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Belay DM, Erku D, Bayih WA, Kassie YT, Minuye Birhane B, Assefa Y. Improving the quality of neonatal health care in Ethiopia: a systematic review. Front Med (Lausanne) 2024; 11:1293473. [PMID: 38841585 PMCID: PMC11150606 DOI: 10.3389/fmed.2024.1293473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/19/2024] [Indexed: 06/07/2024] Open
Abstract
Background Ensuring high-quality healthcare for newborns is essential for improving their chances of survival within Ethiopia's healthcare system. Although various intervention approaches have been implemented, neonatal mortality rates remain stable. Therefore, the present review seeks to identify initiatives for enhancing healthcare quality, their effects on neonatal wellbeing, and the factors hindering or supporting these Quality Improvement (QI) efforts' success in Ethiopia. Methods We searched for original research studies up to June 23, 2023, using PubMed/Medline, WHO-Global Health Library, Cochrane, Clinical Trials.gov, and Hinari. After selecting eligible studies, we assessed their quality using a mixed-method appraisal tool. Quality of care refers to how healthcare services effectively improve desired outcomes for individuals and patient populations. It encompasses vital principles such as safety, effectiveness, timeliness, efficiency, equity, and patient-centeredness. Results We found 3,027 publication records and included 13 studies during our search. All these interventions primarily aimed to provide safe healthcare, with a strong focus on Domain One, which deals with the evidence-based routine upkeep and handling of complications, and Domain Seven, which revolves around ensuring staff competency, emerged as a frequent target for intervention. Many interventions aimed at improving quality also concentrate on essential quality measure elements such as processes, focusing on the activities that occur during care delivery, and quality planning, involving distributing resources, such as basic medicine and equipment, and improving infrastructure. Moreover, little about the facilitators and barriers to QI interventions is investigated. Conclusions This review highlights the significance of introducing QI initiatives in Ethiopia, enhancing the healthcare system's capabilities, engaging the community, offering financial incentives, and leveraging mobile health technologies. Implementing QI interventions in Ethiopia poses difficulties due to resource constraints, insufficient infrastructure, and medical equipment and supplies shortages. It necessitates persistent endeavors to improve neonatal care quality, involving ongoing training, infrastructure enhancement, the establishment of standardized protocols, and continuous outcome monitoring. These efforts are crucial to achieving the optimal outcomes for newborns and their families.
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Affiliation(s)
- Demeke Mesfin Belay
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Daniel Erku
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Addis Consortium for Health Economics and Outcomes Research (AnCHOR)
| | - Wubet Alebachew Bayih
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | | | - Binyam Minuye Birhane
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
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Kansiime WK, Atusingwize E, Ndejjo R, Balinda E, Ntanda M, Mugambe RK, Musoke D. Barriers and benefits of mHealth for community health workers in integrated community case management of childhood diseases in Banda Parish, Kampala, Uganda: a cross-sectional study. BMC PRIMARY CARE 2024; 25:173. [PMID: 38769485 PMCID: PMC11103880 DOI: 10.1186/s12875-024-02430-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Low-quality data presents a significant challenge for community health workers (CHWs) in low and middle-income countries (LMICs). Mobile health (mHealth) applications offer a solution by enabling CHWs to record and submit data electronically. However, the barriers and benefits of mHealth usage among CHWs in informal urban settlements remain poorly understood. This study sought to determine the barriers and benefits of mHealth among CHWs in Banda parish, Kampala. METHODS This qualitative study involved 12 key informant interviews (KIIs) among focal persons from Kampala City Council Authority (KCCA) and NGOs involved in data collected by CHWs, and officials from the Ministry of Health (MOH) and two mixed-sex Focused Group Discussions (FGDs) of CHWs from Banda parish, Kampala district. Data analysis utilised Atlas Ti Version 7.5.7. Thematic analysis was conducted, and themes were aligned with the social-ecological model. RESULTS Three themes of institutional and policy, community and interpersonal, and individual aligning to the Social ecological model highlighted the factors contributing to barriers and the benefits of mHealth among CHWs for iCCM. The key barriers to usability, acceptability and sustainability included high training costs, CHW demotivation, infrastructure limitations, data security concerns, community awareness deficits, and skill deficiencies. Conversely, mHealth offers benefits such as timely data submission, enhanced data quality, geo-mapping capabilities, improved CHW performance monitoring, community health surveillance, cost-effective reporting, and CHW empowering with technology. CONCLUSION Despite limited mHealth experience, CHWs expressed enthusiasm for its potential. Implementation was viewed as a solution to multiple challenges, facilitating access to health information, efficient data reporting, and administrative processes, particularly in resource-constrained settings. Successful mHealth implementation requires addressing CHWs' demotivation, ensuring reliable power and network connectivity, and enhancing capacity for digital data ethics and management. By overcoming these barriers, mHealth can significantly enhance healthcare delivery at the community level, leveraging technology to optimize resource utilization and improve health outcomes. mHealth holds promise for transforming CHW practices, yet its effective integration necessitates targeted interventions to address systemic challenges and ensure sustainable implementation in LMIC contexts.
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Affiliation(s)
- Winnifred K Kansiime
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Edwinah Atusingwize
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Emmanuel Balinda
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Moses Ntanda
- Department of Networks, College of Computing and Information Science, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Richard K Mugambe
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Ng’oma M, Atif N, Meltzer-Brody S, Chirwa E, Stewart RC. Piloting a psychosocial intervention for perinatal depression, the Thinking Healthy Programme-Peer delivered (THPP), in a primary care setting in Lilongwe District, Malawi. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002128. [PMID: 38691572 PMCID: PMC11062519 DOI: 10.1371/journal.pgph.0002128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/27/2024] [Indexed: 05/03/2024]
Abstract
Despite the evidence for the effectiveness of psychosocial interventions for perinatal depression, their uptake is low in Low- and Middle-Income Countries. Reasons for this include the lack of contextually adapted interventions and mental health specialists to deliver them. This study aimed to test the acceptability and feasibility of a psychosocial intervention for perinatal depression, the Thinking Healthy Programme-Peer Delivered, adapted for use in rural Malawi. A multi-method evaluation of feasibility and acceptability of the intervention was conducted using a one-group pretest-posttest quasi-experimental design and an exploratory qualitative study. Pre-post intervention change in depression scores (paired t-test) and recruitment, retention and session adherence rates were calculated. Qualitative data were collected through 29 in-depth interviews (22 mothers and 7 peer volunteers) and 1 Focus Group Discussion (18 mothers). Thematic analysis approach was used to analyse qualitative data. Seven (7) out of 8 peer volunteers were successfully trained to deliver the intervention. A total of 31 pregnant women with Edinburgh Postnatal Depression Scale (EPDS) score ≥12 were offered intervention, of whom 24 were enrolled (recruitment rate 77.4%). Out of these 24 women, 22 completed the intervention (retention rate 91.6%). Mean difference between pre- and post-test EPDS scores one week after 8th session was 7.59 (95% CI 4.98 to 10.19), p<0.001. Qualitative evaluation showed that the intervention was acceptable despite some challenges including stigma and issues around incentivization of peer volunteers. The Thinking Healthy Programme-Peer Delivered, adapted for use in Malawi, was feasible to deliver and acceptable to its target population. The intervention may be useful in management of perinatal depression in primary care settings in Malawi. However, definitive trials are needed to evaluate its effectiveness.
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Affiliation(s)
- Mwawi Ng’oma
- Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Programs Department, St John of God Hospitaller Services, Lilongwe, Malawi
| | - Najia Atif
- Human Development Research Foundation, Islamabad, Pakistan
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Ellen Chirwa
- Department of Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Robert C. Stewart
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
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Tikkanen RS, Closser S, Prince J, Chand P, Justice J. An anthropological history of Nepal's Female Community Health Volunteer program: gender, policy, and social change. Int J Equity Health 2024; 23:70. [PMID: 38614976 PMCID: PMC11015651 DOI: 10.1186/s12939-024-02177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/06/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Community health workers (CHWs) are central to Primary Health Care globally. Amidst the current flourishing of work on CHWs, there often is a lack of reference to history-even in studies of programs that have been around for decades. This study examines the 35-year trajectory of Nepal's Female Community Health Volunteers (FCHVs). METHODS We conducted a content analysis of an archive of primary and secondary research materials, grey literature and government reports collected during 1977-2019 across several regions in Nepal. Documents were coded in MAXQDA using principles of inductive coding. As questions arose from the materials, data were triangulated with published sources. RESULTS Looking across four decades of the program's history illuminates that issues of gender, workload, and pay-hotly debated in the CHW literature now-have been topics of discussion for observers and FCHVs alike since the inception of the program. Following experiments with predominantly male community volunteers during the 1970s, Nepal scaled up the all-female FCHV program in the late 1980s and early 1990s, in part because of programmatic goals focused on maternal and child health. FCHVs gained legitimacy as health workers in part through participation in donor-funded vertical campaigns. FCHVs received a stable yet modest regular stipend during the early years, but since it was stopped in the 1990s, incentives have been a mix of activity-based payments and in-kind support. With increasing outmigration of men from villages and growing work responsibilities for women, the opportunity cost of health volunteering increased. FCHVs started voicing their dissatisfaction with remuneration, which gave rise to labor movements starting in the 2010s. Government officials have not comprehensively responded to demands by FCHVs for decent work, instead questioning the relevance of FCHVs in a modern, medicalized Nepali health system. CONCLUSIONS Across public health, an awareness of history is useful in understanding the present and avoiding past mistakes. These histories are often not well-archived, and risk getting lost. Lessons from the history of Nepal's FCHV program have much to offer present-day debates around CHW policies, particularly around gender, workload and payment.
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Affiliation(s)
- Roosa Sofia Tikkanen
- Institute of Sociology and Political Science, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Edvard Bulls veg 1, 7491, Trondheim, Norway.
| | - Svea Closser
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
| | - Justine Prince
- Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, 3400 N. Charles Street, Baltimore, Maryland, 21218, USA
| | - Priyankar Chand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
| | - Judith Justice
- Institute for Health & Aging, School of Nursing, University of California at San Francisco, 490 Illinois Street, San Francisco, CA, 94143, USA
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Tizifa TA, Kabaghe AN, McCann RS, Gowelo S, Malenga T, Nkhata RM, Chapeta Y, Nkhono W, Kadama A, Takken W, Phiri KS, van Vugt M, van den Berg H, Manda-Taylor L. Assessing the implementation fidelity, feasibility, and sustainability of community-based house improvement for malaria control in southern Malawi: a mixed-methods study. BMC Public Health 2024; 24:951. [PMID: 38566043 PMCID: PMC10988826 DOI: 10.1186/s12889-024-18401-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Despite significant success in the fight against malaria over the past two decades, malaria control programmes rely on only two insecticidal methods: indoor residual spraying and insecticidal-treated nets. House improvement (HI) can complement these interventions by reducing human-mosquito contact, thereby reinforcing the gains in disease reduction. This study assessed the implementation fidelity, which is the assessment of how closely an intervention aligns with its intended design, feasibility, and sustainability of community-led HI in southern Malawi. METHODS The study, conducted in 22 villages (2730 households), employed a mixed-methods approach. Implementation fidelity was assessed using a modified framework, with longitudinal surveys collecting data on HI coverage indicators. Quantitative analysis, employing descriptive statistics, evaluated the adherence to HI implementation. Qualitative data came from in-depth interviews, key informant interviews, and focus groups involving project beneficiaries and implementers. Qualitative data were analysed using content analysis guided by the implementation fidelity model to explore facilitators, challenges, and factors affecting intervention feasibility. RESULTS The results show that HI was implemented as planned. There was good adherence to the intended community-led HI design; however, the adherence could have been higher but gradually declined over time. In terms of intervention implementation, 74% of houses had attempted to have eaves closed in 2016-17 and 2017-18, compared to 70% in 2018-19. In 2016-17, 42% of houses had all four sides of the eaves closed, compared to 33% in 2018-19. Approximately 72% of houses were screened with gauze wire in 2016-17, compared to 57% in 2018-19. High costs, supply shortages, labour demands, volunteers' poor living conditions and adverse weather were reported to hinder the ideal HI implementation. Overall, the community described community-led HI as feasible and could be sustained by addressing these socioeconomic and contextual challenges. CONCLUSION Our study found that although HI was initially implemented as planned, its fidelity declined over time. Using trained volunteers facilitated the fidelity and feasibility of implementing the intervention. A combination of rigorous community education, consistent training, information, education and communication, and intervention modifications may be necessary to address the challenges and enhance the intervention's fidelity, feasibility, and sustainability.
