Identify the Workload of Fieldworkers (FWAs)

under Changed Circumstances

Prof. Dr. M. Nurul IslamAssociates for Research Training and

Computer Processing (ARTCOP)

ObjectivesObjectives

The general objective of the study is to The general objective of the study is to identify the workload of the field workers identify the workload of the field workers (FWAs) under changed circumstances.(FWAs) under changed circumstances.

The specific objectives wereThe specific objectives were

a. To determine the specific reasons a. To determine the specific reasons forfor

workload of the FWAworkload of the FWA

b. To assess how far family planning b. To assess how far family planning

program is affected due to program is affected due to workloadworkload

c.c. To assess the impact of To assess the impact of workload onworkload on

the FP performancethe FP performance

d. To investigate the measures to d. To investigate the measures to be be taken to reducing the taken to reducing the workload of workload of the FWAsthe FWAs

MethodologyMethodology

Study design:Study design:

The study followed a cross-sectional The study followed a cross-sectional design. design.

Data sources:Data sources:

PrimaryPrimary

SecondarySecondary

Respondents:Respondents:

Program Program ManagersManagers

Service Service Provider Provider

& Field & Field WorkersWorkers

FemalesFemales

- UFPOUFPO- AUFPOAUFPO- MO (MCH-FP)MO (MCH-FP)

- AUFWO AUFWO (MCH-FP)(MCH-FP)- SACMOSACMO- FWVFWV- FWAFWA

- Women of Women of

reproductivreproductivee

agesages

Basically three categories of samples were selected for the study purpose, viz.

Multi-stage sampling procedure was Multi-stage sampling procedure was followed to select the samples. At the followed to select the samples. At the first stage, all the upazillas of first stage, all the upazillas of Bangladesh were listed according to Bangladesh were listed according to population size. From the list 20 population size. From the list 20 upazillas were selected by Probability upazillas were selected by Probability Proportional to Size (PPS) method. From Proportional to Size (PPS) method. From each selected upazilla 6 unions were each selected upazilla 6 unions were selected by simple random sampling selected by simple random sampling technique. One village was selected technique. One village was selected randomly from each selected union.randomly from each selected union.

SamplingSampling

Data collection tools:Data collection tools:

Instrument

Quantitative Qualitative

In-depth interview Observation

Specific reasons for work loadSpecific reasons for work load

Increase in the number of couplesIncrease in the number of couples Increase in the number of other Increase in the number of other

activities like 1. CC 2. EPI/ NID 3. activities like 1. CC 2. EPI/ NID 3. Arsenic searching 4. Satellite clinic etc.Arsenic searching 4. Satellite clinic etc.

Required to be engaged on various Required to be engaged on various diboshdibosh

Have to render other health servicesHave to render other health services Have to be engaged in other Have to be engaged in other

government assigned extra work from government assigned extra work from time to timetime to time

CSBA trained FWA have to perform CSBA trained FWA have to perform ANC, normal delivery, PNC, new born ANC, normal delivery, PNC, new born care and refer the complicated casescare and refer the complicated cases

Key findingsKey findings

AreaArea P-valueP-valueBefore Before 20002000

PresentPresent

PopulationPopulation 3319.53319.5 5046.25046.2 0.000.00

HouseholdHousehold 738.6738.6 1065.81065.8 0.000.00

FamilyFamily 764.1764.1 1173.31173.3 0.000.00

Eligible coupleEligible couple 677.6677.6 963.1963.1 0.000.00

PregnantPregnant 35.635.6 29.229.2 0.000.00

Average coverageAverage coverage

Organi-Organi-zational zational activityactivity

Family Family PlanningPlanning

Organizing Organizing Satellite Satellite ClinicClinic

ANC, Delivery ANC, Delivery & PNC & PNC servicesservices

Nutrition Nutrition EducationEducation

- Planning- Planning- PreparePrepare

advanceadvance

programprogram

- Other- Other

- CounselingCounseling- MotivationMotivation- Method Method

distributiondistribution- Take client Take client

to service to service

centercenter- Advise or Advise or

refer forrefer for

side effectside effect

- Door toDoor to

door door

campaigncampaign- PreparePrepare

advance advance

work planwork plan

- Take client- Take client

for side for side

effecteffect

- Send Send

client to centerclient to center

or workeror worker

- Identify- Identify

complicated complicated

cases & refer cases & refer - Provide TTProvide TT

vaccinevaccine- EncourageEncourage

mother for mother for

Satellite clinicSatellite clinic- Provide Provide vaccinevaccine

at Satellite at Satellite clinic clinic

Provide Provide advise onadvise on- Nutrition Nutrition of of

pregnant pregnant

mother mother

- Nutritious - Nutritious

food for food for

children children

- - Importance Importance

of breast of breast

feedingfeeding

Activity of FWA

In addition to these they require to In addition to these they require to prepare report on their activities to prepare report on their activities to submit it the higher officials submit it the higher officials

