An Exploration of Attributes Effecting the Relationship between Competencies and Performance of CHWs in a Rural Block of Central India

Exploration of Attributes Effecting the Relationship between Competencies and Performance of CHWs in a Rural block of Central India. Int 2022;12(2):65-70. This study was conducted with the primary objective to establish if there is a directional relationship between envisioned competencies and real-world performance (PBI)? Whether incentivization reflects in its truest sense the competency? Which was translated to performance by the CHW. Moreover, what are those CHW characteristics at community level like population, distance to the health facility, health system level like availability of logistics, training and individual levels like age, education, caste, religion, marital status etc. 6,7 which may serve as effect modifiers in the aforesaid relationship. However, the existing literature showed almost studies on CHW performance that could three-dimensional relationship. ABSTRACT Introduction: Induction of Community Health Workers (CHWs) into various health programs is considered as an integral strategy to achieve universal health coverage. Thus, it is prudent to explore and understand the CHWs individual and the system level interactions and their further translation into performance and actionable domains. Objectives: To quantify the relationship structure between envisioned competencies and CHW performance with factors operating at individual and the immediate system level as effect modifiers. Methods: A cross-sectional study was done in primary rural health care settings of Madhya Pradesh state in Central India. CHWs were stratified as relatively low performing (RLP) and relatively high performing (RHP) based on their annual performance-based incentives for the year (April 2017- March 2018). CHWs were administered a self-reported questionnaire that included socio demographic details, knowledge, skills assessment and availability of logistics. Results: Among the 90 eligible CHWs, 31 RLP and 30 RHP CHWs were interviewed. The CHWs performance was found to be significantly associated with age, education, caste, presence of under 5 children, knowledge and competency scores. However, while adjusting for the confounders only age and educational status were found to be significant. Further cluster analysis revealed two clusters based on individual and system characteristics which was found to influence the CHWs performance. Conclusion: The relationship between the CHWs truest competencies and performance based incentivisation tends to have been influenced by age and education which could help in developing a more focused supportive supervision catering to their needs.