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Affiliation(s)
- Tinashe A Tizifa
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, University of Amsterdam, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands.
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
| | - Alinune N Kabaghe
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Robert S McCann
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
- Centre for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
| | - Steven Gowelo
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Tumaini Malenga
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- National TB and Leprosy Elimination Programme, Ministry of Health, Lilongwe, Malawi
| | - Richard M Nkhata
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Yankho Chapeta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Biological Sciences Department, Mzuzu University, Mzuzu, Malawi
| | - William Nkhono
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Asante Kadama
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Willem Takken
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Kamija S Phiri
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Michele van Vugt
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, University of Amsterdam, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Henk van den Berg
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Lucinda Manda-Taylor
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
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Trout KE, Chaidez V, Ern J, Bremer M, Karsting K, Su D. Differences in Role and Support Between Volunteer and Paid Community Health Workers in the State of Nebraska. J Community Health 2024; 49:257-266. [PMID: 37848655 DOI: 10.1007/s10900-023-01289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/19/2023]
Abstract
Despite the growing importance of community health workers (CHWs) in public health, it has been difficult to characterize the roles and scope of services for this workforce in part because of the variability in the employment status of CHWs, ranging from full-time, part-time, to volunteer. Based on analysis of survey data from a statewide assessment of the CHW workforce in Nebraska (n = 142) conducted between 2019 and 2020, the proportions of CHWs who worked full-time, part-time, or volunteer were respectively 64%, 12%, and 21%. Over three quarters (76.7%) of volunteer CHWs were primarily working with Hispanic communities, as compared to less than 30% among full-time and part-time CHWs. About 80% of volunteer CHWs received training before becoming a CHW, substantially higher than the corresponding proportions among full-time (46.2%) and part-time CHWs (52.9%). In terms of tasks performed, the proportion of volunteer CHWs who provided health screenings (70%) were much higher than full or part-time CHWs (41.8% and 11.8% respectively, p < 0.001); whereas the latter two groups were significantly more likely than volunteer CHWs to provide other tasks such as coordinating care, health coaching, social support, transportation, interpretation, data collection, advocacy, and cultural awareness. Volunteer CHWs may hold potential for serving non-Hispanic communities. Future development of the CHW workforce can benefit from understanding and leveraging the significant differences in roles and scope of services among CHWs with various employment statuses.
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Affiliation(s)
- Kate E Trout
- Department of Health Sciences, College of Health Sciences, University of Missouri-Columbia, Columbia, MO, USA.
| | - Virginia Chaidez
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, USA
| | - Jessica Ern
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mark Bremer
- Department of Health Sciences, College of Health Sciences, University of Missouri-Columbia, Columbia, MO, USA
| | - Kathy Karsting
- Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, NE, USA
| | - Dejun Su
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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Malatji H, Griffiths F, Goudge J. Mobilisation towards formal employment in the healthcare system: A qualitative study of community health workers in South Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002226. [PMID: 38507456 PMCID: PMC10954165 DOI: 10.1371/journal.pgph.0002226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/07/2024] [Indexed: 03/22/2024]
Abstract
In low and middle-income countries, community health workers (CHWs) play a critical role in delivering primary healthcare (PHC) services. However, they often receive low stipends, function without resources and have little bargaining power with which to demand better working conditions. Using a qualitative case study methodology, we studied CHWs' conditions of employment, their struggle for recognition as health workers, and their activities to establish labour representation in South Africa. Seven CHW teams located in semi-urban and rural areas of Gauteng and Mpumalanga Provinces were studied. We conducted 43 in-depth interviews, 10 focus groups and 6 observations to gather data from CHWs and their representatives, supervisors and PHC facility staff. The data was analysed using thematic analysis method. In the rural and semi-urban sites, the CHWs were poorly resourced and received meagre remuneration, their employment outsourced, without employment benefits and protection. As a result of these challenges, the CHWs in the semi-urban sites established a task team to represent them. They held meetings and caused disruptions in the health facilities. After numerous unsuccessful attempts to negotiate for improved conditions of employment, the CHWs joined a labour union in order to participate in the local Bargaining Council. Though they were not successful in getting the government to provide permanent employment, the union negotiated an increase in their stipend. After the study ended, during the height of COVID-19 in 2020, when the need for motivated and effective CHWs became more apparent to decision makers, the semi-urban-based teams received permanent employment with a better remuneration. The task team and their protests raised awareness of the plight of the CHWs, and joining a formal union enabled them to negotiate a modest salary increase. However, it was the emergency created by the world-wide COVID-19 pandemic that forced decision-makers to acknowledge their reliance on this community-based cadre.
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Affiliation(s)
- Hlologelo Malatji
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Frances Griffiths
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jane Goudge
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Kletter M, Harris B, Connolly E, Namathanga C, Nhlema B, Makungwa H, Chabwera B, Phiri B, Brown C. Mixed method evaluation of a learning from excellence programme for community health workers in Neno, Malawi. BMC Health Serv Res 2024; 24:355. [PMID: 38504273 PMCID: PMC10953074 DOI: 10.1186/s12913-024-10686-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/05/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Community Health Workers (CHWs) play an essential role in linking communities to facility-based healthcare. However, CHW programmes have often been hampered by low levels of staff motivation, and new tools aimed at improving staff motivation and work environment are needed. One such intervention is the "Learning from Excellence" (LfE) programme. We aimed to assess feasibility, outputs, and impact of a co-designed LfE programme on CHW motivation, in Neno District. METHODS We conducted a convergent mixed-method evaluation of the LfE programme. Co-design of the programme and forms took place between October 2019 and January 2020. LfE forms submitted between September and November 2020 were analysed using descriptive statistics and memos summarising answers to the open-ended question. To investigate experiences with LfE we conducted in-depth semi-structured interviews with key stakeholders, CHWs, and site supervisors, which were analysed thematically. A pre-post intervention questionnaire was developed to assess the impact of the co-designed LfE intervention on CHW motivation and perceived supervision. Outcomes were triangulated into a logic model. RESULTS In total 555 LfE forms were submitted, with 34.4% of CHWs in Neno District submitting at least one LfE report. Four themes were identified in the interviews: LfE implementation processes, experience, consequences, and recommendations. A total of 50 CHWs participated in the questionnaire in January 2020 and 46 of them completed the questionnaire in December 2020. No statistically significant differences were identified between pre-and post-LfE measurements for both motivation (Site F: p = 0.86; Site G: p = 0.31) and perceived supervision (Site F: p = 0.95; Site G: p = 0.45). A logic model, explaining how the LfE programme could impact CHWs was developed. CONCLUSIONS Many CHWs participated in the LfE intervention between September 2020 and November 2020. LfE was welcomed by CHWs and stakeholders as it allowed them to appreciate excellent work in absence of other opportunities to do so. However, no statistically significant differences in CHW motivation and perceived supervision were identified. While the intervention was feasible in Neno District, we identified several barriers and facilitators for implementation. We developed a logic model to explain contextual factors, and mechanisms that could lead to LfE outcomes for CHWs in Neno District. The developed logic model can be used by those designing and implementing interventions like LfE for health workers.
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Affiliation(s)
- Maartje Kletter
- The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Bronwyn Harris
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Emilia Connolly
- Partners In Health/Abwenzi Pa Za Umoyo, Neno, PO Box 56, Malawi
| | | | | | - Henry Makungwa
- Partners In Health/Abwenzi Pa Za Umoyo, Neno, PO Box 56, Malawi
| | - Benson Chabwera
- Partners In Health/Abwenzi Pa Za Umoyo, Neno, PO Box 56, Malawi
| | - Benson Phiri
- Partners In Health/Abwenzi Pa Za Umoyo, Neno, PO Box 56, Malawi
| | - Celia Brown
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Simwinga M, Gwanu L, Hensen B, Sigande L, Mainga M, Phiri T, Mwanza E, Kabumbu M, Mulubwa C, Mwenge L, Bwalya C, Kumwenda M, Mubanga E, Mee P, Johnson CC, Corbett EL, Hatzold K, Neuman M, Ayles H, Taegtmeyer M. Lessons learned from implementation of four HIV self-testing (HIVST) distribution models in Zambia: applying the Consolidated Framework for Implementation Research to understand impact of contextual factors on implementation. BMC Infect Dis 2024; 22:977. [PMID: 38448832 PMCID: PMC10916003 DOI: 10.1186/s12879-024-09168-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Although Zambia has integrated HIV-self-testing (HIVST) into its Human Immunodeficiency Virus (HIV) regulatory frameworks, few best practices to optimize the use of HIV self-testing to increase testing coverage have been documented. We conducted a prospective case study to understand contextual factors guiding implementation of four HIVST distribution models to inform scale-up in Zambia. METHODS We used the qualitative case study method to explore user and provider experiences with four HIVST distribution models (two secondary distribution models in Antenatal Care (ANC) and Antiretroviral Therapy (ART) clinics, community-led, and workplace) to understand factors influencing HIVST distribution. Participants were purposefully selected based on their participation in HIVST and on their ability to provide rich contextual experience of the distribution models. Data were collected using observations (n = 31), group discussions (n = 10), and in-depth interviews (n = 77). Data were analyzed using the thematic approach and aligned to the four Consolidated Framework for Implementation Research (CFIR) domains. RESULTS Implementation of the four distribution models was influenced by an interplay of outer and inner setting factors. Inadequate compensation and incentives for distributors may have contributed to distributor attrition in the community-led and workplace HIVST models. Stockouts, experienced at the start of implementation in the secondary-distribution and community-led distribution models often disrupted distribution. The existence of policy and practices aided integration of HIVST in the workplace. External factors complimented internal factors for successful implementation. For instance, despite distributor attrition leading to excessive workload, distributors often multi-tasked to keep up with demand for kits, even though distribution points were geographically widespread in the workplace, and to a less extent in the community-led models. Use of existing communication platforms such as lunchtime and safety meetings to promote and distribute kits, peers to support distributors, reduction in trips by distributors to replenish stocks, increase in monetary incentives and reorganisation of stakeholder roles proved to be good adaptations. CONCLUSION HIVST distribution was influenced by a combination of contextual factors in variable ways. Understanding how the factors interacted in real world settings informed adaptations to implementation devised to minimize disruptions to distribution.
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Affiliation(s)
| | | | - Bernadette Hensen
- Department of Public Health, Sexual and Reproductive Health Group, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | | | | | | | | | | | - Moses Kumwenda
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Ellen Mubanga
- National HIV/AID/STI/TB Council (NAC), Lusaka, Zambia
| | - Paul Mee
- Department of Infectious Disease Epidemiology, Medical Research Council International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Cheryl C Johnson
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Global HIV, Hepatitis and STI Programmes, World Health Organisation, Geneva, Switzerland
| | - Elizabeth L Corbett
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Karin Hatzold
- Population Services International, Johannesburg, South Africa
| | - Melissa Neuman
- Department of Infectious Disease Epidemiology, Medical Research Council International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Ayles
- Zambart, Lusaka, Zambia
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Miriam Taegtmeyer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Infectious Diseases Unit, Liverpool University Hospitals Foundation Trust, Liverpool, UK
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10
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Alzain AF, Elhussein N, Hamd ZY, Fadulelmulla IA, Omer AM, Alotaibi A, Alsuhaymi A, Aljohany M, Alharbi N, Ahmed AM, Hussien R, Elamin BA, Mohamed Ahmed Medani A, Khandaker MU. The impact of health volunteering of radiology students on improving their self-skills and practical capabilities in the Kingdom of Saudi Arabia. Front Med (Lausanne) 2024; 10:1243014. [PMID: 38486825 PMCID: PMC10937525 DOI: 10.3389/fmed.2023.1243014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/28/2023] [Indexed: 03/17/2024] Open
Abstract
Background Volunteering is a beneficial activity with a wide range of positive outcomes, from the individual to the communal level. In many ways, volunteering has a positive impact on the development of a volunteer's personality and experience. This study aimed to evaluate the impact of health volunteering on improving the self-skills and practical capacities of students in the western region of the Kingdom of Saudi Arabia. Materials and methods The study was a descriptive cross-sectional electronic web-based survey that was submitted on a web-based questionnaire; 183 students answered the survey, and then, the data were analyzed using SPSS. Results This study shows that 95.6% of participants agree and strongly agree that the health volunteering experience was useful, 2.7% of the participants neither agree nor disagree, and 1.6% disagree and strongly disagree. Regarding the distribution of the participants on skills learned from volunteering experience, the largest proportion of student (36.1%) volunteers in the health sector acquired communication skills and the smallest proportion of student (14.8%) volunteers in the acquired time management skills. Regarding the disadvantages, 81.4% of the participants do not think there were any disadvantages to their previous health volunteering experience, while only 18.6% of them think there were any disadvantages to their previous health volunteering experience. Additionally, the study found that the type of the sector affects the skills acquired from health volunteering. Conclusion Research revealed that the majority considered volunteering a great experience. Volunteering increased the self-skills and practical capacities of radiology students, which proved the hypothesis.
