Village Health Worker Attrition and Function Levels in the ILE-IFE Area of Nigeria

Abstract

Volunteer village health workers (VHWs) form the backbone of primary health care (PHC) from both philosophical and logistical perspectives. They represent an underlying PHC ethic of community involvement as well as a practical means for delivering health care at the grassroots. Although VHW recruitment and training does not rival the cost of training formal medical and health workers, the investment in not insubstantial. Thus when VHW drop-out rates approach 50 percent in many countries, there is cause for alarm and for investigation into the possible causes of attrition. Nigeria embarked on a national PHC program in 1986, supported by national PHC policy in 1987. Nearly 1500 VHWs have been trained in model local government areas (LGAs) during the intervening years. Although there have been anecdotal reports of VHW attrition, little study into the reasons for drop-out from this large scale and expensive operation have been undertaken. This study looked at the former Oranmiyan LGA (now divided into three) where 115 VHWs had been trained. Only 79 percent of trainees took up PHC tasks, and another 7 percent left their villages shortly thereafter due to school admission or job opportunities. Two to three years after the initial training, 58 percent of the original trainees self-reported that they were still functioning as VHWs. A PHC function test, based on VHW job descriptions, was developed and administered within a questionnaire among the VHWs still living in their villages. Three factors were associated with function score: farming as an occupation, reported recent supervision and reported attendance at a continuing education activity. The results indicate two main points of intervention for preventing VHW attrition. During recruitment, effort should be made to explain the voluntary nature of the work and to encourage villagers to select people (like farmers) who will reside permanently in the village. After training, supervision and continuing education must be planned to maintain a high level of VHW functioning.