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Plum A, Tanniru M, Khuntia J. An innovation platform for diffusing public health practices across a global network. HEALTH POLICY AND TECHNOLOGY 2020. [DOI: 10.1016/j.hlpt.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schaaf M, Fox J, Topp SM, Warthin C, Freedman LP, Robinson RS, Thiagarajan S, Scott K, Maboe T, Zanchetta M, Ruano AL, Kok M, Closser S. Community health workers and accountability: reflections from an international "think-in". Int J Equity Health 2018; 17:66. [PMID: 29801493 PMCID: PMC5970525 DOI: 10.1186/s12939-018-0781-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/20/2018] [Indexed: 12/02/2022] Open
Abstract
Community health workers (CHWs) are frequently put forward as a remedy for lack of health system capacity, including challenges associated with health service coverage and with low community engagement in the health system, and expected to enhance or embody health system accountability. During a ‘think in’, held in June of 2017, a diverse group of practitioners and researchers discussed the topic of CHWs and their possible roles in a larger “accountability ecosystem.” This jointly authored commentary resulted from our deliberations. While CHWs are often conceptualized as cogs in a mechanistic health delivery system, at the end of the day, CHWs are people embedded in families, communities, and the health system. CHWs’ social position and professional role influence how they are treated and trusted by the health sector and by community members, as well as when, where, and how they can exercise agency and promote accountability. To that end, we put forward several propositions for further conceptual development and research related to the question of CHWs and accountability.
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Affiliation(s)
- Marta Schaaf
- Averting Maternal Death and Disability Program, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, B3, New York, NY, 10032, USA.
| | - Jonathan Fox
- Accountability Research Center, School of International Service, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, James Cook Dr, Townsville, QLD, 4812, Australia
| | - Caitlin Warthin
- Averting Maternal Death and Disability Program, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, B3, New York, NY, 10032, USA
| | - Lynn P Freedman
- Averting Maternal Death and Disability Program, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, B3, New York, NY, 10032, USA
| | - Rachel Sullivan Robinson
- School of International Service, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA
| | - Sundararaman Thiagarajan
- School of Health Systems Studies, Tata Institute of Social Sciences, VN Purav Marg, Deonar, Mumbai, 400088, India
| | - Kerry Scott
- Independent Consultant, Bangalore, India and Research Associate, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thoko Maboe
- Qondisa Institute Training for Community Health Care Workers, Monument Road, Duncanville, Vereeniging, 1939, South Africa
| | - Margareth Zanchetta
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, 350 Victoria St, Office POD 474A, Toronto, ON, M5B 2K3, Canada
| | - Ana Lorena Ruano
- Center for the Study of Equity and Governance in Health Systems, Guatemala and Center for International Health University of Bergen, Bergen, Norway
| | - Maryse Kok
- KIT
- Royal Tropical Institute, P.O. Box 95001, 1090, HA, Amsterdam, The Netherlands
| | - Svea Closser
- Middlebury College, 301 Munroe Hall, Middlebury, VT, 05753, USA
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Schaaf M, Fox J, Topp SM, Warthin C, Freedman LP, Robinson RS, Thiagarajan S, Scott K, Maboe T, Zanchetta M, Ruano AL, Kok M, Closser S. Community health workers and accountability: reflections from an international "think-in". Int J Equity Health 2018. [PMID: 29801493 DOI: 10.1186/s12939-018-0781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Community health workers (CHWs) are frequently put forward as a remedy for lack of health system capacity, including challenges associated with health service coverage and with low community engagement in the health system, and expected to enhance or embody health system accountability. During a 'think in', held in June of 2017, a diverse group of practitioners and researchers discussed the topic of CHWs and their possible roles in a larger "accountability ecosystem." This jointly authored commentary resulted from our deliberations. While CHWs are often conceptualized as cogs in a mechanistic health delivery system, at the end of the day, CHWs are people embedded in families, communities, and the health system. CHWs' social position and professional role influence how they are treated and trusted by the health sector and by community members, as well as when, where, and how they can exercise agency and promote accountability. To that end, we put forward several propositions for further conceptual development and research related to the question of CHWs and accountability.