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Affiliation(s)
- Amel F. Alzain
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwrah, Saudi Arabia
| | - Nagwan Elhussein
- Department of Diagnostic Radiology, College of Applied Medical Sciences, University of Ha’il, Ha’il, Saudi Arabia
| | - Zuhal Y. Hamd
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Awatif M. Omer
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwrah, Saudi Arabia
| | - Ahoud Alotaibi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwrah, Saudi Arabia
| | - Amani Alsuhaymi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwrah, Saudi Arabia
| | - Maram Aljohany
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwrah, Saudi Arabia
| | - Najwa Alharbi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwrah, Saudi Arabia
| | - Amna Mohamed Ahmed
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Rehab Hussien
- Department of Diagnostic Radiology, College of Applied Medical Sciences, University of Ha’il, Ha’il, Saudi Arabia
| | - Badria Awad Elamin
- Department of Diagnostic Radiology, College of Applied Medical Sciences, University of Ha’il, Ha’il, Saudi Arabia
| | - Afaf Mohamed Ahmed Medani
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Mayeen Uddin Khandaker
- Applied Physics and Radiation Technologies Group, CCDCU, School of Engineering and Technology, Sunway University, Bandar Sunway, Selangor, Malaysia
- Faculty of Graduate Studies, Daffodil International University, Dhaka, Bangladesh
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11
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Nichols C. Equity and empowerment effects: Multiple styles of 'voluntarism' in community-based health projects. WORLD DEVELOPMENT 2024; 174:106448. [PMID: 38304852 PMCID: PMC10753287 DOI: 10.1016/j.worlddev.2023.106448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 02/03/2024]
Abstract
Community health workers (CHW) are individuals with no formal health training who perform various roles to address health disparities. There are long-sustained debates over how different forms of incentives shape CHW programs, which are often staffed with volunteer or minimally remunerated women. These debates are complicated by the diversity of CHW roles and contexts in which they work. Evidence is particularly scant around "change-agent" style CHWs, who shape health knowledge and norms within their community. This paper addresses this gap through an analysis of a change agent-staffed program that provided nutrition participatory education through women's groups in three eastern Indian sites. We examine how contextual factors across sites shaped change-agent management, and analyze the implications of each approach for efficacy, empowerment, and equity. Analyzing 68 interviews and 10 focus groups this study advances a typology of 'varieties' of voluntarism that we name laissez faire, active-cultivation, and honorarium-accountability, and uses comparative analysis to examine the equity and empowerment effects within selection, management, and payment. First, we find tensions in the community-based selection of volunteers because rather than selecting highly motivated women, groups selected women in the most favorable socioeconomic position to volunteer. Second, there is a tension around responsibility and expectations in that greater training and responsibility leads women to see more psychosocial empowerment (e.g., knowledge, confidence), but also may create more 'costs' to participation and leads to wider economic inequities in change-agent ranks. Third, we observe a misplaced focus on payments as central to change-agent motivation. While the two volunteer-only sites see payment as 'the answer' to motivation problems, the honorarium site sees payments as 'the problem' because they attract less intrinsically motivated individuals. We conclude that while payments may not make an unmotivated volunteer into a motivated one, this analysis suggests payments would potentially allow more marginalized women to participate, which may be key to making more equitable and efficacious impacts.
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Affiliation(s)
- Carly Nichols
- Department of Geographical and Sustainability Sciences, University of Iowa, 312 Jessup Hall, Iowa City, IA 52242, USA
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12
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Riang'a RM, Nyanja N, Lusambili A, Mwangi EM, Ehrlich JR, Clyde P, Mostert C, Ngugi A. Implementation framework for income generating activities identified by community health volunteers (CHVs): a strategy to reduce attrition rate in Kilifi County, Kenya. BMC Health Serv Res 2024; 24:132. [PMID: 38267980 PMCID: PMC10809497 DOI: 10.1186/s12913-023-10514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Despite the proven efficacy of Community Health Volunteers (CHVs) in promoting primary healthcare in low- and middle-income countries (LMICs), they are not adequately financed and compensated. The latter contributes to the challenge of high attrition rates observed in many settings, highlighting an urgent need for innovative compensation strategies for CHVs amid budget constraints experienced by healthcare systems. This study sought to identify strategies for implementing Income-Generating Activities (IGAs) for CHVs in Kilifi County in Kenya to improve their livelihoods, increase motivation, and reduce attrition. METHODS An exploratory qualitative research study design was used, which consisted of Focus group discussions with CHVs involved in health promotion and data collection activities in a local setting. Further, key informant in-depth interviews were conducted among local stakeholder representatives and Ministry of Health officials. Data were recorded, transcribed and thematically analysed using MAXQDA 20.4 software. Data coding, analysis and presentation were guided by the Okumus' (2003) Strategy Implementation framework. RESULTS A need for stable income was identified as the driving factor for CHVs seeking IGAs, as their health volunteer work is non-remunerative. Factors that considered the local context, such as government regulations, knowledge and experience, culture, and market viability, informed their preferred IGA strategy. Individual savings through table-banking, seeking funding support through loans from government funding agencies (e.g., Uwezo Fund, Women Enterprise Fund, Youth Fund), and grants from corporate organizations, politicians, and other donors were proposed as viable options for raising capital for IGAs. Formal registration of IGAs with Government regulatory agencies, developing a guiding constitution, empowering CHVs with entrepreneurial and leadership skills, project and group diversity management, and connecting them to support agencies were the control measures proposed to support implementation and enhance the sustainability of IGAs. Group-owned and managed IGAs were preferred over individual IGAs. CONCLUSION CHVs are in need of IGAs. They proposed implementation strategies informed by local context. Agencies seeking to support CHVs' livelihoods should, therefore, engage with and be guided by the input from CHVs and local stakeholders.
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Affiliation(s)
- Roselyter Monchari Riang'a
- Department of Population Health, Aga Khan University, East Africa, Medical College, 3rd Parklands Avenue, off Limuru Road, Nairobi, 30270-00100, Kenya.
| | - Njeri Nyanja
- Department of Family Medicine, Aga Khan University, East Africa, Nairobi, Kenya
| | - Adelaide Lusambili
- Institute for Human Development, Aga Khan University, East Africa, Nairobi, Kenya
| | - Eunice Muthoni Mwangi
- Department of Population Health, Aga Khan University, East Africa, Medical College, 3rd Parklands Avenue, off Limuru Road, Nairobi, 30270-00100, Kenya
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Paul Clyde
- The William Davidson Institute at the University of Michigan and the Ross School of Business, University of Michigan, Ann Arbor, MI, USA
| | - Cyprian Mostert
- Department of Population Health, Aga Khan University, East Africa, Medical College, 3rd Parklands Avenue, off Limuru Road, Nairobi, 30270-00100, Kenya
- Aga Khan University, East Africa, Brain and Mind Institute, Nairobi, Kenya
| | - Anthony Ngugi
- Department of Population Health, Aga Khan University, East Africa, Medical College, 3rd Parklands Avenue, off Limuru Road, Nairobi, 30270-00100, Kenya
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Wagaba MT, Musoke D, Bagonza A, Ddamulira JB, Nalwadda CK, Orach CG. Does mHealth influence community health worker performance in vulnerable populations? A mixed methods study in a multinational refugee settlement in Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002741. [PMID: 38157328 PMCID: PMC10756529 DOI: 10.1371/journal.pgph.0002741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024]
Abstract
Community Health Workers (CHWs) provide healthcare in under-served communities, including refugee settlements, despite various challenges hindering their performance. Implementers have adopted mobile wireless technologies (m-Health) to improve the performance of CHWs in refugee settlements. We assessed the CHWs' performance and associated factors in a multi-national refugee settlement, operating mHealth and paper-based methods. This cross-sectional study employed quantitative and qualitative data collection methods. Data for 300 CHWs was collected from implementing partners' (IPs) databases. Nine focus group discussions (FGDs) with the CHWs and community members, two in-depth interviews (IDIs) with CHW leaders, and eight key informant interviews (KIIs) with six IPs and two local leaders were conducted. The qualitative data were analysed thematically using AtlasTi version 9 while the quantitative data were analysed at the univariate, bivariate and multivariable levels using Stata version14. The study found that only 17% of the CHWs performed optimally. The factors that significantly influenced CHW performance included education level: secondary and above (APR: 1.83, 95% CI: 1.02-3.30), having a side occupation (APR: 2.02, 95% CI: 1.16-3.52) and mHealth use (APR: 0.06, 95% CI: 0.02-.0.30). The qualitative data suggested that performance was influenced by the number of households assigned to CHWs, monetary incentives, adequacy of materials and facilitation. Particularly, mHealth was preferred to paper-based methods. Overall, the CHWs' performance was sub-optimal; only 2 in 10 performed satisfactorily. The main factors that influenced performance included the level of education, use of mHealth, having another occupation, workload and incentivisation. CHWs and IPs preferred mHealth to paper-based methods. IPs should work to improve refugee settlement working conditions for the CHWs and adopt mHealth to improve CHW performance.
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Affiliation(s)
- Michael T. Wagaba
- Department of Community Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Arthur Bagonza
- Department of Community Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John B. Ddamulira
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Christine K. Nalwadda
- Department of Community Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Christopher G. Orach
- Department of Community Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Avila P. Decolonizing Global Health: Increasing Capacity of Community Health Worker Programs. Ann Glob Health 2023; 89:90. [PMID: 38145161 PMCID: PMC10742167 DOI: 10.5334/aogh.4325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/17/2023] [Indexed: 12/26/2023] Open
Abstract
Many global health volunteer experiences and research projects are focused on the needs of the host country participants, which perpetuates a sovereign or superior relationship towards low- or middle-income countries (LMIC). The purpose of this paper is to discuss ethical and culturally sensitive practices in LMIC when providing health care as a volunteer or researcher. International ethical standards for providing global health care are discussed. The author participated in a volunteer global health experience for three months in Kenya. An evaluation of a nongovernmental organization (NGO)-sponsored community health worker (CHW) program was conducted and is presented here. Health indicators such as prenatal care visits, birth attendance by skilled personnel, and full vaccination of children improved by 34%, 36%, and 24%, respectively, following 5 years of implementation of the CHW program. Global health care can be provided in a more socially responsible and sustainable manner by supporting NGO-sponsored CHW programs affiliated with local ministries of health in LMICs.
