Professional Evaluation of Community Health Extension Worker Performance in Taraba State

Community health extension workers form the foundation of primary healthcare service delivery in Nigerian rural communities, and the quality of their performance significantly determines PHC effectiveness, yet systematic evaluation of CHEW performance in northeast Nigeria is limited. This study evaluated the performance of community health extension workers in Taraba State, North East Nigeria. A mixed-methods performance evaluation was conducted across 30 PHC facilities in Jalingo, Wukari, and Gashaka LGAs. Performance was assessed using a structured competency observation checklist covering antenatal care provision, under-five growth monitoring, immunisation activities, health education, and referral practices. Checklist observations were conducted by trained assessors during 30 simulated client encounters. A structured questionnaire assessed CHEW knowledge scores, self-reported workload, and supervisory support. LGA health records were reviewed for service output data. Results showed that observed practice adequacy across all five assessed competency domains was 54.7 percent. Antenatal blood pressure measurement was correctly performed in 73.3 percent of observations, but fundal height assessment was correct in only 46.7 percent. Growth monitoring plotting accuracy was adequate in 61.7 percent. CHEWs with in-service training within the preceding 18 months showed significantly better performance (p < 0.001). Supervisory visit frequency correlated significantly with performance adequacy (r = 0.54; p < 0.001). The study recommends continuous professional development, quarterly supervisory visits, and digital performance monitoring tools for CHEWs in Taraba State. Keywords: community health extension workers, performance evaluation, Taraba State, primary healthcare, North East Nigeria