Empowering Community Health Workers to Collect and Record Maternal and Child Health Data by Resolving Contradictions

  • Caroline Ngoma University of Oslo
  • Faraja Teddy Igira Institute of Finance Management


Background and Purpose: It was noted that traditional birth attendants, village health workers and health facility workers to a substantial extent failed at collecting and recording maternal and child health data in the community.

Methods: This is a qualitative study and data was collected using interviews, observations, participant observations, focus groups and document reviews. To analyse the data, we used the concept of contradictions from the Cultural Historical Activity Theory (CHAT) as an analytical tool to understand manifestations of contradictions that hindered collection and recording of the data.

Results: Based on the analysis, results indicate that, traditional birth attendants and village health workers were empowered to adapt new information practices, which led to improvements in recording and reporting of births, follow-up on pregnant women and an increase of referred women for deliveries to the health center.

Conclusions: This study demonstrates that traditional birth attendants and village health workers’ information practices can be changed through understanding and resolving manifestations of contradiction that hinder them to collect and record maternal and child health data. This study also indicates that, traditional birth attendants and village health workers should be empowered to improve their performance and confidence in capturing and communicating these data.

Keywords: Information practices, Empowerment, Transformation, Community health workers, Contradictions.


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Otieno C, Kaseje D, Ochieng’ B, Githae M. Reliability of community health worker collected data for planning and policy in a peri-urban area of Kisumu, Kenya. J Community Health. 2012;37(1):48-53.

Perez F, Ba H, Dastagire S, Altmann M. The role of community health workers in improving child health programmes in Mali. BMC Int Health Hum Rights. 2009;9(1):1-12.

Kanjo C. Pragmatism or policy: Implications on health information systems success. Electron J Inf System Dev Ctries. 2011;48(1):1-20.

Damtew ZA, Kaasbøll J. Target setting procedures for immunisation services in Ethiopia: Discrepancies between plans and reality. J Health Manag. 2011;13(3):39-58

Ngoma, C, Igira, FT. Contradictions in collecting and recording maternal health data at the community level: A case study from two districts in Tanzania. J Health Inform Dev Ctries. 2012;6(2):509-520.

Damtew ZA, Kaasbøll J. Working towards precise and ambiguous targets: The challenge for health extension workers of Ethiopia. In: Proceedings of IRIS 2008; Åre, Sweden; 2008.

Lippeveld T, Sauerborn R. Introduction. In: Sauerborn R, Lippeveld T, Bodart C, editors. Design and Implementation of Health Information Systems. Geneva: World Health Organization; 2000. p. 1-14.

Ngoma, C, Chawani MS, Herstad J. Adaptation of mobile application to improve flow of birth information from the community to the district level. In: Popescu-Zeletin R, Rai IA, Jonas K, Villafiorita A, editors. E-Infrastructure and E-Services for Developing Countries: Revised Selected Papers; Second International ICST Conference, AFRICOM; Cape Town, South Africa; 2010 November 25-26. Berlin, Heidelberg: Springer; 2011. p. 79-92.

Wilson R. Using computers in health information systems. In: Sauerborn R, Lippeveld T, Bodart C, editors. Design and Implementation of Health Information Systems. Geneva: World Health Organization; 2000. p. 198-212.

Manda TD, Herstad J. Implementing mobile phone solutions for health in resource constrained areas. Understanding the opportunities and challenges. In: Villafiorita A, Saint-Paul R, Zorer A, editors. E-Infrastructures and E-Services on Developing Countries. Proceedings of the First International ICST Conference, AFRICOM; Maputo, Mozambique; 2009 December 3-4. Berlin, Heidelberg: Springer; 2010. p. 95-104.

Wilson RG, Smith DL. Microcomputer applications for primary health care in developing countries. Infect Dis Clin N Am. 1991;5(2):247.

