Assessing the implementation of revamped community health workers programme in Tanga Region, Tanzania

Stephen Adam Mwandambo; George Julius Babune

doi:10.51867/ajernet.7.4.128

Authors

Stephen Adam Mwandambo Tanga City Council, Tanzania
George Julius Babune Tanzania Institute of Accountancy, Tanzania https://orcid.org/0000-0001-6103-3779

DOI:

https://doi.org/10.51867/ajernet.7.4.128

Keywords:

Community Health Workers, Implementation Process, Performance Outcomes, Supervision, Training, Tanzania

Abstract

The purpose of this study was to assess how effective the Community Health Workers (CHWs) program was implemented to effect community health service delivery in Tanga region. Specifically, the study examined the adequacy of CHW training and the extent of supervision among CHWs, health facility supervisors, and community members. The study was guided by the Health Systems Strengthening (HSS) Framework, which emphasises the interconnected roles of service delivery, the health work force, financing and governance. A cross-sectional descriptive design was employed, using structured questionnaires and interview guides to collect data from 206 Community Health Workers, 53 health facility supervisors, and 398 community members selected from three districts of the region through stratified random and purposive sampling techniques. Data were analyzed using both descriptive statistics (frequencies, percentages, and means) to examine key implementation factors. The findings indicated that the majority of CHWs were young, relatively well-educated, and had received formal training and regular supervision. Most CHWs (98%) rated their training as adequate and over 85% expressed satisfaction with the program. The study concludes that the revamped CHW Program has been effectively implemented and has contributed to improved community health outcomes in Tanga Region. However, sustainability depends on enhanced resource allocation, consistent incentives, and strengthened supervision. It is recommended that policymakers institutionalise regular training, ensure reliable supply chains, and integrate CHW performance monitoring into district health systems.

Downloads

Download data is not yet available.

References

Ballard, M., & Montgomery, P. (2017). Systematic review of interventions for improving the performance of community health workers in low-income and middle-income countries. BMJ Open, 7(10), Article e014216. https://doi.org/10.1136/bmjopen-2016-014216

Banteyerga, H. (2011). Ethiopia's health extension program: Improving health through community involvement. MEDICC Review, 13(3), 46-49.

https://doi.org/10.37757/MR2011V13.N3.11

Bhutta, Z. A., Lassi, Z. S., Pariyo, G., & Huicho, L. (2010). Global experience of community health workers for delivery of health-related Millennium Development Goals: a systematic review, country case studies, and recommendations for scaling up. World Health Organization.

Binagwaho, A., & Scott, K. W. (2015). Improving the world's health through the post-2015 development agenda: perspectives from Rwanda. International journal of health policy and management, 4(4), 203-205. https://doi.org/10.15171/ijhpm.2015.46

Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2, Article 40. https://doi.org/10.1186/1748-5908-2-40

https://doi.org/10.1186/1748-5908-2-40

Donabedian, A. (1988). The quality of care: How can it be assessed? JAMA, 260(12), 1743-1748. https://doi.org/10.1001/jama.260.12.1743

Ferla, J. P., Gill, M. M., Komba, T., Abubakar, A., Remes, P., Jahanpour, O., Mariki, M., Mang'enya, M. A., Van de Ven, R., & Antelman, G. (2023). Improvement of community health worker counseling skills through early childhood development (ECD) videos, supervision and mentorship: A mixed methods pre-post evaluation from Tanzania. PLOS Global Public Health, 3(6), e0001152.

https://doi.org/10.1371/journal.pgph.0001152

Frumence, G., Goodman, M., Chebet, J. J., Mosha, I., Bishanga, D., Chitama, D., ... & Baqui, A. H. (2019). Factors affecting early identification of pregnant women by community health workers in Morogoro, Tanzania. BMC Public Health, 19(1), 895.

https://doi.org/10.1186/s12889-019-7179-1

Gadsden, T., Mabunda, S. A., Palagyi, A., Maharani, A., Sujarwoto, S., Baddeley, M., & Jan, S. (2021). Performance-based incentives and community health workers' outputs, a systematic review. Bulletin of the World Health Organization, 99(11), 805-818.

https://doi.org/10.2471/BLT.20.285218

Glenton, C., Javadi, D., & Perry, H. B. (2021). Community health workers at the dawn of a new era: 5. Roles and tasks. Health Research Policy and Systems, 19(Suppl 3), Article 128. https://doi.org/10.1186/s12961-021-00748-4 [1]