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Affiliation(s)
- Marta Schaaf
- Averting Maternal Death and Disability Program, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, B3, New York, NY, 10032, USA.
| | - Jonathan Fox
- Accountability Research Center, School of International Service, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, James Cook Dr, Townsville, QLD, 4812, Australia
| | - Caitlin Warthin
- Averting Maternal Death and Disability Program, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, B3, New York, NY, 10032, USA
| | - Lynn P Freedman
- Averting Maternal Death and Disability Program, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, B3, New York, NY, 10032, USA
| | - Rachel Sullivan Robinson
- School of International Service, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA
| | - Sundararaman Thiagarajan
- School of Health Systems Studies, Tata Institute of Social Sciences, VN Purav Marg, Deonar, Mumbai, 400088, India
| | - Kerry Scott
- Independent Consultant, Bangalore, India and Research Associate, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thoko Maboe
- Qondisa Institute Training for Community Health Care Workers, Monument Road, Duncanville, Vereeniging, 1939, South Africa
| | - Margareth Zanchetta
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, 350 Victoria St, Office POD 474A, Toronto, ON, M5B 2K3, Canada
| | - Ana Lorena Ruano
- Center for the Study of Equity and Governance in Health Systems, Guatemala and Center for International Health University of Bergen, Bergen, Norway
| | - Maryse Kok
- KIT | Royal Tropical Institute, P.O. Box 95001, 1090, HA, Amsterdam, The Netherlands
| | - Svea Closser
- Middlebury College, 301 Munroe Hall, Middlebury, VT, 05753, USA
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Prentiss T, Zervos J, Tanniru M, Tan J. Community Health Workers (CHWs) as Innovators. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2018. [DOI: 10.4018/ijhisi.2018010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Community health workers (CHWs) have a longstanding role in improving the health and well-being of underserved populations in resource-limited settings. CHWs are trusted in the communities they serve and are often able to see through solutions on community challenges that outside persons cannot. Notwithstanding, such solutions often must be low-cost, easily implementable, and permit knowledge gaps among CHWs to be filled via appropriate training. In this sense, use of cost-effective information technology (IT) solutions can be key to increasing access to knowledge for these community agents. This paper highlights insights gleaned from a pilot study performed in Detroit, Michigan with a group of CHWs in basic grant-writing training via an e-platform, the Community Health Innovator Program (CHIP). The results are discussed within the context of learning theory. It is concluded that e-platforms are necessary for CHWs to leverage knowledge from multiple sources in an adaptive environment towards addressing ever-evolving global health challenges.
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Affiliation(s)
- Tyler Prentiss
- Henry Ford Health System, Global Health Initiative, Detroit, MI, USA
| | - John Zervos
- Henry Ford Health System, Global Health Initiative, Detroit, MI, USA
| | - Mohan Tanniru
- School of Business Administration, Oakland University, Rochester, MI, USA
| | - Joseph Tan
- Professor of eHealth Informatics and eBusiness Innovation, McMaster University, Hamilton, Canada
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Criteria to assess potential reverse innovations: opportunities for shared learning between high- and low-income countries. Global Health 2017; 13:4. [PMID: 28122623 PMCID: PMC5264440 DOI: 10.1186/s12992-016-0225-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 12/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) are developing novel approaches to healthcare that may be relevant to high-income countries (HICs). These include products, services, organizational processes, or policies that improve access, cost, or efficiency of healthcare. However, given the challenge of replication, it is difficult to identify innovations that could be successfully adapted to high-income settings. We present a set of criteria for evaluating the potential impact of LMIC innovations in HIC settings. METHODS An initial framework was drafted based on a literature review, and revised iteratively by applying it to LMIC examples from the Center for Health Market Innovations (CHMI) program database. The resulting criteria were then reviewed using a modified Delphi process by the Reverse Innovation Working Group, consisting of 31 experts in medicine, engineering, management and political science, as well as representatives from industry and government, all with an expressed interest in reverse innovation. RESULTS The resulting 8 criteria are divided into two steps with a simple scoring system. First, innovations are assessed according to their success within the LMIC context according to metrics of improving accessibility, cost-effectiveness, scalability, and overall effectiveness. Next, they are scored for their potential for spread to HICs, according to their ability to address an HIC healthcare challenge, compatibility with infrastructure and regulatory requirements, degree of novelty, and degree of current collaboration with HICs. We use examples to illustrate where programs which appear initially promising may be unlikely to succeed in a HIC setting due to feasibility concerns. CONCLUSIONS This study presents a framework for identifying reverse innovations that may be useful to policymakers and funding agencies interested in identifying novel approaches to addressing cost and access to care in HICs. We solicited expert feedback and consensus on an empirically-derived set of criteria to create a practical tool for funders that can be used directly and tested prospectively using current databases of LMIC programs.
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