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Development of a tool for assessing quality of comprehensive care provided by community health workers in a Community-Based Care programme in South Africa

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Griffiths, Frances, Babalola, Olukemi, Brown, Celia A., de Kadt, Julia, Malatji, Hlologelo, Thorogood, Margaret, Tseng, Yu-Hwei and Goudge, Jane (2019) Development of a tool for assessing quality of comprehensive care provided by community health workers in a Community-Based Care programme in South Africa. BMJ Open, 9 . e030677. doi:10.1136/bmjopen-2019-030677

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Official URL: https://doi.org/10.1136/bmjopen-2019-030677

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Abstract

Objective To develop a tool for use by non-clinical fieldworkers for assessing the quality of care delivered by community health workers providing comprehensive care in households in low- and middle-income countries.

Design We determined the content of the tool using multiple sources of information, including interactions with district managers, national training manuals and an exploratory study that included observations of 70 community health workers undertaking 518 household visits collected as part of a wider study. We also reviewed relevant literature, selecting relevant domains and quality markers. To refine the tool and manual we worked with the fieldworkers who had undertaken the observations. We constructed two scores summarising key aspects of care: (1) delivering messages and actions during household visit, and (2) communicating with the household; we also collected contextual data. The fieldworkers used the tool with community health workers in a different area to test feasibility.

Setting South Africa, where community health workers have been brought into the public health system to address the shortage of healthcare workers and limited access to healthcare. It was embedded in an intervention study to improve quality of community health worker supervision.

Primary and secondary outcomes Our primary outcome was the completion of a tool and user manual.

Results The tool consists of four sections, completed at different stages during community health worker household visits: before setting out, at entry to a household, during the household visit and after leaving the household. Following tool refinement, we found no problems on field-testing the tool.

Conclusions We have developed a tool for assessing quality of care delivered by community health workers at home visits, often an unobserved part of their role. The tool was developed for evaluating an intervention but could also be used to support training and management of community health workers.

Item Type: Journal Article
Alternative Title:
Subjects: R Medicine > RA Public aspects of medicine
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH)
Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Primary health care -- Evaluation -- South Africa, Community health aides -- South Africa, Health services accessibility -- South Africa, Medical care -- Evaluation
Journal or Publication Title: BMJ Open
Publisher: BMJ
ISSN: 2044-6055
Official Date: 5 September 2019
Dates:
DateEvent
5 September 2019Published
29 July 2019Accepted
Volume: 9
Article Number: e030677
DOI: 10.1136/bmjopen-2019-030677
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
Copyright Holders: The Authors
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
MR/N015908/1[MRC] Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
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