Clinical trial NCT05176106: Advancing the Health of Rural Communities in Uganda Through Strong Community Health Programs
Official title: Advancing the Health of Rural Communities in Uganda Through Strong Community Health Programs
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Incentives
Health Behavior
Health Care Utilization
Keywords: Community Health Workers
Incentives
Uganda
Motivation
Retention
Performance
Lead sponsor: Johns Hopkins Bloomberg School of Public Health
Sponsor class: OTHER
Collaborators: name: Makerere University
First posted: 2022-01-04
Enrollment: 769
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Parishes will be randomized to intervention or control. VHTs in the intervention parishes will receive the incentives package as part of the intervention.
Primary purpose: TREATMENT

Brief summary: The overarching goal of this study is to improve the health of women and children in rural areas of Uganda through strengthening of the community health workforce, which provides critical health services to the rural poor.

Detailed description: Uganda, like several countries in Sub-Saharan Africa, faces a shortage of skilled healthcare workers, and a disproportionate concentration of workers in urban areas. This disparity has dire consequences for rural populations, who have higher fertility rates, lower utilization of maternal and child health services, lower levels of access to safe drinking water and sanitation services, and poorer vaccination coverage. Women and children in rural and remote communities bear the disproportionate brunt of poor access to and poor quality of health care. Village Health Teams (VHTs), Uganda's community health workers (CHW), were introduced to address some of these inequities by providing basic health services to the rural poor. However, like many CHW programs globally, the VHT program has high levels of attrition, owing to inadequate systems and financial support.

The objectives of this study are to understand:

1. What structure and group of incentives is best suited to motivate VHTs, improve their performance in the delivery of services, and increase their retention in the health workforce?
2. What is the behavioral mechanisms through which new incentives may work or fail to work?
3. How do the changes in the national VHT program impact utilization of maternal and child health services, sanitary practices, and perception of quality of health services at the community-level? What is the impact of COVID-19 on VHT practices on community health?

This study will evaluate a 1-year incentives intervention provided to VHTs in Uganda's Masindi District. It is a two-armed clinical trial, where parishes will be randomized to the incentives intervention (i.e., an incentives package will be provided to VHTs practicing in the intervention parishes; control parishes VHTs will not receive an incentives package). The primary outcomes include assessing VHT performance, VHT motivation, VHT retention, trends in utilization of maternal and child health services, and trends in the adoption of sanitary practices. Outcomes for VHT performance, VHT retention, trends in utilization of maternal and child health services, and trends in adoption of sanitary practices will be measured monthly. Outcomes for VHT motivation will be measured twice, at baseline (Month 1) and endline (Month 12).

Eligibility criteria: Inclusion Criteria:

* Must be an active VHT in Uganda's Masindi district.

Exclusion Criteria:

* Anyone who fails to meet the inclusion criteria specified above will be excluded.

Primary outcomes:
measure: Change in VHT Performance
timeFrame: Measured monthly for 12 months
measure: Change in VHT Motivation
timeFrame: Baseline (Month 1) and Endline (Month 12)
measure: Change in VHT Retention
timeFrame: Measured monthly for 12 months
measure: Change in Maternal and Child Health Services Utilization
timeFrame: Measured monthly for 12 months
measure: Change in Adoption of Sanitary Practices
timeFrame: Measured monthly for 12 months
Secondary outcomes:
Other outcomes:
Locations:
city: Kampala
country: Uganda
facility: Makerere University School of Public Health
Study officials:
References: