Development of strategies for registered nurses to facilitate services rendered by community health workers in Hardap, Kavango east and Khomas regions, Namibia
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Date
2022
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Publisher
University of Namibia
Abstract
With the adoption of the community health worker programme, the primary health care directorate of the ministry of health aimed at delivering family and community-centred promotive, preventive, rehabilitative and basic curative services to all citizens of Namibia. The programme’s services focused on preventive and promotive infant and under-five-year-olds’ health care, maternal and neonatal health care, adolescent and youth-friendly health services, human immunodeficiency virus and acquired immunodeficiency syndrome and tuberculosis prevention, social welfare and disability prevention. However, no functional unit with its own ideal structure for monitoring and facilitation of community health workers’ services was established. The latter resulted in the programme experiencing challenges with the planning of facilitation strategies that would enhance the programme’s effects.
The overall purpose of the study was to investigate the effectiveness and functionality of facilitation (mentoring, supervision, monitoring, evaluation and training) by the registered nurses to the community health workers deployed by the ministry in the Hardap, Kavango East and Khomas regions of Namibia. It was also to develop strategies for registered nurses to facilitate services rendered by CHWs based on Standard Operating Procedures Guidelines of primary health care. This study was conducted in a quantitative and qualitative nature, thus a mixed methods approach in five phases. Phase1 being a situational analysis, phase 2 conceptual framework development, phase 3 strategy development and phases 4 and 5 comprising testing the implementability and preliminary evaluation of the developed strategies in the Khomas region. The study was conducted within a pragmatist
paradigm, which employed the quantitative research approach, exploratory, descriptive, and non experimental designs. At the same time, it was interpretive, employing a qualitative phenomenological, exploratory, contextual and descriptive research approach to understand recipients’ experiences.
Four groups of respondents (138 community health workers for the quantitative design, three primary health care supervisors, 10 registered nurses and 64 community health workers for the qualitative design) were used to learn their responses and experiences. Structured questionnaires were completed
for the quantitative part, while eight focus group discussions were performed with community health workers. Unstructured in-depth interviews were conducted with registered nurses and primary health care supervisors until data saturation.
The main challenges that were identified from the situational analysis include, inadequate and infrequent facilitation of community health workers’ services, negative perceptions on facilitation of community health workers’ services and insufficient communication among implementers.
Furthermore, the findings indicated lack of feedback and training, lack of supportive supervision, monitoring and evaluation and poor management of the community health worker programme.
The findings shaped the basis for the conceptualisation in phase 2. Key findings from the mixed methods research were linked to the practice-oriented theory of Dickoff, James and Wiedenbach (as cited in Chinn & Kramer, 2015). The practice-oriented theory consists of concepts such as agent (the researcher), the recipient (registered nurse who will primarily be introduced to the developed strategies
and community health workers who will benefit from registered nurse knowledge on strategies) as well as the context (health facilities where the developed strategies are to be used and communities where community health workers are deployed and where facilitation will take place). In this study, dynamics refer to the challenges that registered nurses experience in facilitating services rendered by community health workers. Procedure refers to the process followed by the agent in the development of strategies for effective implementation of the community health worker programme. The terminus refers to facilitators and supervisors who utilise the developed strategies to facilitate the services rendered by community health workers, ensure the community health worker programme is managed appropriately and functioning optimally, and that community health workers are receiving in-service training and are satisfied with the facilitation of their services. Phase 3 dealt with the development of the strategies for facilitators of the community health workers. The researcher used the findings from the situational
analysis (phase 1) and the survey list of Dickoff et al. (as cited in Chinn & Kramer, 2015) as the reasoning map. The Standard Operating Procedure Guidelines of the ministry of health (Ministry of Health and Social Services, 2014) supplemented the information of the five strategies.
Phase 4 aimed at determining implementability of developed strategies in the Khomas region, as there were limitations to determining implementability in the Hardap and Kavango East regions. This was done to authenticate and ensure accessibility of developed strategies. The researcher made use of
national and international professionals who were experts in the field of community health workers.
During phase 5, a preliminary evaluation of the strategies was done in accordance with the criteria proposed by Chinn and Kramer (2011), namely clarity, simplicity, generality, accessibility and importance. The researcher achieved this by conducting a two-day discussion workshop during which
attendees gave their comments and inputs. The study recommends that districts construct a supervision structure and deploy a knowledgeable enrolled nurse to provide frequent, supportive supervision to community health workers. Furthermore, the researcher recommends compulsory attachment of community health workers to outreach teams. Another recommendation proposed is the strengthening of advocacy within the community.
Description
A dissertation submitted in fulfillment of the requirements for the Degree of Doctor in Nursing Science
Keywords
Community health workers, Ministry of Health, strategies