Mudau, A. G.Mashau, N. S.Munyai, Ofhani2025-09-122025-09-122025-09-05Munyai, O. 2025. Strategies to improve the effectiveness and efficiency of village health workers in service delivery in a seleceted district of Zimbabwe. . .https://univendspace.univen.ac.za/handle/11602/2909PhD (in Public Health)Department of Public HealthBackground The advent of the Alma-Ata Conference has sparked a renewed global interest in community health programs to strengthen primary healthcare systems. The goal is to address inequities, respond to community health needs, and realise universal health coverage. Village Health Workers are vital for health systems to achieve universal health coverage by bringing primary healthcare services closer to the communities. They complement healthcare systems in low- and middle-income countries (LMICs), including Zimbabwe, that are affected by shortages of nurses. Their social connectedness fosters positive behaviour change and helps build trust in the healthcare system. Despite their importance, in Zimbabwe, these continue to face numerous challenges that impact their effectiveness and efficiency in service delivery, such as limited training and skills, poor remuneration, support and supervision, inadequate resource provision, and a lack of clear-cut implementation strategies, as evidenced by the 2017 Village Health Worker Strengthening Program, which was never operationalised. This necessitated the development and validation of strategies to enhance the effectiveness and efficiency of VHWs in service delivery. Aim The study aimed to develop and validate strategies to improve the effectiveness and efficiency of Village Health Workers in service delivery, leveraging the empirical findings and reviewing relevant literature. Setting Beitbridge district, Matabeleland South Province, Zimbabwe. Methods A review of the literature, using Rodgers’ Evolutionary Concept Analyses, identified the antecedents, attributes, and consequences of effective and efficient community health systems. An exploratory sequential mixed methods design was used to explore the roles of Village Health Workers in primary health care. . In-depth interviews in the first stage collected qualitative data from 45 purposely selected healthcare workers and Village Health Workers using interviews,and then they were thematically analysed with MAXQDA Software. The variables generated were validated by a cross-sectional survey, which collected quantitative data from 134 Village Health Workers and was analysed using SPSS. The strengths, weaknesses, opportunities, and threats enabled the identification of internal and external factors of the village health worker program. The program logic models were used to develop strategies, which were validated by a panel of experts using the Delphi technique and key stakeholders. Results Fifty-two articles and two reports were reviewed and analysed. Antecedents included an enabling work environment, community participation, motivation, incentives, community health integration into national health systems, and the use of information and communication technology. Attributes were ongoing training and skills development, mutual respect and trust, enhanced contact between Village Health Workers and communities, and supportive supervision. The consequences were equitable access and improved quality of primary healthcare services. The exploratory sequential mixed methods study revealed that health education, child growth monitoring, and referrals are the primary roles of Village Health Workers, who frequently face challenges with logistical supplies, allowances, knowledge, and skills. Eight strategies, developed and validated, included community engagement, ongoing training, role clarification, supportive supervision, optimal resourcing, mobile health technology, incentives, and the integration of VHWs into the mainstream healthcare system. Conclusion This paper clarifies the roles and strategies of Village Health Workers, providing valuable insights for program managers and stakeholders seeking to improve primary healthcare service delivery. Contribution Findings from the reviewed literature informed the development of a conceptual framework. Context-specific Village Health Worker service delivery strategies were developed through the novel application of strategic planning frameworks, models, and validation by a consensus of experts and key stakeholders.1 online resource (256 leaves): color illustrations, color mapsenUniversity of VendaDevelopmentUCTDPrimary Health CareStrategiesStrategic planningVillage Health Workers362.12095891Community health aides -- ZimbabweCommunity health services -- ZimbabwePublic health personnel -- ZimbabweHome health aides -- ZimbabweThesisMunyai O. Strategies to improve the effectiveness and efficiency of village health workers in service delivery in a seleceted district of Zimbabwe. []. , 2025 [cited yyyy month dd]. Available from:Munyai, O. (2025). <i>Strategies to improve the effectiveness and efficiency of village health workers in service delivery in a seleceted district of Zimbabwe</i>. (). . Retrieved fromMunyai, Ofhani. <i>"Strategies to improve the effectiveness and efficiency of village health workers in service delivery in a seleceted district of Zimbabwe."