Braa J, Macome E, Mavimbe JC, Nhampossa JL, Leopoldo JC, Manave A, Sitói A. A study of the actual and potential usage of information and communication technology at district and provincial levels in Mozambique with a focus on the health sector. Electron J Inf Syst Dev Ctries. 2001;5(2):1-29.

Bodvala R. ICT applications in public healthcare system in India: A review. ASCI J Manag. 2002;31(1-2):56-66.

Igira, FT. The dynamics of healthcare work practices: Implications for health management information systems design and implementation. Manag Res Rev. 2012;35(3/4):245-259.

Igira, FT. The situatedness of work practices and organisational culture: Implications for information system uptake. J Inf Technol. 2008;23:79 - 88.

Kimaro H, Twaakyondo H. Analysing the hindrance to the use of information and technology for improving efficiency of health care delivery system in Tanzania. Tanzan J Health Res. 2006;7(3):189-197.

Korpela M, Ikävalko P, Luukkonen I, Martikainen S, Palmén M, Tiihonen T, Toivanen M, Vainikainen V. How to co-develop services, work, and information systems in healthcare: The Daisy approach. In: Beuscart-Zéphir M-C, Jaspers M, Kuziemsky C, Nøhr C, Aarts J, editors. Context Sensitive Health Informatics: Human and Sociotechnical Approaches. Amsterdam: IOS; 2013. p. 126-132.

Korpela M, Soriyan HA, Olufokunbi KC. Activity analysis as a method for information systems development. Scand J Inf Syst. 2001;12(1-2):191-210.

Sahay S, Avgerou C. Introducing the special issue on information and communication technologies in developing countries. Inf Soc. 2002;18(2):73-76.

Korpela M, Mursu A, Soriyan HA. Information systems development as an activity. Comput Support Coop Work. 2002;11:111-128.

Freitas MR, Byrne E. Activity Theory as an analytical tool: A case study of IS development for an anti-retroviral treatment clinic in South Africa. In: Proceedings of the 2006 Annual Research Conference of the SAICSIT on IT Research in Developing Countries. Somerset West, South Africa: South African Institute for Computer Scientists and Information Technologists; 2006. p. 90-99.

Engeström Y, Sannino A. Discursive manifestations of contradictions in organizational change efforts: A methodological framework. J Organ Change Manag. 2011;24(3):368-387.

Engeström Y. Learning by Expanding: An Activity Theoretical Approach to Developmental Research. Helsinki, Finland: Orienta-Konsultit; 1987.

Engeström Y. Developmental Work Research. Expanding Activity Theory in Practice, vol. 12. Berlin, Lehmanns Media; 2005.

Nardi BA. Studying context: A comparison of Activity Theory, situated action models, and distributed cognition. In: Nardi BA, editor. Context and Consciousness: Activity Theory and Human-Computer Interaction. MIT; 1996. p. 69-102.

Kuutti K. Activity Theory as a potential framework for human-computer interaction research. In: Nardi BA, editor. Context and Consciousness: Activity Theory and Human-Computer Interaction. MIT; 1996. p. 9-22.

Engeström Y. Developmental studies of work as a test bench of activity theory: The case of primary care medical practice. In: Chaiklin S, Lave J, editors. Understanding Practice: Perspectives on activity and context. Cambridge, MA: Cambridge University Press; 1993. p. 64-103.

Engeström Y. Expansive learning at work: Toward an Activity Theoretical reconceptualization. J Educ Work. 2001;14(1).

Bonneau RJ. Information, Decision & Complex Networks. AFOSR/RTC Overview. Arlington, VA: Air Force Office of Scientific Research; 2013.

Sannino A. Sustaining a non-dominant activity in school: Only a utopia? J Educ Change. 2008;9(4):329-338.

Virkkunen J, Kuutti K. Understanding organisational learning by focusing on “activity systems”. Account Manag Inf Technol. 2000;10:291-319.

