Assessment of Community Health Workers Activities in Zambézia Province, Mozambique
Bibliographic record
Abstract
Abstract Introduction: Mozambique’s Community Health Worker (CHW) or Agentes Polivalentes Elementares in Portuguese (APE) in Mozambique was reinitiated in 2010 after an unsuccessful first attempt decades prior. Years after this reinitialization, the Ministry of Health of Mozambique (MoH) and other interested parties sought to understand how the implementation of APEs interventions is progressing. Given its low coverage of many health intervention, the province of Zambézia was of specific interest.Methodology: We carried out a cross-sectional study in six districts of the Province of Zambézia, namely: Ile, Inhassunge, Milange, Mocubela, Mulevala and Pebane. We designed a questionnaire based on government plans, APE training material, and best practices for the implementation of CHW programs found in the literature. We conducted descriptive analysis to summarize the different components of the APEs program according to responses.Results: A total of 144 APEs were interviewed, of which 67% were male, 63% aged between 18 to 39 years, 60% had a first cycle of education and 46% had worked as APEs for 5 or more years. While 91% reported having received training after their initial training, only 19% had received training in the past 3 months. Only 48% of APEs replenished their kits every month, and stock-outs of medications ranged from 19% to 92%, with expired medication being found for 5-13% of the medications. Although the quality of supervision appears high with APEs reporting service delivery observation (88%), discussion of work performance (81%) and work-related problems (91%), checking of supplies (90%), review of records (93%), and praise (92%) during their last supervision, only 59% of our sample reported having had their last meeting with their supervisor less than 1 month ago.Conclusions: While there have been some successes in this renewed implementation, challenges persist around ensuring the proper implementation of the program as it is designed. Additionally, a review of the program to match the current realities of field (e.g., increased population per APE, increase of the stipends) is becoming increasingly necessary.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".