Abstract:

This study monitored quality improvement performance standards of Community Health Workers (CHWs) who were providing integrated community case management of malaria, pneumonia and diarrhea (iCCM) in two selected LGAs. One hundred and fifty-two trained CHWs providing iCCM services in Akwa Ibom State, Nigeria were monitored and assessed using one page tool on quality improvement performance standards. The tool has 37 performance criteria (PC) to measure CHWs’ knowledge, skills and competence in 3 sections: History taking and Examination; Conducting RDTs for Malaria; and Illness Management. Trained assessors observed CHWs providing services. Each correctly performed criterion was scored 1 point. Four rounds of assessments were conducted at an interval of two months from June 2011 - March, 2012 as part of the efforts to strengthen services provided by CHWs. The result shows that during Round 1 CHWs achieved an average of 19 (52.2%) performance standards. This rose to 25 (67.5%) in Round 2; 28 (75. 6%) in 3 and 30 (81.1%) in round 4 and (p = 0.00). Therefore, the number of CHWs that scored >=80 increased from 79 in round-1 to 124 in round-4. PC that needed to be strengthened the most included reinforcement on checking RDT expiry date, recording results, and safe disposing of sharps. Providing feedback in-between rounds of assessments contributed to CHWs improved performance during the subsequent round. The feedback mechanism provides the platform for addressing the barriers that limits the CHWs extent of achieving performance standards for malaria improved service delivery

Keywords: Measurement, Quality improvement performance standards, community health workers, integrated community case management of malaria, pneumonia and diarrhea.

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