Haque, M., Skolnik, L. C., & Van Lith, L. M. (2014). Bangladesh: The BRAC Shasthya Shebika program. In L. Crigler, K. LeBan, & H. Perry (Eds.), Developing and strengthening community health worker programs at scale: A reference guide and case studies for program managers and policy makers (pp. 1-13). Maternal and Child Health Integrated Program (MCHIP)/USAID. chwcentral.org

Kok, M. C., Broerse, J. E., Theobald, S., Ormel, H., Dieleman, M., & Taegtmeyer, M. (2015). Performance of community health workers: situating their intermediary position within complex adaptive health systems. Human Resources for Health, 13(1), 59.

https://doi.org/10.1186/s12960-017-0234-z

Lassi, Z. S., Middleton, P. F., Bhutta, Z. A., & Crowther, C. (2016). Strategies for improving health care seeking for maternal and newborn illnesses in low- and middle-income countries: A systematic review and meta-analysis. Global Health Action, 9(1), Article 31408. https://doi.org/10.3402/gha.v9.31408

Mboera, L. E. G., Rumisha, S. F., Mbata, D., Mremi, I. R., Lyimo, E. P., & Joachim, C. (2021). Data utilisation and factors influencing the performance of the health management information system in Tanzania. BMC Health Services Research, 21(1), Article 498. doi.org

https://doi.org/10.1186/s12913-021-06559-1

Ministry of Health. (2017). National Community-Based Health Programme Policy Guidelines. United Republic of Tanzania.

Nyamhanga, T., Frumence, G., Mwangu, M., & Hurtig, A. K. (2014). 'We do not do any activity until there is an outbreak': barriers to disease prevention and health promotion at the community level in Kongwa District, Tanzania. Global health action, 7, 23878. https://doi.org/10.3402/gha.v7.23878

Nyamtema, A. S., Urassa, D. P., & van Roosmalen, J. (2019). Strengthening community-based health programs: Recruitment, training, and retention of younger community health worker cadres in sub-Saharan Africa. Journal of Community Health, 44(3), 120-135. doi.org

Perry, H. B., Zulliger, R., & Rogers, M. M. (2014). Community health workers in low-, middle-, and high-income countries: An overview of their history, recent evolution, and current effectiveness. Annual Review of Public Health, 35, 399-421.

https://doi.org/10.1146/annurev-publhealth-032013-182354

Sirili, N., Simba, D., Zulu, J. M., Frumence, G., & Tetui, M. (2022). Accommodate or Reject: The Role of Local Communities in the Retention of Health Workers in Rural Tanzania. International Journal of Health Policy and Management, 11(Special Issue on CHS-Connect), 59-66.

https://doi.org/10.34172/ijhpm.2021.77

Tashakkori, A., & Teddlie, C. (2010). Mixed Methodology: Combining Qualitative and Quantitative Approaches. Sage.

Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach's alpha. International Journal of Medical Education, 2, 53-55.

https://doi.org/10.5116/ijme.4dfb.8dfd

United Republic of Tanzania, Ministry of Health. (2020). National community-based health care (CBHC) policy guidelines. United Republic of Tanzania.

World Health Organization. (1978). Declaration of Alma-Ata (Document No. WHO/EURO:1978-3938-43697-61471). World Health Organization Institutional Repository for Information Sharing (IRIS).

World Health Organization. (2007). Everybody's business: strengthening health systems to improve health outcomes: WHO's framework for action.

World Health Organization. (2018). WHO guideline on health policy and system support to optimize community health worker programmes. Geneva: WHO.

World Health Organization. (2020). WHO guideline on health policy and system support to optimize community health worker programmes: Selected highlights. WHO Institutional Repository for Information Sharing.

Yamane, T. (1967). Statistics: An Introductory Analysis (2nd ed.). Harper and Row.

Zulu, J. M., Silumbwe, A., Munakampe, M., Chavula, M. P., Mulubwa, C., Sirili, N., Zulu, W., Michelo, C., & Tetui, M. (2025). A scoping review of the roles, challenges, and strategies for enhancing the performance of community health workers in the response against COVID-19 in low- and middle-income countries. BMC primary care, 26(1), 163. https://doi.org/10.1186/s12875-025-02853-7

Zulu, J.M., Perry, H.B. (2021). Community health workers at the dawn of a new era. Health Res Policy Sys 19 (Suppl 3), 130. https://doi.org/10.1186/s12961-021-00761-7