHWs) are individuals who are trained and equipped to provide essential health services to their neighbors and have increased access to healthcare in communities worldwide for more than a century. However, the World Health Organization (WHO) Guideline on Health Policy and System Support to Optimize Community Health Worker Programmes reveals important gaps in the evidentiary certainty about which health system design practices lead to quality care. Routine data collection across countries represents an important, yet often untapped, opportunity for exploratory data analysis and comparative implementation science. However, epidemiological indicators must be harmonized and data pooled to better leverage and learn from routine data collection. METHODS: This article describes a data harmonization and pooling Collaborative led by the organizations of the Community Health Impact Coalition, a network of health practitioners delivering community-based healthcare in dozens of countries across four WHO regions. OBJECTIVES: The goals of the Collaborative project are to; (i) enable new opportunities for cross-site learning; (ii) use positive and negative outlier analysis to identify, test, and (if helpful) propagate design practices that lead to quality care; and (iii) create a multi-country 'brain trust' to reinforce data and health information systems across sites. RESULTS: This article outlines the rationale and methods used to establish a data harmonization and pooling Collaborative, early findings, lessons learned, and directions for future research.

Sex differences in family planning knowledge, attitudes, and use in Uganda.

BACKGROUND: Literature is satiated with studies focusing on knowledge, attitude, and practices of family planning (FP) among the female population, conversely, the gaps in sex-disaggregated data on FP continue to exist. This study sought to report sex differences existing in FP knowledge, attitude, and use in Uganda. METHODS: This study uses data from a household survey that covered 16 districts in Uganda. Multi-stage cluster randomized sampling was employed for participant selection. Bivariate analysis for categorical data was conducted. Multilevel logistic regression model was applied to model the effects of socio-demographic characteristics on the use of modern FP methods. RESULTS: Data from 4,352 respondents in the ratios of 70 % females and 30 % of males were analyzed. The mean age was 28.7 SD (8.5) and was not significantly different between males and females. More male respondents had secondary or higher level of education (44 %) than females (36 %). Knowledge of at least one modern FP method was high, but small significant differences were revealed between males (96 %) and females (98 %). Significant knowledge differences were seen in specific FP methods. A higher proportion of females (71 %) than males (67 %) perceived modern FP methods as always available in the community whereas more males (40 %) believed that modern FP methods can result in infertility than females (35 %). There was high self-efficacy about family planning methods use in both males and females. The proportion of married females that reported using or their partner using a modern FP method was 39 % compared to 45 % reported by the married males. Approx. 53 % of the males compared to 37 % of the females that reported condom use also cited STI/HIV prevention as the main reason for condom use suggesting dual protection as a driver for use. Males, young adults, the more educated, and those in marriage or active relationships were more likely to use modern FP methods. CONCLUSIONS: Our study found significant sex differences in knowledge, attitudes, and use of FP methods. The young adults and more educated respondents were more likely to use FP methods. The high self-efficacy observed for both males and females is a signal that both sexes can use FP methods. Project strategies and implementation should take into consideration the existing differences by sex and devise sex-tailored approaches to improve FP knowledge, attitudes, and use in this population. There was increased reporting of condom use as an FP and STI/HIV prevention method, follow-up studies aiming at succinctly measuring dual protection, and its drivers for both sex should be done.