Table 1
Characteristics of Study Participants.
| SURVEY RESPONDENTS (n = 658) | |
|---|---|
| Female (%) | 478 (73%) |
| Median age (interquartile range) | 34 (27–46) |
| Median household size (interquartile range) | 5 (4–7) |
| Households with children < age 15 (%) | 509 (79%) |
| Average number of children per household (SD) | 2.5 (1.9) |
| Heard of VHWs previously (%) | 471 (72%) |
| Received VHW services previously (%) | 293 (45%) |
| FOCUS GROUP DISCUSSION PARTICIPANTS (n = 97) | |
| Male (n = 24) | |
| Average age (range) | 35.5 (18–66) |
| Married (%) | 16 (67%) |
| Completed primary school (%) | 10 (42%) |
| Farming occupation (%) | 15 (63) |
| Received VHW services previously (%) | 18 (25%) |
| YOUNG FEMALE (n = 31) | |
| Average age (range) | 29 (19–50) |
| Married (%) | 31 (100%) |
| Completed primary school (%) | 14 (45%) |
| Farming occupation (%) | 26 (84%) |
| Received VHW services previously (%) | 17 (55%) |
| OLDER FEMALE (n = 42) | |
| Average age (range) | 74 (50–101) |
| Married (%) | 41 (100%) |
| Completed primary school (%) | 0 (0%) |
| Farming occupation (%) | 31 (74%) |
| Received VHW services previously (%) | 15 (36%) |
Table 2
Survey responses.
| QUESTION (QUESTION TYPE) | RESPONSE | ||||
|---|---|---|---|---|---|
| Personal characteristics and qualities of VHWs | |||||
| What gender should a VHW be? (multiple choice) N = 655 | |||||
| Male | 158 (24%) | ||||
| Female | 219 (33%) | ||||
| Does not matter | 278 (42%) | ||||
| What is the appropriate age of a VHW? (free response) | |||||
| Median age (range) | 30 (18–70) | ||||
| Is it important that a VHW have a spouse? (yes/no) N = 644 | |||||
| Yes | 513 (80%) | ||||
| Should a VHW be required to read and write? (yes/no) N = 647 | |||||
| Yes | 647 (100%) | ||||
| What are the most important qualities a VHW should possess? (free response) N = 658†* | |||||
| Educated, smart | 236 (36%) | Active, mobile, energetic | 93 (14%) | ||
| Kind, caring | 210 (32%) | Humble | 76 (12%) | ||
| Respectful of confidentiality, discreet | 199 (30%) | Non-judgmental | 53 (8%) | ||
| Possesses good interpersonal skills, sociable | 199 (30%) | Possesses good morals | 42 (6%) | ||
| Well behaved | 150 (23%) | Acts like a leader or role model | 37 (6%) | ||
| Trustworthy, honest | 130 (20%) | Available | 31 (5%) | ||
| Competent, hardworking, skilled | 120 (18%) | Other | 18 (3%) | ||
| Clean, presentable | 99 (15%) | Reserved, quiet | 6 (1%) | ||
| Responsibilities of VHWs | |||||
| Left: What are the most important activities a VHW should do? (free response) N = 658†* | |||||
| Right: Should a VHW perform the following activities? (yes/no) N = 647–657§¶ | |||||
| Prescribe medications | 605 (92%) | 646 (98%) | Provide women’s health services | 65 (10%) | 640 (98%) |
| Diagnose disease | 246 (37%) | 628 (96%) | Promote sanitation | 51 (8%) | |
| Provide health education | 241 (37%) | 652 (100%) | Promote vaccination | 18 (3%) | |
| Perform home visits | 151 (23%) | Implement public health measures | 17 (3%) | ||
| Refer to higher level of care | 98 (15%) | Other | 6 (1%) | ||
| Provide goods/services | 86 (13%) | 633 (97%) | |||
| VHW selection, job characteristics, and compensation | |||||
| Should a VHW position be open to all or be selected in some way? (multiple choice) N = 656 | |||||
| Selected in some way | 623 (95%) | ||||
| Who should select VHWs? (multiple choice) N = 630 | |||||
| Community members | 568 (90%) | ||||
| District hospital | 539 (6%) | ||||
| Village/district council | 21 (4%) | ||||
| Should VHWs work part-time or full time? (multiple choice) N = 655 | |||||
| Part-time | 377 (58%) | ||||
| Should VHWs be selected for life or for a limited period of time? (multiple choice) N = 653 | |||||
| Limited period of time | 512 (78%) | ||||
| Should VHWs be volunteers or paid for their work? (multiple choice) N = 650 | |||||
| Paid for their work | 610 (94%) | ||||
[i] Questions have been paraphrased for brevity. See supplement for full text.
