Article Sidebar
Main Article Content
Abstract
RÉSUMÉ
Introduction. La satisfaction constitue un indicateur de la qualité de soins de la confiance des populations envers le système de santé. Cette étude visait à estimer le niveau de satisfaction communautaire vis-à-vis des services de santé à base communautaire au Congo et à identifier les facteurs associés. Méthodologie. Une étude descriptive transversale par sondage en grappes a été réalisée en septembre 2025 dans les 12 départements du pays. La collecte des données a été effectuée à l’aide de l’application KoboCollect, en utilisant la méthode CAPI (Computer-Assisted Personal Interviewing). Ont été inclus les adultes (≥18 ans) personnes âgées de 18 ans ou plus résidant dans les grappes sélectionnées au cours des 12 derniers mois. La satisfaction globale ainsi que les sept construits du cadre théorique de l’acceptabilité TFA (Theoretical Framework of Acceptability) ont été mesurés. Les analyses ont été effectuées à l’aide du logiciel Stata version 24 et ont porté sur des statistiques descriptives, des comparaisons de proportions ainsi qu’une régression logistique multivariée. Résultats. Sur 849 répondants, 420 (49,5 %) ont eu un contact avec un ASC. Parmi eux, 88,6 % se déclaraient satisfaits ou très satisfaits. La majorité était de sexe féminin (58,1 %) et âgée de 26 à 47 ans (59,6 %). Les services les plus fréquents concernaient les visites à domicile (52,6 %), l’orientation vers un centre de santé (45,7 %) et l’éducation sanitaire (38,8 %). Les scores moyens des domaines du TFA étaient élevés (auto-efficacité : 4,35 ; éthique : 4,31 ; efficacité perçue : 4,22). L’efficacité perçue ressortait comme principal déterminant de la satisfaction (OR = 4,58 ; IC95 % : 1,81–11,58 ; p = 0,0013). Conclusion. Le niveau de satisfaction communautaire envers les ASC est élevé, dominé par l’efficacité perçue. Ces résultats plaident pour le renforcement de la formation, de la supervision et de l’intégration de la mesure de satisfaction dans le suivi-évaluation.
ABSTRACT
Introduction. Satisfaction is a key indicator of care quality and of community trust in the health system. This study aimed to assess the level of community satisfaction with community-based health services in the Republic of the Congo and to identify associated factors. Methodology. A descriptive cross-sectional study using a cluster sampling design was conducted in September 2025 across the 12 departments of the country. Data were collected through the KoboCollect application using the CAPI (Computer-Assisted Personal Interviewing) method. Adults aged 18 years and above residing in the selected clusters and having had contact with a community health worker (CHW) in the past 12 months were included. Overall satisfaction and the seven constructs of the Theoretical Framework of Acceptability (TFA) were measured. Data analysis was performed using Stata version 24, including descriptive statistics, proportion comparisons, and multivariate logistic regression. Results. Among 849 respondents, 420 (49.5%) reported contact with a CHW. Of these, 88.6% were satisfied or very satisfied. Most were female (58.1%) and aged 26–47 years (59.6%). The most common services received were home visits (52.6%), referral to a health facility (45.7%), and health education (38.8%). The mean TFA domain scores were high (self-efficacy: 4.35; ethics: 4.31; perceived effectiveness: 4.22). Perceived effectiveness emerged as the main determinant of satisfaction (OR = 4.58; 95% CI: 1.81–11.58; p = 0.0013). Conclusion. Community satisfaction with CHW services was high, mainly driven by perceived effectiveness. These findings highlight the need to strengthen CHW training, supervision, and the systematic integration of satisfaction measurement into monitoring and evaluation systems.
Keywords
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
- 1. World Banque. La couverture santé universelle - Vue d’ensemble. World Bank, https://www.banquemondiale.org/fr/topic/universalhealthcoverage accessed 19 August 2025.
- 2. WHO. Global strategy on human resources for health: workforce 2030. World Health Organization, 2016.
- 3. World Health Organization. WHO guideline on health policy and system support to optimize community health worker programmes. Geneva: World Health Organization, https://apps.who.int/iris/handle/10665/275474 2018, accessed 10 April 2023.
- 4. WHO. Community health workers delivering primary health care: opportunities and challenges, https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_R3-en.pdf 2019.
- 5. Scott K, Beckham SW, Gross M, et al. What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Hum Resour Health 2018; 16: 39.
- 6. Dahn B, Woldemariam AT, Perry H, et al. Strengthening primary health care through community health workers: investment case and financing recommendations. World Health Organization; 58.
- 7. Afzal MM, Pariyo GW, Lassi ZS, et al. Community health workers at the dawn of a new era: 2. Planning, coordination, and partnerships. Health Res Policy Sys 2021; 19: 103.
- 8. Knowles M, Crowley AP, Vasan A, et al. Community Health Worker Integration with and Effectiveness in Health Care and Public Health in the United States. Annual Review of Public Health 2023; 44: 363–381.
- 9. Uta Lehmann DS. Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. CHW Central, https://chwcentral.org/resources/community-health-workers-what-do-we-know-about-them-the-state-of-the-evidence-on-programmes-activities-costs-and-impact-on-health-outcomes-of-using-community-health-workers/ 2013, accessed 12 March 2023.
