Establishing Village Health Clubs to Improve Community Health Worker Motivation and Performance

"The Village Health Club intervention, when the key elements are in place, can be an effective approach to achieving behaviour change, while strengthening and supporting the role of the VHT [as village health team]."

The Malaria Consortium's inSCALE project in Uganda has been working to help scale up quality integrated community case management to improve child health. This Learning Paper details the process of establishing Village Health Clubs with the aim of improving the motivation, performance, and acceptance of community health workers, known as village health team members (VHTs).

Village Health Clubs are community-led forums with the VHT as the main focal point and facilitator. The clubs are based on five key pillars (detailed in the learning paper), and use a four step participatory learning and action cycle. Club members define child health problems and decide on and implement actions and solutions together. "The key innovations in the inSCALE community intervention are that Village Health Clubs are focused around VHTs, contrary to existing community groups and health committees, and are designed to be locally owned, with the VHTs accountable to the communities in which they operate."

Data collected through the process evaluation "revealed predominantly positive feedback, especially regarding VHT motivation and performances." For example, the "majority of VHTs reported a positive impact on their status and standing in the community; community support; a feeling of connectedness to the community; improved performance and motivation; and increased access to and use of appropriate treatment for children under five." The Village Health Club flipbook (facilitator's guide) also increased VHT knowledge and skills on disease management and prevention, positively impacting on the quality of service provision. As well, Village Health Clubs reduced VHT supervisors' workload, both at health facility level, owing to reduced patient load, and at community level, as the clubs are performing health education and sensitisation.

The Learning Paper also outlines cases where the Village Health Clubs were not successful. Some of the challenges included lack of interest from the community (in particular from youth and men), inadequate stationery supplies, community members expecting allowances, and lack of support from local leaders.

The report offers a number of lessons learned, which include the following:

• While the clubs can be effectively support the role of the VHT, they can also be used as platforms for other community education and empowerment initiatives, either by the community themselves or for non-governmental and government initiatives.
• "Incorporating peer-to-peer learning sessions for VHTs during district review meetings significantly boosted club formations, membership and activities, and fostered a sense of connectedness and community among the VHTs."
• "Planning for tools and elements to be in place is essential for the successful rollout of the Village Health Club intervention. Simple things such as an adequate stationery supply are vital in retaining and recruiting club members."
• "Linkages should be made to future projects, tackling other health issues such as maternal health and neglected tropical diseases to continue community education on other health topics."
• "Peri-urban areas did not respond well to the Village Health Club concept, whereas rural communities tended to embrace the concept more willingly. The suggestion is that the need for VHTs in peri-urban areas is likely to be different to that in rural areas."

As a step forward, Malaria Consortium will continue to introduce Village Health Clubs in other parts of Uganda, with additional learning materials included on neglected tropical diseases and maternal health. In and beyond the Uganda context, lessons learnt from the Village Health Club intervention are being incorporated into Malaria Consortium,s social mobilisation activities in other countries.