† Free response answers are grouped according to similarities.
* Percentages do not sum to 100% because participants can select more than one answer.
§ Number of respondents to each question varies.
¶ Some free responses did not correspond to predetermined activities listed in yes/no questions.
Table 3
Representative focus group discussion quotes by theme.
| Role of VHWs |
| Treat acute illnesses like typhoid, emergency response, check them while they’re sick, and help them with family planning, diagnosing illnesses. (Men, FN) |
| Diagnose and see how they are in their life, like taking measures such as BP. (Young women, FN) |
| Should be at the home most of the time, maybe take 1–2x per week and walk around the village. One day of the week do follow-up of people in the community, and other days people know where to find them. (Young women, FN) |
| Visiting community to see how they are. (Older women, FN) |
| Should be involved in treating them, asking them about their disease and medical treatment. (Older women, FN) |
| Education level of VHWs |
| Needs enough understanding to explain medications, knows what he or she is doing… cannot train someone who did not go to school. (Men, FN) |
| One may be educated and not available in the community whereas one who don’t have high classes but with special skills and informed may serve the community better than the highly educated. (Men) |
| Usually someone understands more quickly if have education. (Young women, FN) |
| Sometimes a woman has talent even without much schooling. (Young women) |
| This village has few highly educated people and so long as this person knows how to read and write. (Young women) |
| If they don’t know how to read and write, they can’t know how to direct people on the way of taking meds. (Older women, FN) |
| Zero level of education. We never went to school. (Older women) |
| In addition, needs to have other good qualities, not just education. (Older women, FN) |
| VHW hours and payment |
| Won’t be able to do all of their usual work because they will have to be around. (Men, FN) |
| It takes away from their [women’s] time to take care of the home, not a problem for men. (Men, FN) |
| We can even feel happy and the VHW will feel motivated. (Men, when asked whether the community should know about VHW compensation) |
| Full time because having been selected to serve the community, he will always be needed. (Young women) |
| Can’t specify when this person will be working because illnesses are unpredictable. (Young women) |
| Has to be paid [a fixed salary] cause it’s god’s will that no one got sick. (Young women, FN) |
| No because people would get jealous. (Older women, when asked whether the community should know about VHW compensation, FN) |
| The whole village should contribute to giving but only as a token of appreciation, not as a contribution to the salary but the government should pay the salary. (Older women, FN) |
| Selection and accountability |
| If the VHW is paid and not providing services, can report and hold them accountable. (Men, FN) |
| The community will meet and evaluate whether he or she is working for them or not. The hospital should supervise to make sure the services are being delivered. (Men, FN) |
| Yes, to give chance to others. (Young women, when asked whether VHWs should have term limits, FN) |
| If working well, there should be no limit. Someone should work as long as they are able to, but should be removed if not during reselection period. (Older women, FN) |
| Women’s health |
| Those who are enlightened accept [family planning] and those are not they don’t accept. (Men, FN) |
| Can go to VHW even if the opposite gender, because they are trained. (Men, FN) |
| Not accepted fully, many, many misconceptions abound [about family planning]. (Young women, FN) |
| They all said that they can approach [a male VHW] because they trust him and they know he will be secretive. (Young women, FN) |
| Better to have two VHWs, a male and a female. (Older women) |
| Male health workers who can see females is normal. (Older women, FN) |
| Quotes from field notes are labeled FN, otherwise quotes are directly from participants. |
Figure 1
What gender should a VHW be?
Figure 2
What are the most important activities a VHW should do?
Figure 3
What are the most important qualities a VHW should possess?