International Journal For Multidisciplinary Research

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Volume 8 Issue 4
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Factors influencing community health service delivery among Community Health Workers in Nyanza district, Rwanda

Author(s) Mr. Phocas Felicien Tuyisenge
Country Rwanda
Abstract CHWs play a critical role in strengthening primary healthcare systems, particularly in low- and middle-income countries where shortages of skilled health professionals persist. Despite Rwanda’s progress in expanding community health programs, variations in CHW performance and service delivery remain a concern at the community level. A descriptive cross-sectional study design with a mixed-methods approach was employed. The study targeted 1,639 CHWs, from which a sample of 321 participants was selected using Yamane’s formula and a multi-stage sampling technique. Qualitative data were also collected through Focus Group Discussions (FGDs) with CHWs and Key Informant Interviews (KIIs) with CHW cell coordinators and the district CHW in-charge. Data were collected using a structured questionnaire adapted from previous studies and analyzed using SPSS version 21.0. Descriptive statistics, bivariate analysis, and multivariate logistic regression were applied, with statistical significance set at p < 0.05. Qualitative data were analyzed thematically. The findings revealed that CHW performance in Nyanza District remains moderate, with only 39.9% reporting that they meet their monthly targets. Regarding service delivery, 61.1% reported providing timely services, while lower proportions were observed for frequent community utilization (47.0%), effective management of common diseases (41.7%), regular household visits (40.2%), accurate health education (38.6%), and proper referral of patients (30.5%). Multivariate analysis showed that motivation was a significant predictor of CHW performance (AOR = 2.200, 95% CI: 1.230–3.933, p = 0.008). At the organizational level, supportive supervision was significantly associated with improved performance (AOR = 1.785, 95% CI: 1.067–2.986, p = 0.027). In contrast, resource constraints negatively affected performance (AOR = 0.359, 95% CI: 0.155–0.833, p = 0.017). Community-related factors showed high levels of trust (78.5%), leadership support (79.4%), and participation (76.3%), although cultural beliefs (74.8%) were reported as influencing service delivery. Qualitative findings supported these results, revealing that CHWs provide essential services such as health education, malaria case management, maternal follow-up, referrals, and hygiene promotion. However, challenges such as inadequate supplies, irregular supervision, limited refresher training, workload pressure, and varying community acceptance were frequently reported. The study concludes that CHW performance in Nyanza District is shaped by individual motivation, organizational support systems, and community engagement. Strengthening supportive supervision, improving motivation mechanisms, and ensuring adequate resource availability are essential to enhance CHW effectiveness and improve community health outcomes.
Keywords Community Health Workers (CHWs), CHW performance, Service delivery, Motivation, Supportive supervision, Resource constraints , Nyanza District, Rwanda
Field Sociology > Health
Published In Volume 8, Issue 4, July-August 2026
Published On 2026-07-05
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E-ISSN 2582-2160
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CrossRef DOI prefix of IJFMR is 10.36948/ijfmr

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