Engagement of community health workers for the elimination of mother to child HIV transmission: Experience from Morogoro, Tanzania

Introduction: Community health workers (CHWs) programs are used globally as a strategy to improve the provision of primary health care services, especially in communities experiencing a shortage of health workers. Evidence shows that trained and supported CHWs are effective in providing necessary health care services. However, little is known about how CHWs are engaged to provide prevention of mother-to-child transmission (PMTCT) of HIV services. This study was conducted to analyze the engagement process of CHWs in the elimination of mother-to-child transmission of HIV in Tanzania. Methods: An exploratory qualitative case study was employed in Ifakara district, Morogoro region. Key informant interviews were conducted with coordinators of HIV/AIDS and PMTCT programs, as well as community-based health programs coordinators at the district level; health officer and executive officers at the ward level; village executive officers; reproductive and child health (RCH) in-charges, chairman of health facility governing committee and CHWs at health facility level. Twenty participants were interviewed until saturation was reached. The information gathered was analyzed using qualitative content analysis. Results: The uncoordinated process of identifying CHWs by local community leaders, self-introduction of individuals to take role as CHWs and the existence of vertical programs with their own process of locating CHWs were found to challenge the identification process of CHWs at the community level. The recruitment of CHWs was found to involve the selection by community leaders through voting process and some were selected through interviews conducted by in-charges of RCH in health facilities. CHWs received short-term training on HIV/AIDS and treatment adherence from implementing partners, but there was no sustainability plan in place and supportive supervision was limited. Conclusion: The engagement process of CHWs to provide PMTCT services for the elimination of mother-to-child transmission of HIV faces some key challenges in terms of identification, recruitment and training that require attention for it to be optimal. Strong institutional frameworks, enforcing policy adherence, and enhancing multisectoral coordination are needed to optimize the CHWs contribution to this elimination.