Assessment of performance in active malaria case surveillance of female community health volunteers in the high-endemic areas of Nepal

Abstract

Abstract: Malaria is a recognized public health concern in Nepal. This is noted by a significant prevalence of illness and mortality in high-endemic regions. The Nepal government has made efforts to malaria control techniques and strategies under the national malaria elimination by 2030 AD. One most notable approach is the engagement of community health volunteers within the models of the community health strategy. Previous research around the globe has also shown that CHVs perform significantly in active malaria surveillance. Moreover, the Previous literature well emphasizes the importance of psychosocial factors such as autonomy, competence, and relatedness in influencing the performance of CHVs in malaria surveillance. However, there is a gap in understanding how these factors specifically impact FCHVs in Nepal, particularly in the context of active malaria case detection and response. Therefore, this study aimed to assess the performance level of FCHVs and determine the association between factors affecting the performance in active malaria case surveillance in high-endemic regions of Nepal. A cross-sectional survey was conducted from 1 June to 30 August among FCHVs in eight high-risk malaria districts of three provinces of Nepal. A total of 1204 participants were employed as study participants. Data was collected through face-to-face interviews using a structured questionnaire. For data analysis, using SPSS 26.0 and AMOS 29.0 for descriptive statistics, chi-square, correlation, and multiple linear regression were used to predict the performance of FCHVs. followed by confirmatory factor analysis (CFA) to validate the measurement model and structural equation modeling (SEM) to examine the relationships between work motivation, leadership, self-efficacy, social support, and performance.

The result found that 635 (52.7%) of FCHVs had a high level of performance in active malaria case surveillance. The Chi-square tests showed that the factors associated with the performance of FCHVs (p < 0.05) include age (45-60 years), major occupation other than FCHVs as trading/business, and work experience as malaria work (> 5 years). Regarding autonomy as work motivation, both extrinsic (control motivation) and intrinsic (autonomy motivation), Leadership styles, including transformative, political, and teambuilding leadership, competencies such as self-efficacy, and relatedness as social support factors, such as family and health personnel support were significantly associated with higher performance levels. Moreover, Spearman’s product correlation matrix provides a positive significant relationship between performance and autonomy motivation, political, team building leadership, self-efficacy, family, and community support. Additionally, the result of the multiple linear regression model (r20.301), revealed that the independent variable in malaria surveillance causes a 30.10% change in the dependent variable performance in malaria surveillance in FCHVs. Overall, ANOVA results show that autonomy motivation, self-efficacy, political leadership skills, and health personnel support had a significant relationship with performance. Furthermore, the significant standardized coefficient beta results of autonomy motivation, political leadership, self-efficacy, health personnel support, and control supervision (0.510, 0.085, 0.114, -0.105, and 0,005 respectively), which means that a change in autonomy motivation, political leadership, self-efficacy, health personnel support, and control supervision by one unit will bring about a change in FCHVs performance by 0.510, 0.085, 0.114, -0.105, and 0,005 respectively. The five-factors model (Motivation, Leadership, Self-efficacy, social support, and Performance) yielded a good fit for the data: CMIN/DF = 4.956, GFI = .887, CFI= .915, TLI=.907, RMR= .052, and RMSEA = .057. All the indices revealed that the measurement model was acceptable, particularly when items with low factor loading values (<0.50) were excluded from the CFA to decrease measurement errors. Moreover, SEM analysis results reveal that autonomy motivation significantly influenced leadership, which, in turn, along with self-efficacy, affected performance behaviors. Moreover, the support from the community, supervisor, and self-efficacy moderated the effects on performance. This study concluded that imposing autonomy motivation and enhancing leadership skills can effectively promote engagement and sustained performance in active malaria case surveillance among FCHVs. These insights could be useful policy strategies for stakeholders aiming to enhance performance in new disease surveillance activities.