地域医療と健康教育

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Implications of the SURE-P MCH National Village Health Worker Experience in Northern Nigeria for the Road Map for Village Health Workers in Nigeria

Findley SE, Afenyadu G, Okoli U, Baba H, Bature R, Mijinyawa S, Bello-Malabu J and Mohammed Sidi A

Background: Community Health Workers (CHWs) can facilitate access to primary health care services among isolated rural communities. This study examines how Nigeria’s Subsidy Reinvestment and Empowerment Program on Maternal and Child Health (SURE-P MCH) Village Health Worker (VHW) programme provides a model for the Nigerian Road Map for VHWs.

Methods: We used pre-post with comparison model design, comparing two successive VHW cohorts, recruited in 2013 (n=109) and in 2014 (n=147) in Jigawa, Katsina and Zamfara states, northern Nigeria. We collected performance statistics and conducted interviews with the VHWs, and focus group discussions with the VHWs, their CHEW mentors, the in-charges at the facilities, and the village health/ ward development committees overseeing the recruitment and support of the VHWs. Significant differences between the 2013 and 2014 cohort were assessed using bi-variate statistics.

Results: All VHWs were female. The VHWs worked 20.8 hours/week, and averaged 34.3 home visits/month. After their training, 90% were comfortable with their primary tasks of encouraging antenatal care (ANC) visits and teaching about a healthy pregnancy. They identified 11.7 newly pregnant women per month, of whom 9.0 went to ANC. The pictorial guides were the most useful tools for encouraging ANC and facility deliveries. Compared to before the VHWs began work, clinics recorded 84.8% more women making 4+ ANC visits and 119.9% more skilled birth deliveries. Clinical consultations at the PHC referral sites for the VHWs increased significantly after the introduction of the VHWs and again from 2013 to 2014 (p < 0.010). Qualitative feedback identified the following factors supporting their effectiveness: linkage to support systems within  and in the peripheral health facility, pictorial materials and a thank-you stipend for services.

Conclusion: The SURE-P MCH VHWs were associated with significant increases in maternal health service uptake at the rural PHCs to which they were affiliated. The factors associated with their effectiveness should be incorporated into the Nigerian Road Map for VHWs: training in coaching health promotion topics, pictorial guides to assist in coaching, mentoring and support from the CHEWs and the community, and a nominal stipend.