Measuring productivity and its relationship to community health worker performance in Uganda: a cross-sectional study

To explore the nature of the relationship between and factors associated with productivity and performance among the community health volunteer (CHV) cadre (Village Health Teams, VHT) in Busia District, Eastern Uganda. The study was carried out to contribute to the global evidence on strategies to improve CHV productivity and performance.

This cross-sectional study was conducted with 140 VHT members as subjects and respondents. Data were collected between March and May 2013 on the performance and productivity of VHT members related to village visits and activities for saving maternal and child lives, as well as on independent factors that may be associated with these measures. Data were collected through direct observation of VHT activities, structured interviews with VHTs, and review of available records. The correlation between performance and productivity scores was estimated, and LASSO regression analyses were conducted to identify factors associated with these two scores independently.

VHTs demonstrated wide variation in productivity measures, conducting a median of 13.2 service units in a three-month span (range: 2.0-114.9). Performance of the studied VHTs was generally high, with a median performance score (out of 100) of 96.4 (range: 50.9-100.0). We observed a weak correlation coefficient of 0.05 (p = 0.57) between productivity and performance scores. Older VHT age (≥50 years old, reference: <50 years old) (11.14, 95% CI: 3.26-19.01) and knowledge of danger signs (in units of ten-percentage points, 1.92, 95% CI: 0.01-3.83) were positively associated with productivity scores. Job satisfaction (1.46, 95% CI: 0.13-2.80) and knowledge of danger signs (in units of ten-percentage points, 1.02, 95% CI: 0.05-1.98) were positively associated with performance scores.

Older VHT age and knowledge of danger signs were positively associated with productivity, and job satisfaction and knowledge of danger signs were positively associated with performance. No correlation was observed between productivity and performance scores. This lack of correlation suggests that interventions to improve CHV effectiveness may affect the two dimensions of effectiveness differently. We recommend that productivity and performance both be monitored to evaluate the overall impact of interventions to increase CHV effectiveness.