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Affiliation(s)
- Pamela Avila
- Legacy Health System/Oregon Health & Science University, US
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15
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Chen J, Yu G, Li W, Yang C, Ye X, Wu D, Wang Y, Du W, Xiao Z, Zeng S, Luo H, Li X, Wu Y, Liu S. A situational analysis of human resource and non-communicable diseases management for community health workers in Chengdu, China: a cross-sectional study. BMC Health Serv Res 2023; 23:1097. [PMID: 37833662 PMCID: PMC10576308 DOI: 10.1186/s12913-023-09880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 08/07/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) pose a major challenge to health economic cost and residents' health status. Community health workers (CHWs) are the gatekeeper of primary health care. OBJECTIVE This study aimed to conduct a situational analysis of current human resource and requirements of NCDs-related training among CHWs in Chengdu with regard to address to understand the suggestions for improvement of challenges and barriers. METHODS A descriptive online cross-sectional survey was conducted among CHWs (doctors and nurses) from 23 districts and counties in Chengdu. Sociodemographic and NCDs-related variables were collected. Univariate analysis and multiple response analysis were used to describe the characteristics of these variables. RESULTS 711 doctors and 637 nurses completely responded. There were significant differences among gender, age, educational levels, professional title, working year, type of institution, urban circle and registration in general practice between doctors and nurses (P < 0.001). 60.6% of doctors were female, compared to 98.0% for nurses. 58.2% of doctors held a bachelor's degree compared with 45.4% of nurses, while 48.3% of nurses held a junior college degree compared with 25.7% of doctors. Higher levels of professional title and registration in general practice were found in doctors compared with nurses. The proportions of NCDs' category, NCDs-related roles and tasks, NCDs-related training contents and forms that CHWs have attend and hoped to gain more were significantly different between doctors and nurses (P < 0.001). In general, the proportions in nurses were much lower than those of doctors (P < 0.05). The top five diseases managed by CHWs were hypertension, diabetes, cerebrovascular disease, chronic respiratory diseases and mental diseases. The five most reported roles performed among doctors included the distribution of health education (91.4%), following up (85.9%), establishing archives (71.3%), medicine adjustment (64.7%) and treatment implementation (52.0%). The top three diseases managed by nurses were same with doctors. The top four and five tasks were contact with patients or health services (39.6%) and referral (16.6%) in nurses. Most CHWs had received primary and common diseases-related trainings, but they had few opportunities to study in a tertiary hospital (40.4% in doctors and 20.9% in nurses, respectively), attend domestic academic conferences (26.9% in doctors vs. 9.7% in nurses), and take part in training courses (44.9% in nurses). CHWs hoped that the above-discussed training contents and forms could be provided more in the future. Besides basic skills related trainings, some specific skills related trainings should be strengthened. CONCLUSION The qualifications in doctors were much better than those of nurses. The roles performed by CHWs in NCDs management are varied form common and frequent disease management to subsequent follow up and supervision. CHWs hope to receive more desired and oriented trainings. There is a need for building capacity of CHWs, optimizing and defining CHWs' role, facilitating postgraduate medical education support and strengthening multidisciplinary collaboration would be effective in NCDs management.
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Affiliation(s)
- Jinhua Chen
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Guo Yu
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Wei Li
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Chunyan Yang
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Xiaoping Ye
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Dan Wu
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Yijun Wang
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Wen Du
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Zhu Xiao
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Shuqin Zeng
- Shiyang Community Health Service Center, Chengdu Hi-tech Zone, Chengdu, 610041, China
| | - Honglin Luo
- Zhonghe Community Health Service Center, Chengdu Hi-tech Zone, Chengdu, 610041, China
| | - Xiuhua Li
- Guixi Community Health Service Center, Chengdu Hi-tech Zone, Chengdu, 610041, China
| | - Yuelei Wu
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China.
| | - Shuyi Liu
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China.
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Ballard M, Olaniran A, Iberico MM, Rogers A, Thapa A, Cook J, Aranda Z, French M, Olsen HE, Haughton J, Lassala D, Carpenter Westgate C, Malitoni B, Juma M, Perry HB. Labour conditions in dual-cadre community health worker programmes: a systematic review. Lancet Glob Health 2023; 11:e1598-e1608. [PMID: 37734803 DOI: 10.1016/s2214-109x(23)00357-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 06/23/2023] [Accepted: 07/17/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Health care delivered by community health workers reduces morbidity and mortality while providing a considerable return on investment. Despite growing consensus that community health workers, a predominantly female workforce, should receive a salary, many community health worker programmes take the form of dual-cadre systems, where a salaried cadre of community health workers works alongside a cadre of unsalaried community health workers. We aimed to determine the presence, prevalence, and magnitude of exploitation in national dual-cadre programmes. METHODS We did a systematic review of available evidence from peer-reviewed databases and grey literature from database inception to Aug 2, 2021, for studies on unsalaried community health worker cadres in dual-cadre systems. Editorials, protocols, guidelines, or conference reports were excluded in addition to studies about single-tier community health worker programmes and those reporting on only salaried cadres of community health workers in a dual-cadre system. We extracted data on remuneration, workload, task complexity, and self-reported experiences of community health workers. Three models were created: a minimum model with the shortest time and frequency per task documented in the literature, a maximum model with the longest time, and a median model. Labour exploitation was defined as being engaged in work below the country's minimum wage together with excessive work hours or complex tasks. The study was registered with PROSPERO, CRD42021271500. FINDINGS We included 117 reports from 112 studies describing community health workers in dual-cadre programmes across 19 countries. The majority of community health workers were female. 13 (59%) of 22 unsalaried community health worker cadres and one (10%) of ten salaried cadres experienced labour exploitation. Three (17%) of 18 unsalaried community health workers would need to work more than 40 h per week to fulfil their assigned responsibilities. Unsalaried community health worker cadres frequently reported non-payment, inadequate or inconsistent payment of incentives, and an overburdensome workload. INTERPRETATION Unsalaried community health workers in dual-cadre programmes often face labour exploitation, potentially leading to inadequate health-care provision. Labour laws must be upheld and the creation of professional community health worker cadres with fair contracts prioritised, international funding allocated to programmes that rely on unsalaried workers should be transparently reported, the workloads of community health workers should be modelled a priori and actual time use routinely assessed, community health workers should have input in policies that affect them, and volunteers should not be responsible for the delivery of essential health services. FUNDING None.
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Affiliation(s)
- Madeleine Ballard
- Community Health Impact Coalition, London, UK; Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | - M Matías Iberico
- Partners in Health Mexico, Ángel Albino Corzo, México; Tulane University School of Medicine, New Orleans, LA, USA
| | - Ash Rogers
- Lwala Community Alliance, Nashville, TN, USA
| | | | | | - Zeus Aranda
- Partners in Health Mexico, Ángel Albino Corzo, México; El Colegio de la Frontera Sur, San Cristóbal de las Casas, México
| | | | | | - Jessica Haughton
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Salm S, Houwaart S, Cecon-Stabel N, Dresen A, Pfaff H, Scholten N, Krieger T. Integrating one-to-one peer support into psycho-oncological care in Germany: multi-perspective, mixed-methods evaluation of the isPO onco-guide service. J Cancer Res Clin Oncol 2023; 149:10399-10422. [PMID: 37273104 PMCID: PMC10240138 DOI: 10.1007/s00432-023-04951-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/27/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE One-to-one peer supporters called isPO onco-guides (isPO OGs) are an integral part of the new German psycho-oncological form of care 'integrated, cross-sectoral Psycho-Oncology' (isPO), additionally to professional care. The isPO OGs are cancer survivors with experiential knowledge, offering information on local support services and answering questions 'all around cancer' to newly diagnosed cancer patients. We aimed to evaluate the isPO OG service from three perspectives: patients, isPO OGs, and professional service providers. METHODS A mixed-methods approach was pursued. We conducted interviews and focus groups with the three person groups, and applied qualitative content analysis on the reported resources, processes and outcomes regarding the isPO OG service. Relations with patients' utilisation and isPO OGs' work satisfaction were identified with regression and correlation analyses of questionnaire and isPO care data. We compared isPO care networks (CN) with X2-tests or ANOVA. Qualitative and quantitative results were integrated during interpretation phase. RESULTS Qualitatively, the three person groups agreed on the benefits of the isPO OG service. The implementation's maturity differed between the CN concerning established processes and resource availability. Attitudes of professional service providers appeared to be crucial for patients' utilisation of the isPO OG service. Quantitative results emphasised the differences between the CN. CONCLUSION Beyond differences in the CN, the isPO OG service has two psychosocial benefits: providing relevant, reliable, and understandable information; and offering the encouraging example that surviving and living with cancer is possible. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register (No. DRKS00015326) on 30.10.2018.
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Affiliation(s)
- Sandra Salm
- Faculty of Medicine, Faculty of Human Sciences, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, University Hospital Cologne, Eupener Str. 129, 50933, Cologne, Germany.
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany.
| | - Stefanie Houwaart
- House of the Cancer Patient Support Associations of Germany (HKSH-BV), Bonn, Germany
| | - Natalia Cecon-Stabel
- Faculty of Medicine, Faculty of Human Sciences, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, University Hospital Cologne, Eupener Str. 129, 50933, Cologne, Germany
- Unit of Health Services Research in Childhood and Adolescence, Clinic of General Pediatrics, Neonatology and Pediatric Cardiology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Antje Dresen
- Faculty of Medicine, Faculty of Human Sciences, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, University Hospital Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Holger Pfaff
- Faculty of Medicine and University Hospital Cologne, Faculty of Human Sciences, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, University of Cologne, Cologne, Germany
- Center for Health Services Research, University of Cologne, Cologne, Germany
| | - Nadine Scholten
- Faculty of Medicine, Faculty of Human Sciences, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, University Hospital Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Theresia Krieger
- Faculty of Medicine, Faculty of Human Sciences, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, University Hospital Cologne, Eupener Str. 129, 50933, Cologne, Germany
- Faculty of Medicine, Department of Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, University Hospital Cologne, Cologne, Germany
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Fraisl D, See L, Estevez D, Tomaska N, MacFeely S. Citizen science for monitoring the health and well-being related Sustainable Development Goals and the World Health Organization's Triple Billion Targets. Front Public Health 2023; 11:1202188. [PMID: 37637808 PMCID: PMC10450341 DOI: 10.3389/fpubh.2023.1202188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/07/2023] [Indexed: 08/29/2023] Open
Abstract
Achieving the health and well-being related Sustainable Development Goals (SDGs) and the World Health Organization's (WHO) Triple Billion Targets depends on informed decisions that are based on concerted data collection and monitoring efforts. Even though data availability has been increasing in recent years, significant gaps still remain for routine surveillance to guide policies and actions. The COVID-19 crisis has shown that more and better data and strengthened health information systems are needed to inform timely decisions that save lives. Traditional sources of data such as nationally representative surveys are not adequate for addressing this challenge alone. Additionally, the funding required to measure all health and well-being related SDG indicators and Triple Billion Targets using only traditional sources of data is a challenge to achieving efficient, timely and reliable monitoring systems. Citizen science, public participation in scientific research and knowledge production, can contribute to addressing some of these data gaps efficiently and sustainably when designed well, and ultimately, could contribute to the achievement of the health and well-being related SDGs and Triple Billion Targets. Through a systematic review of health and well-being related indicators, as well as citizen science initiatives, this paper aims to explore the potential of citizen science for monitoring health and well-being and for mobilizing action toward the achievement of health and well-being related targets as outlined in the SDG framework and Triple Billion Targets. The results demonstrate that out of 58 health and well-being related indicators of the SDGs and Triple Billion Targets covered in this study, citizen science could potentially contribute to monitoring 48 of these indicators and their targets, mostly at a local and community level, which can then be upscaled at a national level with the projection to reach global level monitoring and implementation. To integrate citizen science with official health and well-being statistics, the main recommendation is to build trusted partnerships with key stakeholders including National Statistical Offices, governments, academia and the custodian agencies, which is mostly the WHO for these health and well-being related targets and indicators.
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Affiliation(s)
- Dilek Fraisl
- International Institute for Applied Systems Analysis, Laxenburg, Austria
| | - Linda See
- International Institute for Applied Systems Analysis, Laxenburg, Austria
| | | | | | - Steve MacFeely
- World Health Organization, Geneva, Switzerland
- University College Cork, Cork, Ireland
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Guo L, Hau KT. Attracting adolescents to become doctors and nurses: differential importance of personal and environmental factors in 61 economies. HUMAN RESOURCES FOR HEALTH 2023; 21:40. [PMID: 37189198 DOI: 10.1186/s12960-023-00823-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Doctors and nurses play a fundamental role in maintaining global health systems and achieving universal health care coverage. However, significant shortages persist, and little is known about the popularity of these careers among young people in various economies or the relative impact of personal inputs and contextual factors. METHODS Using data from the large-scale Programme of International Student Assessment (PISA) 2018, we showed the recent distribution of adolescents' medical (doctor) and nursing career expectations in 61 economies. With multilevel logistic and hierarchical linear regression, we examined the relative importance of economic indicators, health work conditions, and personal background factors in affecting adolescents' health career expectations. RESULTS Approximately 11% of adolescents expected to be doctors in each economy, while only 2% expected to be nurses. Adolescents were attracted to health professions mainly by system-level favourable conditions (accounting for 1/3 variance), including (a) government health expenditure beyond that expected gross domestic product (GDP); (b) a safe working environment for doctors in wealthy nations; and (c) high salaries for nurses in less-developed economies. In contrast, adolescents' background (gender, social status, and academic ability) was less influential, explaining only 10% of the differences. CONCLUSIONS In the technological and digital era, high-ability students are equally competitive for emerging careers other than doctors and nurses. In developing countries, a high salary package and societal respect are enough to attract adolescents to nursing careers. In contrast, for developed countries, extra expenditures beyond regular GDP allocation and a safe work environment are crucial in attracting adolescents to become doctors. Salary may effectively attract international-trained doctors and nurses, but the work environment will likely emerge as an essential factor in retaining migrants in their positions. TRIAL REGISTRATION NUMBER No human participants were involved in this study.
