Sustaining health worker performance in Burkina Faso

The Measles Initiative, launched by the US Agency for International Development's Child Survival Program in three African countries (Kenya, Niger, and Burkina Faso), seeks to increase the number of children who receive the full series of vaccines during immunization contacts scheduled in the first year of life. In the two Burkina Faso program sites--Boulkiemde and Passore--only 17.4% and 9.2% of children, respectively, were fully vaccinated by 1 year of age and immunization promotion was not routinely provided by health workers. Program activities included training for health workers in interpersonal communication, health worker performance review and feedback, and mass media and print materials for mothers. The interpersonal communication skills of health workers were evaluated in two areas: content (messages given to mothers) and behaviors essential for establishing rapport and mutual respect. Health workers received feedback in the form of bar graphs on their performance related both to their own performance over time and to an untrained control group. After feedback sessions, health workers demonstrated improvements in information given about caring for fever and sores, the number of remaining immunizations, and the date of the next visit. Improved behaviors included eye contact with mothers, responding to questions, and waiting for a child to calm. Mothers' knowledge of immunization increased with every increase in the number of educational materials presented.