Vhts) in Health Promotion, a Case Study of Makindye Division
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FACTORS INFLUENCING THE PERFORMANCE OF VILLAGE HEALTH TEAMS (VHTS) IN HEALTH PROMOTION, A CASE STUDY OF MAKINDYE DIVISION A POST GRADUATE RESEARCH DISSERTATION REPORT PRESENTED TO THE INSTITUTE OF HEALTH POLICY AND MANAGEMENT SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE AWARD OF A MASTERS DEGREE IN PUBLIC HEALTH NAKIGUDDE FAITH REG NO: 2009 – MPH- PT- 003 SUPERVISOR DR. WOODING NICK INTERNATIONAL HEALTH SCIENCES UNIVERSITY DECEMBER 2011 1 DECLARATION I, Nakigudde Faith, I hereby declare that all the work in this dissertation is original and has not been submitted for another degree in this or any other university or institution of higher learning. Signature Date ------------------------------------- --------------------------------- NAKIGUDDE FAITH i ii APPROVAL This dissertation is submitted for further examination with my approval as a university supervisor. DR. WOODING NICK --------------------------------- SIGNATURE iii DEDICATION This book is dedicated to my parents Mr. Nakabaale Grace and Ms. Namirimu Joyce for the love and sacrifice they have bestowed upon me. Also to my lord and savior Jesus Christ for his grace and mercy towards me. Without him, I would not have completed this thesis. iv ACKNOWLEDGEMETS First and foremost, I wish to express my most sincere gratitude to my supervisor, Dr. Wooding Nick for the untiring support and exceptional guidance throughout the entire course. Your constant help made this work possible Also I would like to appreciate the special people who have offered support in completing this thesis such as Dr. Nkundeki Martin, Komugisha Sarah, Nagadya Juliet, and Nakaye Prossy. Last but not least to my sisters and brothers namely Olivia, Hellen, Juliet, Lillian, Evelyn, Godfrey, Geoffrey, and Samuel. I am so grateful for your love and prayers. Finally to the respondents, who willingly spared their precious time to participate in this study, thank you very much. v LIST OF ACRONYMS CBOs Community Based Organizations CHWs Community Health Workers GMP Growth Monitoring Promotion HIV/AIDS Human Immuno Virus/ Acquired immune deficiency syndrome M.O.H Ministry of Health MUAC Mid Upper Arm Circumference UNICEF United Nations International Children Education Fund VHT Village Health Teams W.H.O World Health Organization vi TABLE OF CONTENTS DECLARATION..............................................................................................................................i APPROVAL ..................................................................................................................................iii DEDICATION................................................................................................................................iv ACKNOWLEDGEMETS................................................................................................................v LIST OF ACRONYMS..................................................................................................................vi TABLE OF CONTENTS..............................................................................................................vii LIST OF TABLES..........................................................................................................................ix LIST OF FIGURES.........................................................................................................................x ABSTRACT...................................................................................................................................xi CHAPTER ONE..............................................................................................................................1 INTRODUCTION...........................................................................................................................1 CHAPTER TWO.........................................................................................................................9 LITERATURE REVIEW............................................................................................................9 2.1 Introduction............................................................................................................................9 2.2 Theoretical Review................................................................................................................9 2.2.1 Theory of Equity.................................................................................................................9 2.2.2 Theory of Decentralization...............................................................................................10 2.2.3 Community health action model.......................................................................................10 2.3 VHTs in the world...............................................................................................................11 2.4 Incentives to VHTs performance.........................................................................................19 2.5 Availability of supplies to VHTs performance....................................................................20 2.6 Support supervision of VHTs..............................................................................................20 CHAPTER THREE.......................................................................................................................22 METHODOLOGY........................................................................................................................22 3.1 Introduction .........................................................................................................................22 c.2Research Design....................................................................................................................22 3.3 Study population..................................................................................................................23 3.4 Sample size determination...................................................................................................23 3.5 Study Unit............................................................................................................................25 3.6 Study Variables and their indicators....................................................................................25 3.7 Data collection techniques and instruments.........................................................................26 3.7.1 Focus group discussions...................................................................................................26 3.7.2 Questionnaires...................................................................................................................26 3.7.3 Interviews..........................................................................................................................26 3.8 Data Analysis techniques and Presentation.........................................................................26 3.9 Quality Control Techniques.................................................................................................27 3.10 Ethical Considerations.....................................................................................................27 3.11 Limitations of the study.....................................................................................................28 CHAPTER FOUR..........................................................................................................................29 INTERPRETATION AND ANALYSIS OF FINDINGS.............................................................29 4.1 Introduction..........................................................................................................................29 4.2 Demographic data ...............................................................................................................29 4.3.1 Awareness of VHTs in the area........................................................................................31 vii 4.3.4 Record keeping by VHTs..................................................................................................33 4.3.8 Health surveys carried out in the area...............................................................................37 4.4 Incentives among VHTs......................................................................................................38 4.4.1 Percentages of respondents who have ever received incentives.......................................38 4.4.2 Forms of incentives received by VHTs............................................................................38 4.4.3 Effect of incentives on VHTs performance......................................................................39 4.5.1 Reaction of respondents on availability of supplies among VHT activities.....................42 4.6 Support supervision on performance of VHTs on health promotion ..................................43 4.6.1 VHT’s views as to whether they receive support supervision for health promotion .......43 4.7.1 Level of performance of VHTs on health promotion ......................................................45 4.8 Constraints/factors that hinder the performance of VHTs on promotion of health.............47 4.9 Interventions that can be taken to improve on VHT’s performance....................................48 4.11 Relationship between variables..........................................................................................50 4.11.1 Table 15: Shows Chi-square test using bivariate analysis of Incentives