- 10. Hjortdahl P, Laerum E. Continuity of care in general practice: effect on patient satisfaction. BMJ 1992; 304: 1287–1290.
- 11. Lautamatti E, Sumanen M, Raivio R, et al. Continuity of care is associated with satisfaction with local health care services. BMC Fam Pract 2020; 21: 181.
- 12. Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: A theoretical framework and proposed assessment method. BMC Health Services Research 2017; 17: 88.
- 13. Condo J, Mugeni C, Naughton B, et al. Rwanda’s evolving community health worker system: a qualitative assessment of client and provider perspectives. Hum Resour Health 2014; 12: 71.
- 14. Kok MC, Dieleman M, Taegtmeyer M, et al. Which intervention design factors influence performance of community health workers in low-and middle-income countries? A systematic review. Health policy and planning 2015; 30: 1207–1227.
- 15. Teklehaimanot HD, Teklehaimanot A. Human resource development for a community-based health extension program: a case study from Ethiopia. Hum Resour Health 2013; 11: 39.
- 16. Perry HB, Chowdhury M, Were M, et al. Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All”. Health Res Policy Sys 2021; 19: 111.
- 17. Hill Z, Dumbaugh M, Benton L, et al. Supervising community health workers in low-income countries – a review of impact and implementation issues. Global Health Action 2014; 7: 24085.
- 18. Scott K, Beckham SW, Gross M, et al. What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Hum Resour Health 2018; 16: 39.
- 19. Kok MC, Ormel H, Broerse JEW, et al. Optimising the benefits of community health workers’ unique position between communities and the health sector: A comparative analysis of factors shaping relationships in four countries. Global Public Health 2017; 12: 1404–1432.
- 20. Ndima SD, Sidat M, Give C, et al. Supervision of community health workers in Mozambique: a qualitative study of factors influencing motivation and programme implementation. Hum Resour Health 2015 ; 13: 63.
References
1. World Banque. La couverture santé universelle - Vue d’ensemble. World Bank, https://www.banquemondiale.org/fr/topic/universalhealthcoverage accessed 19 August 2025.
2. WHO. Global strategy on human resources for health: workforce 2030. World Health Organization, 2016.
3. World Health Organization. WHO guideline on health policy and system support to optimize community health worker programmes. Geneva: World Health Organization, https://apps.who.int/iris/handle/10665/275474 2018, accessed 10 April 2023.
4. WHO. Community health workers delivering primary health care: opportunities and challenges, https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_R3-en.pdf 2019.
5. Scott K, Beckham SW, Gross M, et al. What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Hum Resour Health 2018; 16: 39.
6. Dahn B, Woldemariam AT, Perry H, et al. Strengthening primary health care through community health workers: investment case and financing recommendations. World Health Organization; 58.
7. Afzal MM, Pariyo GW, Lassi ZS, et al. Community health workers at the dawn of a new era: 2. Planning, coordination, and partnerships. Health Res Policy Sys 2021; 19: 103.
8. Knowles M, Crowley AP, Vasan A, et al. Community Health Worker Integration with and Effectiveness in Health Care and Public Health in the United States. Annual Review of Public Health 2023; 44: 363–381.
9. Uta Lehmann DS. Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. CHW Central, https://chwcentral.org/resources/community-health-workers-what-do-we-know-about-them-the-state-of-the-evidence-on-programmes-activities-costs-and-impact-on-health-outcomes-of-using-community-health-workers/ 2013, accessed 12 March 2023.
10. Hjortdahl P, Laerum E. Continuity of care in general practice: effect on patient satisfaction. BMJ 1992; 304: 1287–1290.
11. Lautamatti E, Sumanen M, Raivio R, et al. Continuity of care is associated with satisfaction with local health care services. BMC Fam Pract 2020; 21: 181.
12. Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: A theoretical framework and proposed assessment method. BMC Health Services Research 2017; 17: 88.
13. Condo J, Mugeni C, Naughton B, et al. Rwanda’s evolving community health worker system: a qualitative assessment of client and provider perspectives. Hum Resour Health 2014; 12: 71.
14. Kok MC, Dieleman M, Taegtmeyer M, et al. Which intervention design factors influence performance of community health workers in low-and middle-income countries? A systematic review. Health policy and planning 2015; 30: 1207–1227.
15. Teklehaimanot HD, Teklehaimanot A. Human resource development for a community-based health extension program: a case study from Ethiopia. Hum Resour Health 2013; 11: 39.
16. Perry HB, Chowdhury M, Were M, et al. Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All”. Health Res Policy Sys 2021; 19: 111.
17. Hill Z, Dumbaugh M, Benton L, et al. Supervising community health workers in low-income countries – a review of impact and implementation issues. Global Health Action 2014; 7: 24085.
18. Scott K, Beckham SW, Gross M, et al. What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Hum Resour Health 2018; 16: 39.
19. Kok MC, Ormel H, Broerse JEW, et al. Optimising the benefits of community health workers’ unique position between communities and the health sector: A comparative analysis of factors shaping relationships in four countries. Global Public Health 2017; 12: 1404–1432.
20. Ndima SD, Sidat M, Give C, et al. Supervision of community health workers in Mozambique: a qualitative study of factors influencing motivation and programme implementation. Hum Resour Health 2015 ; 13: 63.