Respondents by family planning activity

23.3

15

26.1

18

30.8

0

5

10

15

20

25

30

35

Counseling Motivation Distribution ofmethods

Take client tocenter

Advise or refer forside effect

Activity

Per

cen

t

Respondents by their average coverage (completely)

53.9

7.86.9

18.1

0

2

4

6

8

10

12

14

16

18

20

Population Household Family Eligible couple Pregnant

Area

Perc

en

t

Respondents by organizational activity

93.6

94.2 94.2

93.3

93.4

93.5

93.6

93.7

93.8

93.9

94

94.1

94.2

94.3

Planning Prepare advance program Other

Activivity

Per

cen

t

Respondents by organizational activity of satellite clinic

1512.8

41.4

0

5

10

15

20

25

30

35

40

45

Door to door campaign Prepare advance plan Take client for management ofside effect

Activity

Per

cent

Respondents by services during and after pregnancy

16.9

30.3

40.3

28.6

59.7

0

10

20

30

40

50

60

70

Send to efficientworker

Identifiedcomplecated

pregnancy andrefer them

Provide TTvaccine

Encouraged togo to satellite

clinic

Provide vaccineat satellite clinic

Service

Perc

en

t

Respondents by nutrition education

27.5

33.3

44.4

0

5

10

15

20

25

30

35

40

45

50

Advise on nutrition ofpregnant mother

Advise on nutritious food ofchildren of pregnant mother

Advise on usefulness ofbreast feeding

Activity

Perc

en

t

Major reasons to fail to cover the Major reasons to fail to cover the

areaarea

Major reasonsMajor reasons PercentagePercentage

Work at community Work at community clinicclinic

78.478.4

Extra pressureExtra pressure 75.475.4

Large working areaLarge working area 52.052.0

A large number of field workers failed to cover the target due to:

• Extra pressure of work• Being involved with other projects

Factors affecting proper performance Factors affecting proper performance

ActivityActivity

ReasonReasonLarge Large

working working areaarea

Work at Work at CCCC

Poor Poor communicommuni

cationcation

Work at Work at various various diboshdibosh

Shortage Shortage of of

manpowemanpowerr

PlanningPlanning -- 39.139.1 -- -- --

CounselingCounseling 80.080.0 80.080.0 -- 70.070.0 --

MotivationMotivation 56.256.2 48.048.0 45.145.1 -- 62.462.4

Method Method distributiodistributionn

64.364.3 -- -- -- 47.447.4

Take client Take client to centerto center

54.954.9 64.764.7 -- 51.351.3 --

ActivityActivity

ReasonReasonLarge Large workinworking areag area

Work at Work at CCCC

Poor Poor communicommuni

cationcation

Work at Work at various various disboshdisbosh

Shortage Shortage of of

manpowmanpowerer

Advise/ Advise/ refer for refer for side effectside effect

45.845.8 63.563.5

Door to Door to door door campaigncampaign

50.750.7 35.735.7 61.461.4

Send to Send to efficient efficient workerworker

59.559.5 68.968.9 55.955.9 36.536.5

Identify Identify complicatiocomplication during n during pregnancy pregnancy and referand refer

59.459.4

ActivityActivity

ReasonReasonLarge Large workinworking areag area

Work at Work at CCCC

Poor Poor communicommuni

cationcation

Work at Work at various various disboshdisbosh

Shortage Shortage of of

manpowmanpowerer

Provide TTProvide TT 54.454.4

Encourage Encourage to go to to go to satellite satellite clinicclinic

51.051.0

Provide Provide advise on advise on nutritionnutrition

61.361.3 68.268.2 32.632.6 56.756.7

Give idea Give idea about about usefulness usefulness of breast of breast feedingfeeding

63.563.5

Effects of excessive workload on Effects of excessive workload on family planning servicesfamily planning services

The number of permanent method users is not The number of permanent method users is not increasing as expected. increasing as expected.

Clients suffering from various complications fail to Clients suffering from various complications fail to get proper treatment / services / advice or get proper treatment / services / advice or facilities.facilities.

