The Influence of Community Health Workers on Uptake of Maternal Health Services: Case Study of Musanze District, Rwanda

Abstract

Background: Community-based initiatives are a worldwide policy that guarantees that key health services are available and accessible closer to the community. CHWs are an important element of healthcare services in Rwanda. Community health workers integrate individuals of their communities to provide preventive, habitual, and emergency maternity healthcare requirements. Maternal health is still a challenge to the achievement of SDGs by 2030 in the health-care sector compared with the effort provided by CHWs.  The aim of study was to assess the influence of community health workers' role on uptake of maternal health services in Musanze District. Methods: The study design used was an analytical cross-sectional study design utilizing both quantitative and qualitative methods. Simple random sample approach was employed to choose 208 CHWs and 16 CHWs’ supervisors were interviewed for qualitative data (KII). The statistical tool for social sciences (SPSS) Version 26, was used to examine the data. Categorical variables were summarized with descriptive statistics for frequencies and percentages. Bivariate analysis with the Chi-square test of independence was used to check the association between both dependent and independent variables. Ordinal logistic regression was used as the most suitable inferential statistic. Qualitative data were analyzed by NVIVO version 10. Results: This study found that the uptake of maternal health services was regarded as very high. 85.1% of CHWs were knowledgeable on the warning signs of an emergency among pregnant mothers, and 89.4% reported that they would act based on these warning signs. CHWs had necessary training to provide care to pregnant mothers with p* =. 001. Skills that CHWs have on the administration of misoprostol to prevent post-partum hemorrhage was significant with p* <.001. Factors that influenced uptake of maternal health services were CHW’s regular supervision with p*=.001, provision of transportation p*=.001, regular refresher training p* =.002, and motivation/incentives p*=.001, as they were associated with the performance of CHWs towards the uptake of Maternal Health care services. The research recommends improvement of maternal health services through access to contraception, antenatal care, and postnatal care, with particularly scale-up key motherly health services, regular supervision should be done at least every month and training for CHWs quarterly, governmental support in terms of motivations of CHWs.