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Affiliation(s)
- Luyang Guo
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China.
| | - Kit-Tai Hau
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
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Rahman R, Ross AM, Huang D, Kirkbride G, Chesna S, Rosenblatt C. Predictors of burnout, compassion fatigue, and compassion satisfaction experienced by community health workers offering maternal and infant services in New York State. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1820-1838. [PMID: 36378115 DOI: 10.1002/jcop.22967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/14/2022] [Accepted: 11/02/2022] [Indexed: 05/23/2023]
Abstract
Although burnout has been increasingly well studied among medical (nurses, physicians, residents) and mental health providers (psychologists, psychiatrists, social workers), there continues to be a lack of attention on the well-being of community-based providers, such as Community Health Workers (CHWs), within the United States. Using cross-sectional data from 75 CHWs employed in 14 agencies funded through the Maternal and Infant Community Health Collaboratives Initiative (MICHC) in New York, our study examined predictors (anxiety, physical health, adverse childhood experiences, job satisfaction, role certainty, demographic and work characteristics) of burnout, compassion fatigue (CF) and compassion satisfaction (CS). Descriptive statistics were used to characterize our sample and linear regression was employed to investigate the correlates of burnout, CF and CS. Results indicated that CHWs with higher levels of anxiety and lower job satisfaction were more likely to have higher burnout scores. CHWs with higher levels of anxiety, lower job satisfaction and fewer days of poorer health were more likely to report higher CF. Those who worked more than 35 h per week were less likely to report higher CS. The study provides recommendations for organizational-level interventions to address risk factors of burnout and CF and promote CS among CHWs, such as bolstering supervision, encouraging greater communication, offering recognition/appreciation of CHWs and creating opportunities for self-care. Findings should be considered when designing organizational-level preventive measures that mitigate burnout and CF and promote CS.
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Affiliation(s)
- Rahbel Rahman
- Graduate School of Social Service, Fordham University, New York, New York, USA
| | - Abigail M Ross
- Graduate School of Social Service, Fordham University, New York, New York, USA
| | - Debbie Huang
- Department of Biostatistics, Psychiatric Epidemiology Training Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gwyneth Kirkbride
- Workplace Center, Columbia School of Social Work, New York, New York, USA
| | - Sharon Chesna
- Mothers & Babies Perinatal Network of SCNY, Inc., Binghamton, New York, USA
| | - Cassidy Rosenblatt
- Graduate School of Social Service, Fordham University, New York, New York, USA
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Gu L, Liu F, Wang J, Li J, Wei J, Xu J. Stress load and volunteer motivation of patient volunteers in Fangcang shelter hospitals in Shanghai, China during the COVID-19 pandemic: a cross-sectional survey. BMJ Open 2023; 13:e066930. [PMID: 37015786 PMCID: PMC10083531 DOI: 10.1136/bmjopen-2022-066930] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES This study aims to assess the volunteer motivation and stress load of patient volunteers in the Fangcang shelter hospitals (FSHs), examine their associations, and explore the potential influence factors of volunteer motivation. DESIGN Cross-sectional online survey conducted from 21 April to 20 May 2022. SETTING Questionnaires were collected from patient volunteers selected by random cluster sampling in the FSHs in Shanghai, China. PARTICIPANTS 197 participants who met the inclusion criteria as patients who were asymptomatic or presenting with mild symptoms in the FSHs and who volunteered to assist with routine work under quarantined settings. OUTCOME MEASURES We investigated sociodemographic information, stress load and volunteer motivation through an online survey using the Volunteer Function Inventory and the Stress Overload Scale. Comparisons between groups were conducted by applying t-tests or analysis of variance. The correlation between volunteer motivation and stress was analysed by Pearson correlation. Influencing factors of volunteer motivation were determined by multivariable linear regression models. A value of p<0.05 was used to declare statistical significance. RESULTS The mean score of volunteer motivation of patient volunteers was 73.24 (SD 12.00), while that of stress load was 46.08 (SD 21.28). The mean scores of the personal vulnerability (PV) and event load (EL), two dimensions of stress load, were 26.99 (SD 12.46) and 19.09 (SD 9.63), respectively. The majority of the participants (136, 69.04%) were grouped in the low (PV)-low (EL) stress category. Participants' volunteer motivation was negatively correlated with stress load (r=-0.238, p<0.001), as well as PV (r=-0.188, p<0.01) and EL (r=-0.283, p<0.001). Multivariable linear regression analysis identified that the potential influencing factors of volunteer motivation were occupation (B=1.100, 95% CI 0.037 to 2.164, p=0.043), health condition (B=-3.302, 95% CI -5.287 to -1.317, p<0.001) and EL (B=-0.434, 95% CI -0.756 to -0.111, p=0.009). Participants who worked in the public sector, had better health conditions and had lower EL were more likely to have higher volunteer motivation. CONCLUSIONS Our study suggested that reducing stress load might be a possible pathway to encourage and maintain volunteerism in the FSH context. Implications and suggestions for future research on patient volunteer recruitment and management could be drawn from our findings.
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Affiliation(s)
- Liyan Gu
- Department of Neurology, NO. 905 Hospital of PLA Navy affiliated to Naval Medical University, 200052 Shanghai, China
| | - Fengmei Liu
- Nursing Department, NO. 905 Hospital of PLA Navy affiliated to Naval Medical University, 200052 Shanghai, China
| | - Ji Wang
- Nursing Department, NO. 905 Hospital of PLA Navy affiliated to Naval Medical University, 200052 Shanghai, China
| | - Jie Li
- Department of Disease Control and Prevention, NO. 905 Hospital of PLA Navy affiliated to Naval Medical University, 200052 Shanghai, China
| | - Jie Wei
- Department of Neurology, NO. 905 Hospital of PLA Navy affiliated to Naval Medical University, 200052 Shanghai, China
| | - Jiping Xu
- NO. 905 Hospital of PLA Navy affiliated to Naval Medical University, 200052 Shanghai, China
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Al-Ashbal MA, Lami FH. Performance evaluation of health houses in Iraq 2021-2022: A descriptive study. J Family Community Med 2023; 30:116-122. [PMID: 37303842 PMCID: PMC10252635 DOI: 10.4103/jfcm.jfcm_362_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/15/2023] [Accepted: 01/30/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND A health house (HH) is a basic health facility in rural Iraq. The function of a HH is to provide simple health services and treatments such as giving injections, dressing simple wounds, and monitoring mother and child health. The duties also include dispensing medications, measuring blood pressure, and the daily monitoring of chlorine levels in water. These HHs also provide awareness on different subjects. The main objectives of this study are to assess the availability of the basic features of the HHs and core components of the framework of the World Health Organization (WHO) building blocks. MATERIALS AND METHODS A multistage sampling technique was used to select 50 HHs out of 497 in Iraq. A questionnaire comprising closed-ended questions was developed to be completed using the researcher's observations and interviews with the healthcare workers in the HHs. The questionnaire covered the basic features of HHs as recommended by the Iraq Ministry of Health (MOH) and the six WHO health system building blocks. RESULTS Fifty HHs were enrolled in the study. The availability score of basic features was 43.6% and the general service score was 55.1%. The service-specific score was 23.3%, the health workforce score was 29.6%, and the health information system score was 79.5%. The availability of essential medicines score was 21.2%, the health financing system score was 0.0%, and the leadership and governance score was 66.7%. CONCLUSION The HHs need to follow the standard criteria determined by the Iraq MOH to ensure the proper functioning of the health outlets.
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Affiliation(s)
- Mariam A. Al-Ashbal
- Department of Community Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Faris H. Lami
- Department of Family and Community Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
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Nursing Workforce Retention in Rural Ghana: The Predictive Role of Satisfaction, Rural Fit, and Resilience. J Nurs Manag 2023. [DOI: 10.1155/2023/9396817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Introduction. High turnover of nurses in rural healthcare settings contributes to challenges in healthcare delivery. Various incentive packages have been introduced in rural healthcare settings to curb this phenomenon, but the canker still exists. The study aimed at assessing the predictive role of job satisfaction, rural fit, and resilience on nurses’ retention in rural Ghana. Materials and Methods. A multicentre cross-sectional design was adopted to collect data from 462 nurses. Analysis through descriptive statistics, one-way ANOVA, Pearson moment product correlation, and multiple regression was done. Results. There was low resilience and rural fit among nurses with higher turnover intention, which was predicted by average daily attendance (β = 0.108), rural fit (β = −0.144), resilience (β = −0.350), satisfaction with prospects (β = −0.187), and satisfaction with prospect and pay (β = −0.171) at the significance of 0.05. Conclusion. Policymakers can be assured that not just improving financial incentives to nurses, but the integration of nurses to rural settings, commensurate workload and improving pay and prospects for professional growth and resilience are needed for rural retention. Implications for nursing management, nurse managers, and policymakers have a role to develop sustainable strategies to integrate rural fit, resilience, and job satisfaction to help reduce turnover among nurses.
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Abbas F, Monroe A, Kiware S, Khamis M, Serbantez N, Al- Mafazy AW, Mohamed F, Kigadye E. Stakeholder perspectives on a door-to-door intervention to increase community engagement for malaria elimination in Zanzibar. Malar J 2023; 22:51. [PMID: 36774478 PMCID: PMC9921074 DOI: 10.1186/s12936-023-04474-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 01/29/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Malaria remains a major public health problem in sub-Saharan Africa. The 2021 World Health Organization (WHO) World Malaria Report indicates a slowing in the decline of malaria incidence since 2015. Malaria prevalence in Zanzibar has been maintained at less than 1% since 2010, however from 2018 to 2021, the annual number of reported malaria cases has gradually increased from 4106 to 9290. Community engagement has been emphasized by the WHO for reducing malaria transmission. To better understand the potential for a door-to-door approach for malaria, a three-month pilot programme was carried out. This qualitative study aimed at understanding stakeholder experiences with the pilot programme and considerations for its implementation. METHODS Through multistage sampling, four shehias (wards-the lowest administrative structure) with comparatively high (> 1.9 per 1000) and four with low (< 1 per 1000) incidence of local malaria cases were selected and involved in a door-to-door pilot intervention. The qualitative study was conducted after the pilot intervention and employed focus group discussions and in-depth interviews. All field notes were written on paper and audiotaped using digital audio-recorders. Summaries were developed by integrating field notes with reviews of recordings; themes were developed based on the topics identified a priori. Responses for each theme were summarized using an iterative process. RESULTS Most community members reported high levels of acceptance of door-to-door interventions. Some factors that might affect implementation of door-to-door include, low risk perception of the disease, local beliefs and practice, lack of initiative from the programme level to involve communities, and political instability during the election period. All Community Health Volunteers (CHVs) recommended this approach for community engagement, however, ensuring adequate resources was identified as a key factor for ensuring its sustainability. CONCLUSION The door-to-door intervention was perceived as helpful for promoting community engagement. There are several factors to consider including ensuring that CHVs are provided with adequate education, regular supervision, and have access to essential resources. Community leaders should be fully involved in choosing CHVs that are acceptable to the community. To ensure sustainability, the government should allocate sufficient resources and improve coordination systems.
