Poor performance of community health workers in Kalabo District, Zambia

Health Policy. 2003 Aug;65(2):109-18. doi: 10.1016/s0168-8510(02)00207-5.


Objective: To determine the factors contributing to low performance of community health workers in Kalabo District, Zambia.

Methods: In a cross-sectional descriptive study, 86 community members, 27 community health workers and nine rural health centre staff were interviewed using semi-structured questionnaires. Other methods were focus group discussions and checklists. Data analysis was done manually.

Results: The low performance of community health workers is a real problem for Kalabo District. The two most important factors are the irregular and unreliable supply of drugs and selection of the wrong people to be trained for community health workers.

Conclusion: Though initially implemented as such, the comprehensive approach of the primary health care project is no longer functioning in Kalabo. Community health workers are mainly valued because of their curative services. Communities do not properly follow the official criteria for selection of people to be trained, but have other considerations. Strategies will have to be formulated to rehabilitate the programme, mainly focussing on these two findings. Other factors, like inadequate community support and inadequate supervision, were mentioned by many contributors.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Community Health Workers / standards*
  • Cross-Sectional Studies
  • Female
  • Health Services Research
  • Humans
  • Male
  • Middle Aged
  • Personnel Selection
  • Pharmaceutical Preparations / supply & distribution
  • Professional Competence / statistics & numerical data*
  • Rural Health Services* / standards
  • Workforce
  • Zambia


  • Pharmaceutical Preparations