Electronic Thesis and Dissertation Repository

Thesis Format



Master of Science




Dr. Isaac Luginaah



Introduction: In Rwanda, although there has been some progress in health care delivery as expressed in the reduction in maternal and child mortality, rates are still high and geographically variable. Improving equitable access to quality healthcare services for maternal, neonatal and child healthcare (MNCH), community-based maternal, neonatal and child healthcare (CBMNCH) depends upon using “community health workers” (CHWs). Yet CHWs program faces difficulties that upset delivery of the quality of the comprehensive package of services. Unfortunately, little is known about CHWs` performance and job satisfaction in the provision of CBMNCH.

Goal: The study aimed to provide insight into the performance and job satisfaction of CHWs for timely access to maternal, neonatal, and child healthcare for rural communities in Rwanda

Method: This quantitative cross-sectional study involved a survey of 500 sampled CHWs who are involved in CBMNCH in three selected rural districts of the southern province: Gisagara, Muhanga, and Ruhango district. The sample size in each district was calculated based on a district proportionate allocation sampling technique, probability proportional to size. The survey was conducted from June to September 2019. CHWs` job performance and job satisfaction were categorized as high, middle and low. Ordinal regression analysis was used to examine the correlates of CHWs` job performance and the determinants of their job satisfaction.

Results: CHWs who were more likely to report high performance on the job had more years of experience (2.51, pConclusion: The findings indicated that the managers of community health program and other stakeholders need to find on how to reduce CHWs heavy the workloads and how to improve the severe working conditions of CHWs when considering the assignment of their responsibilities to enable effective CBMNCH with good quality.

Keywords: Maternal, Health, Child, Access, Healthcare, Community, Worker, Rwanda

Summary for Lay Audience

Summary for Lay Audience

The purpose of this thesis entitled “Timely access to Maternal, neonatal and Child healthcare for rural communities in Rwanda: role of Community Health Workers” is to understand the performance and job satisfaction of CHWs in service provision of Community-based maternal, newborn and child healthcare (CBMNCH). CHWs have been used as primary caregivers for improving equitable access to quality services for maternal, neonatal, and child healthcare. Despite the presence of the Community Health Worker`s program, to date, little is known on CHWs` performance and job satisfaction. It is in this context that this study was designed to examine the performance and job satisfaction of CHWs for service provision of CBMNCH. The results showed that CHW`s performance, like any other health workers, is influenced by their job satisfaction and motivation. CHWs` job satisfaction was associated with factors such as peer support, workload, access to required materials, financial incentives, and individual supportive supervision. In conclusion, there is a need to enable the effectiveness and quality of services provided for timely access to maternal, neonatal, and child healthcare in rural communities. This study recommends that healthcare managers and stakeholders need to put into consideration the factors influencing CHWs` job performance and job satisfaction as Rwanda strife’s to improve maternal and child health.