Community Health Workers: Train or Restrain? – A Longitudinal Survey to Assess Training Impact in Community Health Workers Performance

The shortage of human resources of health is affecting developing countries that frequently use Community Health Workers (CHW)-people chosen and trained in their communities to respond to small health problems.

Twenty-two out of 28 CHW from the region of Bolama (Guinea-Bissau) participated in this study, which intended to assess the impact that training on management of diarrheal diseases in children younger than 5years of age had in the effectiveness of diagnosis and treatment of these diseases. A longitudinal survey was developed with 3 evaluation moments: one before training and two other after training (one and 3 months after, respectively).

An observation grid was used during the consultations made by CHW which evaluated both “Signs and Symptoms” and “Diagnosis and Treatments” identified by the CHW. A similar grid was filled by a medical doctor - considered as the external validation standard.

Friedman’s 2-way ANOVA analysis and Q-Cochran tests were applied to compare the success obtained by CHW in the identification of the items throughout the study. A logistic regression model was also applied to check which CHW characteristics could possibly influence the diagnosis and treatment effectiveness.

Results illustrate that CHW improved significantly their performance after training: correct identification of diagnosis got statistically significantly better (p=0.001) and all treatment items showed a significant improvement. However, 3 months later both diagnosis and treatment identification got worse.

CHW training impact is limited and fades 3 months after training, possibly because CHW tend to lose capabilities and reduce the use of treatment algorithms and guidelines over time. This decrease in effectiveness can be also caused by the lack of support, supervision and continuous training.

In conclusion, selection and supervision, together with support and continuous training of CHW are as important as initial training and should be considered by all health policy-makers.