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Affiliation(s)
- Faiza Abbas
- Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania. .,Open University of Tanzania, Dar es Salaam, Tanzania.
| | - April Monroe
- grid.449467.c0000000122274844Johns Hopkins Center for Communication Programs, Baltimore, MD USA
| | - Samson Kiware
- grid.414543.30000 0000 9144 642XIfakara Health Institute, Dar es Salaam, United Republic of Tanzania ,Pan African Mosquito Control Association (PAMCA), Nairobi, Kenya
| | - Mwinyi Khamis
- Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania
| | - Naomi Serbantez
- U.S. President’s Malaria Initiative, U.S. Agency for International Development, Dar es Salaam, Tanzania
| | | | - Fauzia Mohamed
- grid.442447.50000 0001 0819 3175Open University of Tanzania, Dar es Salaam, Tanzania
| | - Emmanuel Kigadye
- grid.442447.50000 0001 0819 3175Open University of Tanzania, Dar es Salaam, Tanzania
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Curry D, Islam MA, Sarker BK, Laterra A, Khandaker I. A novel approach to frontline health worker support: a case study in increasing social power among private, fee-for-service birthing attendants in rural Bangladesh. HUMAN RESOURCES FOR HEALTH 2023; 21:7. [PMID: 36750825 PMCID: PMC9906919 DOI: 10.1186/s12960-022-00773-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 10/18/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Expanding the health workforce to increase the availability of skilled birth attendants (SBAs) presents an opportunity to expand the power and well-being of frontline health workers. The role of the SBA holds enormous potential to transform the relationship between women, birthing caregivers, and the broader health care delivery system. This paper will present a novel approach to the community-based skilled birth attendant (SBA) role, the Skilled Health Entrepreneur (SHE) program implemented in rural Sylhet District, Bangladesh. CASE PRESENTATION The SHE model developed a public-private approach to developing and supporting a cadre of SBAs. The program focused on economic empowerment, skills building, and formal linkage to the health system for self-employed SBAs among women residents. The SHEs comprise a cadre of frontline health workers in remote, underserved areas with a stable strategy to earn adequate income and are likely to remain in practice in the area. The program design included capacity-building for the SHEs covering traditional techno-managerial training and supervision in programmatic skills and for developing their entrepreneurial skills, professional confidence, and individual decision-making. The program supported women from the community who were social peers of their clients and long-term residents of the community in becoming recognized, respected health workers linked to the public system and securing their livelihood while improving quality and access to maternal health services. This paper will describe the SHE program's design elements to enhance SHE empowerment in the context of discourse on social power and FLHWs. CONCLUSION The SHE model successfully established a private SBA cadre that improved birth outcomes and enhanced their social power and technical skills in challenging settings through the mainstream health system. Strengthening the agency, voice, and well-being of the SHEs has transformative potential. Designing SBA interventions that increase their power in their social context could expand their economic independence and reinforce positive gender and power norms in the community, addressing long-standing issues of poor remuneration, overburdened workloads, and poor retention. Witnessing the introduction of peer or near-peer women with well-respected, well-compensated roles among their neighbors can significantly expand the effectiveness of frontline health workers and offer a model for other women in their own lives.
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Affiliation(s)
- Dora Curry
- CARE (formerly for Curry, Islam, and Laterra; current for Khandaker), Atlanta, USA.
- University of Georgia, Athens, Georgia.
| | - Md Ahsanul Islam
- CARE (formerly for Curry, Islam, and Laterra; current for Khandaker), Atlanta, USA
| | - Bidhan Krishna Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh (formerly CARE-Bangladesh), Dhaka, Bangladesh
| | - Anne Laterra
- CARE (formerly for Curry, Islam, and Laterra; current for Khandaker), Atlanta, USA
| | - Ikhtiar Khandaker
- CARE (formerly for Curry, Islam, and Laterra; current for Khandaker), Atlanta, USA
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Usability and acceptance of a mobile health wallet for pregnancy-related healthcare: A mixed methods study on stakeholders' perceptions in central Madagascar. PLoS One 2023; 18:e0279880. [PMID: 36595530 PMCID: PMC9810191 DOI: 10.1371/journal.pone.0279880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/16/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Several sub-Saharan African countries use digital financial services to improve health financing, especially for maternal and child health. In cooperation with the Malagasy Ministry of Health, the NGO Doctors for Madagascar is implementing a mobile health wallet for maternal health care in public-sector health facilities in Madagascar. Our aim was to explore the enabling and limiting factors related to the usability and acceptance of the Mobile Maternal Health Wallet (MMHW) intervention during its implementation. METHODS We conducted a cross-sectional, mixed methods study with mothers and pregnant women and facility- (FBHWs) and community-based (CHWs) health workers from public-sector health facilities in three districts of the Analamanga region in Madagascar. We used a convergent design in collecting and analyzing quantitative and qualitative data. We performed one-stage proportional sampling of women who had signed up for the MMHW. All FBHWs and CHWs at primary care facilities in the intervention area were eligible to participate. RESULTS AND SIGNIFICANCE 314 women, 76 FBHWs, and 52 CHWs were included in the quantitative survey. Qualitative data were extracted from in-depth interviews with 12 women and 12 FBHWs and from six focus group discussions with 39 CHWSs. The MMHW intervention was accepted and used by health workers and women from different socioeconomic backgrounds. Main motivations for women to enroll in the intervention were the opportunity to save money for health (30.6%), electronic vouchers for antenatal ultrasound (30.2%), and bonus payments upon reaching a savings goal (27.9%). Main motivation for health workers was enabling pregnant women to save for health, thus encouraging facility-based deliveries (57.9%). Performance-based payments had low motivational value for health workers. Key facilitators were community sensitization, strong women-health worker relationship, decision making at the household level, and repetitive training on the use of the MMHW. Key barriers included limited phone ownership, low level of digital literacy, disinformation concerning the effects of the intervention, and technical problems like slow payout processes.
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Ndu M, Andoniou E, McNally S, Olea Popelka F, Tippett M, Nouvet E. The experiences and challenges of community health volunteers as agents for behaviour change programming in Africa: a scoping review. Glob Health Action 2022; 15:2138117. [PMID: 36314363 PMCID: PMC9629118 DOI: 10.1080/16549716.2022.2138117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Community health volunteers are considered a vital part of the community health structure in Africa. Despite this vital role in African health systems, very little is known about the community health volunteers’ day-to-day lived experiences providing services in communities and supporting other health workers. This scoping review aims to advance understanding of the day-to-day experiences of community health volunteers in Africa. In doing so, this review draws attention to these under-considered actors in African health systems and identifies critical factors and conditions that represent challenges to community health volunteers’ work in this context. Ultimately, our goal is to provide a synthesis of key challenges and considerations that can inform efforts to reduce attrition and improve the sustainability of community health volunteers in Africa. This scoping review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews checklist to achieve the objectives. A comprehensive search of six databases returned 2140 sources. After screening, 31 peer-reviewed studies were selected for final review. Analytical themes were generated based on the reviewers’ extraction of article data into descriptive themes using an inductive approach. In reviewing community health volunteers’ accounts of providing health services, five key challenges become apparent. These are: (1) challenges balancing work responsibilities with family obligations; (2) resource limitations; (3) exposure to stigma and harassment; (4) gendered benefits and risks; and (5) health-system level challenges. This scoping review highlights the extent of challenges community health volunteers must navigate to provide services in communities. Sustained commitment at the national and international level to understand the lived experiences of community health volunteers and mitigate common stressors these health actors face could improve their performance and inform future programs.
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Affiliation(s)
- Mary Ndu
- Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Ellena Andoniou
- Faculty of Health Science, Western University, London, ON, Canada
| | - Sorcha McNally
- Faculty of Health Science, Western University, London, ON, Canada
| | - Francisco Olea Popelka
- Department of Pathology and Laboratory Medicine, Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Marisa Tippett
- Research & Scholarly Communications Librarian, Western Libraries, Western University, London, ON, Canada
| | - Elysée Nouvet
- Faculty of Health Science, Western University, London, ON, Canada
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Pandya S, Hamal M, Abuya T, Kintu R, Mwanga D, Warren CE, Agarwal S. Understanding Factors That Support Community Health Worker Motivation, Job Satisfaction, and Performance in Three Ugandan Districts: Opportunities for Strengthening Uganda's Community Health Worker Program. Int J Health Policy Manag 2022; 11:2886-2894. [PMID: 35461208 PMCID: PMC10105203 DOI: 10.34172/ijhpm.2022.6219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 03/30/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Uganda's community health worker (CHW) program experiences several challenges related to the appropriate motivation, job satisfaction, and performance of the CHW workforce. This study aims to identify barriers in the effective implementation of financial and non-financial incentives to support CHWs and to strengthen Uganda's CHW program. METHODS The study was implemented in Uganda's Lira, Wakiso, and Mayuge districts in May 2019. Ten focus group discussions (FGDs) were held with 91 CHWs, 17 in-depth interviews (IDIs) were held with CHW supervisors, and 7 IDIs were held with policy-level stakeholders. Participants included stakeholders from both the Ugandan government and non-governmental organizations (NGOs). Utilizing a thematic approach, themes around motivation, job satisfaction, incentive preferences, and CHW relationships with the community, healthcare facilities, and government were analyzed. RESULTS CHWs identified a range of factors that contributed to their motivation or demotivation. Non-monetary factors included recognition from the health system and community, access to transportation, methods for identification as a healthcare worker, provision of working tools, and training opportunities. Monetary factors included access to monthly stipends, transportation-related refunds, and timely payment systems to reduce refund delays to CHWs. Additionally, CHWs indicated wanting to be considered for recruitment into the now-halted rollout of a salaried CHW cadre, given the provision of payment. CONCLUSION It is imperative to consider how to best support the current CHW program prior to the introduction of new cadres, as it can serve to exacerbate tensions between cadres and further undermine provision of community health. Providing a harmonized, balanced, and uniform combination of both monetary incentives with non-monetary incentives is vital for effective CHW programs.
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Affiliation(s)
- Shivani Pandya
- Department of International Health, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mukesh Hamal
- Department of International Health, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Smisha Agarwal
- Department of International Health, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Bentley-Edwards KL, Jordan Fleming P, Doherty IA, Whicker DR, Mervin-Blake S, Barrett NJ. The 5Ws of Racial Equity in Research: A Framework for Applying a Racial Equity Lens Throughout the Research Process. Health Equity 2022; 6:917-921. [PMID: 36636118 PMCID: PMC9811832 DOI: 10.1089/heq.2022.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
Ensuring equity in research is a critical step in advancing health equity. In this perspective, the authors introduce a guiding framework for advancing racial equity in research processes, environments, and among the research workforce, the 5Ws of Racial Equity in Research. Centering their discussion on the 5Ws: Who, What, When, Where, and Why, they use historical and contemporary examples of research inequities to demonstrate how these five simple questions can encourage open discussion and proactive planning for equity in research. They close with an acknowledgment of the framework's broad utility and a researcher-directed call to action.
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Affiliation(s)
- Keisha L. Bentley-Edwards
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Samuel DuBois Cook Center on Social Equity, Duke University, Durham, North Carolina, USA.,Center for Equity in Research, Duke Clinical and Translational Science Institute, Duke University, Durham, North Carolina, USA.,Address correspondence to: Keisha L. Bentley-Edwards, PhD, Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Patrice Jordan Fleming
- Center for Equity in Research, Duke Clinical and Translational Science Institute, Duke University, Durham, North Carolina, USA.,Community Engaged Research Initiative, Duke Clinical and Translational Science Institute, Duke University, Durham, North Carolina, USA
| | - Irene A. Doherty
- Julius L. Chambers Biomedical Biotechnology Research Institute, North Carolina Central University, Durham, North Carolina, USA.,RCMI Center for Health Disparities Research, North Carolina Central University, Durham, North Carolina, USA
| | - Dane R. Whicker
- Center for Equity in Research, Duke Clinical and Translational Science Institute, Duke University, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sabrena Mervin-Blake
- Center for Equity in Research, Duke Clinical and Translational Science Institute, Duke University, Durham, North Carolina, USA.,Community Engaged Research Initiative, Duke Clinical and Translational Science Institute, Duke University, Durham, North Carolina, USA
| | - Nadine J. Barrett
- Center for Equity in Research, Duke Clinical and Translational Science Institute, Duke University, Durham, North Carolina, USA.,Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Cancer Institute, Duke University, Durham, North Carolina, USA
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Lar L, Stewart M, Isiyaku S, Dean L, Ozano K, Mpyet C, Theobald S. Does inter-border conflict influence the views of task sharing among community health volunteers in Nigeria? A qualitative study. Confl Health 2022; 16:43. [PMID: 35871004 PMCID: PMC9308912 DOI: 10.1186/s13031-022-00472-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/27/2022] [Indexed: 01/17/2023] Open
Abstract
Background Volunteer community health workers are increasingly being engaged in Nigeria, through the World Health Organization’s task sharing strategy. This strategy aims to address gaps in human resources for health, including inequitable distribution of health workers. Recent conflicts in rural and fragile border communities in northcentral Nigeria create challenges for volunteer community health workers to meet their community's increasing health needs. This study aimed to explore the perception of volunteers involved in task sharing to understand factors affecting performance and delivery in such contexts. Methods This was a qualitative study conducted in fragile border communities in north central Nigeria. Eighteen audio recorded, semi-structured interviews with volunteers and supervisors were performed. Their perceptions on how task sharing and allocation of tasks affect performance and delivery were elucidated. The transactional social framework was applied during the thematic analysis process to generate an explanatory account of the research data, which was analysed using NVivo software. Results Promotive and preventive tasks were shared among the predominantly agrarian respondents. There was a structured task allocation process that linked the community with the health system and mainly cordial relationships were in place. However, there were barriers related to ethnoreligious crises and current conflict, timing of task allocations, gender inequities in volunteerism, shortage of commodities, inadequate incentives, dwindling community support and negative attitudes of some volunteers. Conclusion The perception of task sharing was mainly positive, despite the challenges, especially the current conflict. In this fragile context, reconsideration of non-seasonal task allocations within improved community-driven selection and security systems should be encouraged. Supportive supervision and providing adequate and timely renumeration will also be beneficial in this fragile setting.
