Assessment of community health workers activities in six districts of Zambézia Province, Mozambique

Mozambique’s Community Health Worker (CHW) or Agentes Polivalentes Elementares in Portuguese (APE) in Mozambique was reinitiated in 2010 after an unsuccessful first attempt decades prior. Two decades after this reinitialization, the Ministry of Health of Mozambique (MoH) and other interested parties sought to understand how the implementation of APEs interventions is progressing. Given its low coverage of many health interventions. A cross-sectional study was carried out in six districts of the Province of Zambézia, namely: Ile, Inhassunge, Milange, Mocubela, Mulevala, and Pebane. A questionnaire was developed based on government plans, APE training material, and best practices for implementing ACS programs found in the literature for individual face-to-face interviews with APEs. A descriptive analysis was carried out to summarize the different components of the APEs program according to the interviewees' responses. A total of 148 APEs were interviewed. Only 48% of APEs replenished their kits every month, and stock-outs of medications ranged from 19 to 92%, with expired medication being found for 5–13% of the medications. Although the quality of supervision appears high with APEs reporting service delivery observation (88%), discussion of work performance (81%) and work-related problems (91%), checking of supplies (90%), review of records (93%), and praise (92%) during their last supervision, only 59% of the sample study reported having had their last meeting with their supervisor less than 1 month ago. APEs are very important in providing care to patients in remote communities. Nonetheless, challenges persist in ensuring the proper performance of the APEs program. More urgently, there is a need to focus more on securing a constant supply of APE kits to provide patient care and on regular and timely delivery of subsidies as an incentive.