Sufferings of the clients create a negative impact Sufferings of the clients create a negative impact

on the other people of the locality and they on the other people of the locality and they become de-motivated towards permanent and become de-motivated towards permanent and long term methods. long term methods.

Field workers cannot render proper services to Field workers cannot render proper services to pregnant mothers resulting in creation of pregnant mothers resulting in creation of complications during pregnancy.complications during pregnancy.

In the absence of effective follow-up services, In the absence of effective follow-up services, most of the complicated patients failed to get most of the complicated patients failed to get proper services and this may ultimately proper services and this may ultimately increase the maternal and child death. increase the maternal and child death.

People of the locality remained deprived of People of the locality remained deprived of MCH services.MCH services.

Number of underweight and ill health Number of underweight and ill health children is increasing. children is increasing.

New–born suffer from various diseases after New–born suffer from various diseases after their birth and many of them died within a their birth and many of them died within a year. This is likely to increase the infant and year. This is likely to increase the infant and child mortality. child mortality.

SuggestionSuggestion

TargetTarget Before Before

20002000 Current Current

levelevell Revision Revision

desireddesired % %

reduction reduction desireddesired

Population Population 3319 3319 5046 5046 3999 3999 20.7 20.7

Household Household 738 738 1065 1065 622 622 41.6 41.6

Family Family 764 764 1173 1173 641 641 45.4 45.4

Eligible Eligible couple couple

677 677 963 963 594 594 38.3 38.3

Pregnant Pregnant women women

36 36 29 29 15 15 48.3 48.3

TargetTarget BeforBefore e

20002000

Current Current

levellevel RevisioRevisio

n n

desireddesired

% % reduction reduction desireddesired

CounselinCounseling g

4.2 4.2 5.7 5.7 2.9 2.9 49.1 49.1

Motivation Motivation 40.3 40.3 73.6 73.6 19.3 19.3 73.8 73.8

Method Method distributiodistribution n

146.4 146.4 275.3 275.3 103.7 103.7 62.3 62.3

Take Take clients to clients to service service center center

8.1 8.1 17.7 17.7 6.3 6.3 64.4 64.4

Referring Referring clients clients

2.8 2.8 3.6 3.6 1.4 1.4 61.1 61.1

50

43.7

68.7

37.5

28.1

0

10

20

30

40

50

60

70

Pe

rce

nt

Removefrom CC

Reduceworking

Area

Free themfrom dibosh

Appointmore FWA

Free themfrom other

project

Suggestion

Figure: Suggestion of the program manager for better services

Lesson learned/ImpactLesson learned/Impact

Partial coverage of the assigned works Partial coverage of the assigned works thus has left negative impacts in the thus has left negative impacts in the implementation of family planning implementation of family planning program and service delivery. program and service delivery.

Number of permanent method users is Number of permanent method users is not increasing as expected. not increasing as expected.

Clients suffer from various complications Clients suffer from various complications but fail to get proper but fail to get proper treatment/services/advice or facilities.treatment/services/advice or facilities.

People become de-motivated towards People become de-motivated towards permanent and long term method permanent and long term method

Creates complications during Creates complications during pregnancy.pregnancy.

Increase the number of maternal Increase the number of maternal and child deaths.and child deaths.

Increase the number of Increase the number of malnourished children.malnourished children.

RecommendationsRecommendations

A revision of the existing target in terms A revision of the existing target in terms of the coverage should be considered to of the coverage should be considered to lessen the burden on the workers lessen the burden on the workers However, an assessment to this end is However, an assessment to this end is required to determine the feasibility of required to determine the feasibility of this target. this target.

Field workers should be withdrawn from Field workers should be withdrawn from the community clinics.the community clinics.

Field workers should not be engaged in Field workers should not be engaged in the programs of the various dibosh of the programs of the various dibosh of the family planning. the family planning.

Proper steps should be taken to reduce Proper steps should be taken to reduce the extra burden of the imposed other the extra burden of the imposed other programs on the workers. This may programs on the workers. This may include recruitment of more field include recruitment of more field workers.workers.

An efficient and supportive supervision An efficient and supportive supervision system should be introduced for smooth system should be introduced for smooth operation and functioning of the family operation and functioning of the family planning program to undertake the planning program to undertake the responsibilities referred to above.responsibilities referred to above.

Steps should be taken to provide further Steps should be taken to provide further training on issues not covered thus far.training on issues not covered thus far.

Thank YouThank You