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Nichols C, Jalali F, Fischer H. The "Corona Warriors"? Community health workers in the governance of India's COVID-19 response. POLITICAL GEOGRAPHY 2022; 99:102770. [PMID: 36213893 PMCID: PMC9531667 DOI: 10.1016/j.polgeo.2022.102770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 06/10/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
India's nearly 1-million strong band of quasi-volunteer accredited social health activists (ASHAs) have been key actors in government efforts to control COVID-19. Utilizing a nationalist rhetoric of war, ASHAs were swiftly mobilized by the government in March 2020 as 'COVID warriors' engaged in tracking illness, disseminating information, and caring for quarantined individuals. The speed at which ASHAs were mobilized into mentally and physically grueling labor was all the more stunning given these minimally paid community health workers have long been seen to have low morale given their precarious, informalized work arrangements. Building on work examining the spatialities of global health governance alongside literature on geographic contingency, this paper explores the ways that nationalist COVID-19 war rhetoric promulgated from Delhi worked as a technology of health governance to propel ASHAs into certain forms of action, yet also opened up spaces of potentiality for them to reimagine their relationship to both the state and the communities they serve. In particular, in our analysis of in-depth telephone interviews with ASHA workers in the state of Himachal Pradesh, we find that their hailing as COVID warriors inspired patriotic calls to duty and legitimized their (long over-looked) roles as critical governance actors, yet also was subject to resistance and reworking due to a combination of institutional histories, local politics, as well as happenstantial everyday encounters of ASHA work. The precarious employment of ASHAs - in terms of basic remuneration as well as the great on-the-job risks that they have faced - underscores both the fragile nature of India's health governance system as well as possible political movements for its renewal. We conclude by calling for geographers to give greater attention to community health care workers as a key window into understanding the uneven ways in which health systems are made manifest on the ground, and their ability to respond to citizens' healthcare needs - both in the COVID-19 pandemic and beyond.
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Affiliation(s)
- Carly Nichols
- University of Iowa, 312 Jessup Hall, Iowa City, IA, 52245, USA
| | - Falak Jalali
- University of Iowa, 312 Jessup Hall, Iowa City, IA, 52245, USA
| | - Harry Fischer
- Department of Urban and Rural Development, Swedish University of Agricultural Sciences, Sweden
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Ajisegiri WS, Peiris D, Abimbola S, Odusanya OO, Tesema AG, Joshi R, Angell B. It is not all about salary: a discrete-choice experiment to determine community health workers' motivation for work in Nigeria. BMJ Glob Health 2022; 7:bmjgh-2022-009718. [PMID: 36270659 PMCID: PMC9594556 DOI: 10.1136/bmjgh-2022-009718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/03/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Community health workers (CHWs) constitute the majority of primary healthcare (PHC) workers in Nigeria, yet little is understood about their motivations or the most effective interventions to meet their needs to ensure quality health coverage across the country. We aimed to identify factors that would motivate CHWs for quality service delivery. Methods A discrete-choice experiment was conducted among 300 CHWs across 44 PHC facilities in the Federal Capital Territory, Abuja Nigeria. Based on the literature review and qualitative research, five attributes, namely: salary, educational opportunities, career progression and in-service training, housing and transportation, were included in the experiment. CHWs were presented with 12 unlabelled choice sets, using tablet devices, and asked to choose which of two hypothetical jobs they would accept if offered to them, or whether they would take neither job. Mixed multinomial logistic models were used to estimate stated preferences for the attributes and the likely uptake of jobs under different policy packages was simulated. Results About 70% of the respondents were women and 39% worked as volunteers. Jobs that offered career progression were the strongest motivators among the formally employed CHWs (β=0.33) while the ‘opportunity to convert from CHW to another cadre of health workers, such as nursing’ was the most important motivator among the volunteers’ CHWs (β=0.53). CHWs also strongly preferred jobs that would offer educational opportunities, including scholarship (β=0.31) and provision of transport allowances (β=0.26). Policy scenario modelling predicted combined educational opportunities, career progression opportunities and an additional 10% of salary as incentives was the employment package that would be most appealing to CHWs. Conclusion CHWs are motivated by a mix of non-financial and financial incentives. Policy interventions that would improve motivation should be adequate to address various contexts facing different CHWs and be flexible enough to meet their differing needs.
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Affiliation(s)
- Whenayon Simeon Ajisegiri
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Seye Abimbola
- School of Public Health, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Olumuyiwa O Odusanya
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Azeb Gebresilassie Tesema
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia,School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Rohina Joshi
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia,The George Institute for Global Health, New Delhi, India
| | - Blake Angell
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
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Gadsden T, Maharani A, Sujarwoto S, Kusumo BE, Jan S, Palagyi A. Does social capital influence community health worker knowledge, attitude and practices towards COVID-19? Findings from a cross-sectional study in Malang district, Indonesia. SSM Popul Health 2022; 19:101141. [PMID: 35693476 PMCID: PMC9173822 DOI: 10.1016/j.ssmph.2022.101141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/11/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022] Open
Abstract
Community health workers (CHWs) are the first point of contact with the primary health care system in many low- and middle-income countries and are situated to play a critical role in the public health response to the COVID-19 pandemic. The knowledge, attitude and practices of CHWs regarding COVID-19 may be influenced by their level of trust and participation in the community, collectively defined as their level of social capital. To assess whether social capital influences CHWs’ knowledge, attitude and practices related to COVID-19, we conducted a web-based survey of CHWs (n = 478) in Malang district, Indonesia between October 2020 and January 2021. CHW social capital was measured using the Shortened Adapted Social Capital Assessment Tool. Multiple logistic regression results show that cognitive social capital was associated with higher self-reported knowledge of COVID-19, more confidence in answering COVID-related questions from the community and feeling safe from COVID-19 when working. Membership of community organisations was associated with a higher number of COVID-related tasks conducted. Thus, CHWs in Malang district with higher levels of cognitive social capital were more likely to be confident in their knowledge and ability to respond to COVID-19, and CHWs embedded in their community were more likely to be engaged in pandemic response duties. Our findings suggest that policies aimed at promoting CHW embeddedness, targeted recruitment and addressing training needs hold promise in strengthening the positive contribution of the community health workforce to the COVID-19 response. We conducted a survey to examine how social capital influences CHW knowledge, attitudes and practices re COVID-19 in Malang district, Indonesia. Structural social capital was associated with a higher number of COVID-related tasks conducted. Cognitive social capital was associated with higher knowledge of COVID-19 and higher confidence in answering COVID-related questions. Promoting CHW embeddedness and targeted recruitment may strengthen the contribution of CHWs to future public health crises in Malang district.
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Affiliation(s)
- Thomas Gadsden
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Asri Maharani
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - Sujarwoto Sujarwoto
- Department of Public Administration, University of Brawijaya, Malang, Indonesia
| | - Budiarto Eko Kusumo
- Department of Public Administration, University of Brawijaya, Malang, Indonesia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, Australia
| | - Anna Palagyi
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Zou Q, He X, Zhang L. Community health workers' mobility in China: Evidence from 2008 to 2017. Front Public Health 2022; 10:947984. [PMID: 36081472 PMCID: PMC9446455 DOI: 10.3389/fpubh.2022.947984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/08/2022] [Indexed: 01/21/2023] Open
Abstract
Background Community health workers (CHWs) are essential to improve the responsiveness of the national health system and the capacity of community health services. Since the implementation of the new program for health system reform in 2009, China has adopted an unprecedented policy to attract and retain CHWs to increase the quantity and quality of CHWs equitably. The policy's effects need to be further determined. The purpose of this study was to illustrate the temporal and spatial dynamics of CHWs' mobility in China from 2008 to 2017. Methods This study used a multistage stratified sampling method to collect 14,094 CHW mobility records from 24 counties and 12 districts in six provinces in China for analysis. The data cover the period from 2008 to 2017. Descriptive statistics and chi-square test were adopted to analyse the distribution of mobile CHWs across different years and different subgroups from 2008 to 2017. Results This study found that China's CHWs were in a state of net inflow from 2008 to 2017. The number of net inflows continued to increase from 2008 to 2011 and had a slight downward trend afterwards. CHW turnover occurred more in rural areas and amongst males, physicians, management and support staff, intermediate and senior professional titles, ≥30 years old group and contractual temporary employees. By contrast, the attraction and retention of CHWs are remarkable amongst nurses, pharmacists, imaging and laboratory technicians, junior title, junior college degree and above and <30 years old group. Conclusions China has made great achievements with the policy targeting the attraction and retention of CHWs since the implementation of the new program for health system reform in 2009. However, CHWs in China are faced with the dilemma of an extremely high total mobility, the attraction of CHWs in rural areas is still insufficient, the professional structure of CHWs is unreasonable, and the attrition of high-quality health workers exists. China must pay attention to the fair allocation of urban and rural areas, dynamically adjust the recruitment structure of health technicians, improve the mechanism for attracting and retaining technicians with higher titles and guarantee the benefits of temporary employees.
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Affiliation(s)
- Qi Zou
- College of Public Administration, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoqun He
- Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Liang Zhang
- School of Political Science and Public Administration, Wuhan University, Wuhan, China,*Correspondence: Liang Zhang
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Mukherjee A, Daniel M, Kaur A, Devarapalli S, Kallakuri S, Essue B, Raman U, Thornicroft G, Saxena S, Peiris D, Maulik PK. Operational challenges in the pre-intervention phase of a mental health trial in rural India: reflections from SMART Mental Health. Int J Ment Health Syst 2022; 16:42. [PMID: 35974341 PMCID: PMC9379869 DOI: 10.1186/s13033-022-00549-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Availability of mental health services in low- and middle-income countries is largely concentrated in tertiary care with limited resources and scarcity of trained professionals at the primary care level. SMART Mental Health is a strategy that combines a community anti-stigma campaign with a primary health care workforce strengthening initiative, using electronic decision support with the goal of better identifying and supporting people with common mental disorders in India. METHODS We describe the challenges faced and lessons learnt during the pre-intervention phase of SMART Mental Health cluster Randomised Controlled Trial. Pre-intervention phase includes preliminary activities for setting-up the trial and research activities prior to delivery of the intervention. Field notes from project site visit, project team meetings and detailed follow-up discussions with members of the project team were used to document operational challenges and strategies adopted to overcome them. The socio-ecological model was used as the analytical framework to organise the findings. RESULTS Key challenges included delays in government approvals, addressing community health worker needs, and building trust in the community. These were addressed through continuous communication, leveraging support of relevant stakeholders, and addressing concerns of community health workers and community. Issues related to use of digital platform for data collection were addressed by a dedicated technical support team. The COVID-19 pandemic and political unrest led to significant and unexpected challenges requiring important adaptations to successfully implement the project. CONCLUSION Setting up of this trial has posed challenges at a combination of community, health system and broader socio-political levels. Successful mitigating strategies to overcome these challenges must be innovative, timely and flexibly delivered according to local context. Systematic ongoing documentation of field-level challenges and subsequent adaptations can help optimise implementation processes and support high quality trials. TRIAL REGISTRATION The trial is registered with Clinical Trials Registry India (CTRI/2018/08/015355). Registered on 16th August 2018. http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=23254&EncHid=&userName=CTRI/2018/08/015355.