</i> ., , 2025.TY - Thesis AU - Munyai, Ofhani AB - Background The advent of the Alma-Ata Conference has sparked a renewed global interest in community health programs to strengthen primary healthcare systems. The goal is to address inequities, respond to community health needs, and realise universal health coverage. Village Health Workers are vital for health systems to achieve universal health coverage by bringing primary healthcare services closer to the communities. They complement healthcare systems in low- and middle-income countries (LMICs), including Zimbabwe, that are affected by shortages of nurses. Their social connectedness fosters positive behaviour change and helps build trust in the healthcare system. Despite their importance, in Zimbabwe, these continue to face numerous challenges that impact their effectiveness and efficiency in service delivery, such as limited training and skills, poor remuneration, support and supervision, inadequate resource provision, and a lack of clear-cut implementation strategies, as evidenced by the 2017 Village Health Worker Strengthening Program, which was never operationalised. This necessitated the development and validation of strategies to enhance the effectiveness and efficiency of VHWs in service delivery. Aim The study aimed to develop and validate strategies to improve the effectiveness and efficiency of Village Health Workers in service delivery, leveraging the empirical findings and reviewing relevant literature. Setting Beitbridge district, Matabeleland South Province, Zimbabwe. Methods A review of the literature, using Rodgers’ Evolutionary Concept Analyses, identified the antecedents, attributes, and consequences of effective and efficient community health systems. An exploratory sequential mixed methods design was used to explore the roles of Village Health Workers in primary health care. . In-depth interviews in the first stage collected qualitative data from 45 purposely selected healthcare workers and Village Health Workers using interviews,and then they were thematically analysed with MAXQDA Software. The variables generated were validated by a cross-sectional survey, which collected quantitative data from 134 Village Health Workers and was analysed using SPSS. The strengths, weaknesses, opportunities, and threats enabled the identification of internal and external factors of the village health worker program. The program logic models were used to develop strategies, which were validated by a panel of experts using the Delphi technique and key stakeholders. Results Fifty-two articles and two reports were reviewed and analysed. Antecedents included an enabling work environment, community participation, motivation, incentives, community health integration into national health systems, and the use of information and communication technology. Attributes were ongoing training and skills development, mutual respect and trust, enhanced contact between Village Health Workers and communities, and supportive supervision. The consequences were equitable access and improved quality of primary healthcare services. The exploratory sequential mixed methods study revealed that health education, child growth monitoring, and referrals are the primary roles of Village Health Workers, who frequently face challenges with logistical supplies, allowances, knowledge, and skills. Eight strategies, developed and validated, included community engagement, ongoing training, role clarification, supportive supervision, optimal resourcing, mobile health technology, incentives, and the integration of VHWs into the mainstream healthcare system. Conclusion This paper clarifies the roles and strategies of Village Health Workers, providing valuable insights for program managers and stakeholders seeking to improve primary healthcare service delivery. Contribution Findings from the reviewed literature informed the development of a conceptual framework. Context-specific Village Health Worker service delivery strategies were developed through the novel application of strategic planning frameworks, models, and validation by a consensus of experts and key stakeholders. DA - 2025-09-05 DB - ResearchSpace DP - Univen KW - Development KW - Primary Health Care KW - Strategies KW - Strategic planning KW - Village Health Workers LK - https://univendspace.univen.ac.za PY - 2025 T1 - Strategies to improve the effectiveness and efficiency of village health workers in service delivery in a seleceted district of Zimbabwe TI - Strategies to improve the effectiveness and efficiency of village health workers in service delivery in a seleceted district of Zimbabwe UR - ER -