Evaluation of the Village Health Team Radio Distance Learning Program in Mukono District

This 38-page evaluative study was designed to assess the effectiveness of the Obbanywa Village Health Team Radio Distance Learning Program in Uganda in improving the skills and knowledge of village health teams (VHTs), as well as establishing the reach and effects of the programme among the general population beyond the VHT listening groups. Findings indicate that the radio distance learning (RDL) programme increased the knowledge of VHTs who participated in the programme as knowledge in all the health topics addressed increased from the baseline to follow up post implementation of the RDL programme. However, the focus group discussions showed that there was a very low reach of the radio programme among the general population.

To supplement VHT face-to-face training efforts, the Uganda Ministry of Health and the Health Communication Partnership (HCP) established a RDL programme for VHTs in Mukono district to provide them with continuing education on a regular basis. The overall purpose of the RDL programme was to provide them with information and skills that would assist them to fulfill their roles and responsibilities including maintaining good health in the community, strengthening the capacity of family members to provide quality care and support in the home, and liaising with health facilities through referrals and data collection. The study included a total of 230 and 194 VHT members at baseline and follow up respectively. The following are some of the findings:

• Knowledge of VHT roles in the community: Results indicate that the level of knowledge of at least three roles played by VHTs increased from 19% to 32% between the two data collection points. Notably, the most known role for VHTs was mobilisation of the community, mentioned by 63 and 83% at baseline and follow up respectively.
• Knowledge of family planning: Results indicate that knowledge of at least three benefits of family planning almost doubled from 22% at baseline to 40% at follow up while the proportion of VHT members who did not know any benefit of family planning drastically dropped to 0 percent at follow up down from six percent at baseline. The level of knowledge of all the four LAPM methods increased five fold from two percent upward to eleven percent at follow up.
• Knowledge of HIV among VHTs: The percentage of VHTs who knew at least three benefits of HIV testing increased from 32% at baseline to 58% at follow up. Knowledge that pregnant women can prevent transmission of HIV to their unborn child was the least known benefit for HIV testing at follow up. With regard to level of knowledge of practices that couples can undertake to prevent HIV infection, there was an increase from 19% to 30%, while knowledge of signs of HIV infection among children increased from zero to two percent.
• Knowledge of key PLHIV positive practices: VHT members were also asked about knowledge of key practices that PLHIVs should do in order to delay progression to AIDS. Knowledge of at least three practices increased almost two fold from 30% to 56%, while knowledge of all the six PLHIV practices to delay progression to AIDS rose from three to nine percent.
• Knowledge of benefits of safe male circucision: VHTs were also asked about the benefits of safe male circumcision during the survey. The RDL programme increased the level of knowledge of benefits for SMC among the VHTs enrolled in the programme as the percentage of those who could mention all the three benefits correctly increased five fold from two percent to eleven percent.
• Knowledge of violence and dangers of alcohol abuse: Knowledge of all three types of violence increased more than two fold from 11 percent to 32 percent at baseline and follow up respectively. On the other hand, the percentage of those who do not know any type of violence decreased from twelve to five percent. Results obtained indicate that knowledge of at least three dangers of alcohol abuse more than doubled from 28% to 67%, while knowledge of all the dangers of alcohol also increased from two percent to four percent.
• Self efficacy in addressing key health topics: Results indicate that the RDL programme increased self-efficacy of VHTs in only two out of the eight health topics. The health topics for which self-efficacy was increased were family planning - from 75% to 84%; and HIV prevention and transmission - from 73% to 87% at baseline and follow respectively.
• VHT perception about the effectiveness and relevancy of the RDL programme: Overall, the majority of the VHTs felt that the RDL programme was effective for all the three elements asked; 83, 77 and 82 percent of the VHTs reporting that the weekly episodes on radio, the listener's guide, and the listening groups were effective respectively. Results show that all the topics were very relevant. However the most relevant topics were benefits of HIV testing, and causes and dangers of alcohol abuse with 91% of the VHTs saying that they were very relevant.
• Qualitative findings:The general population mentioned VHTs and the radio as the main sources of health information. Only a few community members interviewed reported to have listened to the programme on Radio Dunamis partly because it was not one of their favorite radio FM stations, its signal was poor in some areas, and that no community promotional activities were conducted before airing the programme. Community members who had listened to the programme described it as very interesting, engaging, and not boring. Based on experiences from Mukono, future RDL programmes are more likely to reach and influence the general population if radio stations with high listenership are identified to air the episodes, prior community awareness/promotional drives are conducted, and proper timing of the different episodes is well thought out.

The evaluation concludes that knowledge benefits of family planning knowledge doubled from baseline to follow up, and similar trends were observed with the knowledge of at least three benefits of HIV testing doubling, knowledge of practices that couples need to undertake to prevent HIV infection increasing by 11%, with the most mentioned practice being use of condoms consistently and correctly. Knowledge of key PLHIV positive practices also increased but knowledge of exercising as a key PLHIV positive practice decreased from baseline to follow up. Other health topics where there was an observed increase in level of knowledge included benefits of safe male circumcision, violence against women, and the dangers of alcohol abuse. Among the general population, results indicated that the general reach was very low as few community members who were interviewed reported to have listened to the programme.

The study offers the following as recommendations:

• A very small percentage of VHTs viewed record keeping at one of the key roles they play. Future programmes need to emphasise record keeping as a key role in addition to other roles mentioned in the programme. One way would be to include more time about record keeping as well as including extra exercises about record keeping.
• Study findings clearly show that listenership to a health programme is greatly influenced by the popularity and listenership of the chosen radio station, the strength of the signal, and its coverage. For future RDL programming purposes, there is need to use media monitoring statistics from Synovate Uganda (formerly Steadman Group) to choose radio stations with high listenership rates and wider coverage.
• There is need to conduct community promotional activities in order to raise community awareness and interest in future RDL programmes before their launch.
• Given the success of the programme in increasing the knowledge of VHTs as observed in this evaluative study, such interventions should be scaled up in order to build the capacity of VHTs to reach more individuals and households with accurate health information and ensure proper linkage to health services.
• Although there was increase in knowledge across all the health topics, the results showed that knowledge of dangers of alcohol abuse (4%), knowledge of long term family planning methods (11%), and the knowledge of benefits of SMC (11%) is still low. Future RDL programmes need to review the content and place more emphasis on these health topics so as to increase the levels of knowledge among the VHTs.
• The timing of the programme on Sunday afternoon at 3.00pm should be maintained whereas a repeat of the programme during week days should be shifted from morning to evening hours to have more listeners tune in.
• During the discussions, messages about HIV/AIDS prevention and family planning were the most frequently recalled by respondents who listened to Obbanywa whereas other key health topics including safe male circumcision, anti-retroviral therapy, HIV stigma, dangers of alcohol abuse, and violence against women did not feature anywhere. There is need to re-emphasise these messages on radio and in the distribution of relevant materials.
• The RDL programme did not increase the self-efficacy of the VHTs in addressing the key health issues and therefore future RDL programmes need to include modules or exercises that can increase their self efficacy in addressing the topics covered by the programmes.
• Lastly, future evaluative studies need to include more in depth interviews with selected VHT members who listened and fully participated (by doing the exercises) in the radio programme to get a better and deeper understanding of the effectiveness of the training materials used so as to improve on the training materials. This was outside the scope of the evaluative study.