Castelloe P, Watson T. Participatory education as a community practice method: A case example from a comprehensive head start program. J Community Pract. 1999;6(1):71-89.

Roth W. Emotion at work: A contribution to third-generation Cultural-Historical Activity Theory. Mind Cult Act. 2007;14(1):40-63.

Chambers R: Rural Development: Putting the last first. New York: Longman; 1994.

WHO. The World Health Report 2000 - Health Systems: Improving Perfomance. Geneva: World Health Organization; 2000.

Lippeveld T. Routine health information systems: The glue of a unified health system. In: International Workshop on Issues and Innovation in Routine Health Information in Developing Countries; Potomac, MD, USA; 2001 March 14-16.

Braa J, Hedberg C. The struggle for district-based health information systems in South Africa. Inf Soc. 2002;8(2):113-127.

Franco LM, Bennett S, Kanfer R. Health sector reform and public sector health worker motivation: A conceptual framework. Soc Sci Med. 2002;54:1255-1266.

Luoma M. Increasing the motivation of health care workers. Capacity Project Technical Brief 7. IntraHealth International; 2006.

Hamre GA, Kaasbøll J. Motivation and demotivation: A case study of the Malawian health management information system. Electron J Health Inform. 2008;3(2):11.

Dieleman M, Cuong PV, Anh LV, Martineau T. Identifying factors for job motivation of rural health workers in North Viet Nam. Hum Resour Health. 2003;1(10).

Mathauer I, Imhoff I. Health worker motivation in Africa: The role of non-financial incentives and human resource management tools. Hum Resour Health. 2006;4(24).

Henderson LN, Tulloch J. Incentives for retaining and motivating health workers in Pacific and Asian countries. Hum Resour Health. 2008;6(18).

Ashford SJ, Blatt R, VandeWalle D. Reflections on the looking glass: A review of research on feedback-seeking behavior in organizations. J Manag. 2003;29(6):773-799.

Hongoro C, Normand C. Health workers: Building and motivating the workforce. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. Second edition. Washington (DC): World Bank; 2006.

Nadler L. Developing Human Resources. Houston: Gulf; 1970.

Swieringa J, Wierdsma A. Becoming a learning organization: Beyond the learning curve. Addison-Wesley; 1992.

Fiol CM, Lyles MA. Organizational learning. Acad Manag Rev. 1985;10(4):803-813.

Darmstadt GL, Lee ACC, Cousens S, Sibley L, Bhutta ZA, Donnay F, Osrin D, Bang A, Kumar V, Wall SN et al. 60 million non-facility births: Who can deliver in community settings to reduce intrapartum-related deaths? Int J Gynecol Obstet. 2009;107(Suppl):S89-S112.

Sibley LM, Sipe TA, Koblinsky M. Does traditional birth attendant training increase use of antenatal care? A review of the evidence. J Midwifery Women's Health. 2004;49(4):298-305.

Ray AM, Salihu HM. The impact of maternal mortality interventions using traditional birth attendants and village midwives. J Obstet Gynecol. 2004;24(1):5-11.

Smith JB, Coleman NA, Fortney JA, Johnson J, Blumhagen DW, Grey TW. The impact of traditional birth attendant training on delivery complications in Ghana. Health Policy Plan. 2000;15(3):326-331.

Ngoma C. Cultivation Strategies in the Implementation of Health Management Information System in Zanzibar: An Action Research Study. Oslo: University of Oslo; 2007.

Ngoma C, Kaasbøll J, Aanestad M. From training to in-service support. In: IST-Africa 2008 Conference & Exhibition; Windhoek, Namibia; 2008 May 7-9.

How to Cite
Ngoma, C., & Igira, F. T. (2015). Empowering Community Health Workers to Collect and Record Maternal and Child Health Data by Resolving Contradictions. Journal of Health Informatics in Africa, 3(1). https://doi.org/10.12856/JHIA-2015-v3-i1-116
Research article