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Affiliation(s)
| | - Mercian Daniel
- The George Institute for Global Health, New Delhi, India
| | - Amanpreet Kaur
- The George Institute for Global Health, New Delhi, India
| | | | | | - Beverley Essue
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Usha Raman
- Department of Communication, University of Hyderabad, Hyderabad, India
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - David Peiris
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Pallab K. Maulik
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, Australia
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Gadsden T, Sujarwoto S, Purwaningtyas N, Maharani A, Tampubolon G, Oceandy D, Praveen D, Angell B, Jan S, Palagyi A. Understanding community health worker employment preferences in Malang district, Indonesia, using a discrete choice experiment. BMJ Glob Health 2022; 7:bmjgh-2022-008936. [PMID: 35953209 PMCID: PMC9379506 DOI: 10.1136/bmjgh-2022-008936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/28/2022] [Indexed: 11/04/2022] Open
Abstract
Background Community health workers (CHWs) play a critical role in supporting health systems, and in improving accessibility to primary healthcare. In many settings CHW programmes do not have formalised employment models and face issues of high attrition and poor performance. This study aims to determine the employment preferences of CHWs in Malang district, Indonesia, to inform policy interventions. Methods A discrete choice experiment was conducted with 471 CHWs across 28 villages. Attributes relevant to CHW employment were identified through a multistage process including literature review, focus group discussions and expert consultation. Respondents’ choices were analysed with a mixed multinomial logit model and latent class analyses. Results Five attributes were identified: (1) supervision; (2) training; (3) monthly financial benefit; (4) recognition; and (5) employment structure. The most important influence on choice of job was a low monthly financial benefit (US$~2) (β=0.53, 95% CI=0.43 to 0.63), followed by recognition in the form of a performance feedback report (β=0.13, 95% CI=0.07 to 0.20). A large monthly financial benefit (US$~20) was most unappealing to respondents (β=−0.13, 95% CI=−0.23 to −0.03). Latent class analysis identified two groups of CHWs who differed in their willingness to accept either job presented and preferences over specific attributes. Preferences diverged based on respondent characteristics including experience, hours’ worked per week and income. Conclusion CHWs in Malang district, Indonesia, favour a small monthly financial benefit which likely reflects the unique cultural values underpinning the programme and a desire for remuneration that is commensurate with the limited number of hours worked. CHWs also desire enhanced methods of performance feedback and greater structure around training and their rights and responsibilities. Fulfilling these conditions may become increasingly important should CHWs work longer hours.
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Affiliation(s)
- Thomas Gadsden
- Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
| | | | | | - Asri Maharani
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - Gindo Tampubolon
- Global Development Institute, The University of Manchester, Manchester, UK
| | - Delvac Oceandy
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Devarsetty Praveen
- Better Care India, The George Institute for Global Health India, Hyderabad, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Blake Angell
- Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
| | - Stephen Jan
- Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
| | - Anna Palagyi
- Health Systems Science, George Institute for Global Health, Sydney, New South Wales, Australia
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Determinants of Patients’ Adherence to Malaria Treatment in the Democratic Republic of the Congo. Trop Med Infect Dis 2022; 7:tropicalmed7070138. [PMID: 35878149 PMCID: PMC9318296 DOI: 10.3390/tropicalmed7070138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: Malaria heavily affects the Democratic Republic of the Congo (DRC) despite the use of effective drugs. Poor adherence to malaria treatment may contribute to this problem. (2) Methods: In one rural and one urban health area in each of the 11 former provinces of the DRC, all households with a case of malaria in the 15 days preceding the survey were selected and the patients or caregivers were interviewed. Adherence to malaria treatment was assessed by self-declaration about its completion. Logistic regression was used to assess predictors. (3) Results: 1732 households participated. Quinine was the most used drug; adherence to artesunate–amodiaquine was the lowest and the main reason for treatment discontinuation was adverse reactions. Predictors of adherence were residence in an urban area, university education, catholic religion, and adoption of recommended behaviour towards a malaria case. Adherence was significantly lower for responders who obtained information on antimalarials from Community Health Workers (CHW). (4) Conclusions: Usage of recommended drugs and adherence to malaria treatment need to be promoted, especially in rural areas, and CHW involvement needs to be improved. Awareness messages need to be made accessible and comprehensible to poorly educated populations and churches need to be involved.
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Jain M, Caplan Y, Ramesh BM, Kemp H, Hammer B, Isac S, Blanchard J, Namasivayam V, Sgaier SK. Improving Community Health Worker Compensation: A Case Study From India Using Quantitative Projection Modeling and Incentive Design Principles. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100413. [PMID: 36332076 PMCID: PMC9242609 DOI: 10.9745/ghsp-d-21-00413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/26/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Although community health workers (CHWs) are effective at mobilizing important health behaviors, there is limited evidence on how financial incentive systems can best be designed to drive their effectiveness. This study intends to bridge this evidence gap by analyzing the compensation model of India's accredited social health activist (ASHA) program and identifying areas of improvement in the system's design and implementation. METHODS We analyze the ASHA program in Uttar Pradesh, India. ASHAs receive compensation through a mix of program-linked, performance-based, and routine activity-based incentive structures. Using multiple data sources, including a novel linked household and ASHA survey, we estimate ASHA performance-linked incentive earnings under different scenarios of ASHA actions and household behaviors. Juxtaposing statistical projection models and actual government payments, we identified which incentives promised the highest payments, which were claimed or not, which could be claimed more by increasing ASHA actions, and which were paid despite not meeting payment criteria. We also report findings on ASHA awareness of and experiences with claiming incentives. RESULTS We find crucial gaps and implementation challenges in the ASHA incentive structure. ASHAs could double their earnings by completing certain tasks within their control. ASHAs may also be paid for partial completion of activities, as incentives are paid in lump sums for a series of activities rather than for each activity. Family planning incentives have the largest gap between potential and actual earnings. Incentivizing ASHAs for achieving certain health outcomes is inefficient, as no clear linkage was found between the achievability of such health outcomes and the claim amounts. CONCLUSION There are several opportunities for improving CHW compensation, from improving the incentive claims process to shifting focus to achievable outcomes. Optimizing incentive system designs can further enhance CHW effectiveness globally to affect key health behaviors.
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Affiliation(s)
| | | | | | | | | | - Shajy Isac
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- India Health Action Trust, Lucknow, India
| | - James Blanchard
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Vasanthakumar Namasivayam
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- India Health Action Trust, Lucknow, India
| | - Sema K Sgaier
- Surgo Ventures, Washington, DC, USA.
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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Hämmerli P, Moukam AD, Wisniak A, Sormani J, Vassilakos P, Kenfack B, Petignat P, Schmidt NC. "My motivation was to save": a qualitative study exploring factors influencing motivation of community healthcare workers in a cervical cancer screening program in Dschang, Cameroon. Reprod Health 2022; 19:133. [PMID: 35668427 PMCID: PMC9167909 DOI: 10.1186/s12978-022-01420-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cervical cancer is a major public health issue among women in Cameroon and uptake of screening programs remains a challenge in many low- and middle-income countries. Community healthcare workers can play an important role in promoting cervical cancer services. This study aimed to explore factors affecting the motivation of community healthcare workers in a cervical cancer screening program in Dschang, Cameroon. Methods A qualitative approach including 11 in-depth individual interviews with community healthcare workers was used. The interviews were audio-recorded, transcribed and coded using thematic analysis assisted by ATLAS.ti software. Results Four women and seven men aged between 21 and 77 years old were interviewed. Community healthcare workers had high motivation. Factors affecting motivation were divided into individual and environmental level, based on a theoretical framework. Factors with a positive influence on motivation were mainly on the individual side while impeding factors were mainly associated with the environmental level. Conclusions Key interventions to improve motivation among community healthcare workers include: (i) more training and supportive supervision; (ii) evaluation of remuneration systems by workload; and (iii) provision of job-enabling resources such as uniforms, cellphone cards and transport. Trial registration: Geneva Cantonal Ethics Committee on Human Research (No. 2017-01110) and the Cameroonian National Ethics Committee for Human Health Research (No. 2018/07/1083/CE/CNERSH/SP). Cervical cancer is the second leading cause of cancer-related death among women in Cameroon. This is mainly due to the absence of routine cervical cancer screening programs and the lack of treatment. However, even in case of availability of cervical cancer screening programs, barriers exist. Therefore, community healthcare workers have been involved successfully to increase the screening coverage. As retention of these actors remains a challenge, the main objective of this study was to identify key factors affecting their motivation aiming to suggest interventions to address motivational factors. 11 qualitative interviews with individual community healthcare workers were conducted at a cervical cancer screening program in Dschang, Cameroon. Motivation was generally high and affecting factors were divided into the individual and the environmental level. Factors with a positive influence on motivation were mainly on the individual side while impeding factors were mainly associated with the environmental level. Ongoing collaboration with community healthcare workers is beneficial for cervical cancer screening programs, and key interventions should therefore include: (i) more training and supportive supervision; (ii) evaluation of remuneration systems by workload; and (iii) provision of job-enabling resources such as uniforms, cellphone cards and transport.
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Affiliation(s)
| | - Alida Datchoua Moukam
- Department of Gynaecology and Obstetrics, District Hospital of Dschang, Dschang, Cameroon
| | - Ania Wisniak
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Jessica Sormani
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.,Geneva School of Health Sciences, HESSO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Bruno Kenfack
- Department of Gynaecology and Obstetrics, District Hospital of Dschang, Dschang, Cameroon
| | - Patrick Petignat
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Nicole Christine Schmidt
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland. .,Faculty of Social Science, Catholic University of Applied Science, Preysingstr. 95, 81667, Munich, Germany.
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Karim A, de Savigny D, Awor P, Cobos Muñoz D, Mäusezahl D, Kitoto Tshefu A, Ngaima JS, Enebeli U, Isiguzo C, Nsona H, Ogbonnaya I, Ngoy P, Alegbeleye A. The building blocks of community health systems: a systems framework for the design, implementation and evaluation of iCCM programs and community-based interventions. BMJ Glob Health 2022; 7:bmjgh-2022-008493. [PMID: 35772810 PMCID: PMC9247653 DOI: 10.1136/bmjgh-2022-008493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/30/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction Almost all sub-Saharan African countries have adopted some form of integrated community case management (iCCM) to reduce child mortality, a strategy targeting common childhood diseases in hard-to-reach communities. These programs are complex, maintain diverse implementation typologies and involve many components that can influence the potential success of a program or its ability to effectively perform at scale. While tools and methods exist to support the design and implementation of iCCM and measure its progress, these may not holistically consider some of its key components, which can include program structure, setting context and the interplay between community, human resources, program inputs and health system processes. Methods We propose a Global South-driven, systems-based framework that aims to capture these different elements and expand on the fundamental domains of iCCM program implementation. We conducted a content analysis developing a code frame based on iCCM literature, a review of policy documents and discussions with key informants. The framework development was guided by a combination of health systems conceptual frameworks and iCCM indices. Results The resulting framework yielded 10 thematic domains comprising 106 categories. These are complemented by a catalogue of critical questions that program designers, implementers and evaluators can ask at various stages of program development to stimulate meaningful discussion and explore the potential implications of implementation in decentralised settings. Conclusion The iCCM Systems Framework proposed here aims to complement existing intervention benchmarks and indicators by expanding the scope and depth of the thematic components that comprise it. Its elements can also be adapted for other complex community interventions. While not exhaustive, the framework is intended to highlight the many forces involved in iCCM to help managers better harmonise the organisation and evaluation of their programs and examine their interactions within the larger health system.
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Affiliation(s)
- Aliya Karim
- University of Basel, Basel, Switzerland .,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Don de Savigny
- University of Basel, Basel, Switzerland.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Phyllis Awor
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daniel Cobos Muñoz
- University of Basel, Basel, Switzerland.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Daniel Mäusezahl
- University of Basel, Basel, Switzerland.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Jean Serge Ngaima
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ugo Enebeli
- Department of Community Medicine, University of Port Harcourt, Choba, Rivers State, Nigeria
| | - Chinwoke Isiguzo
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Society for Family Health Nigeria, Abuja, Nigeria
| | - Humphreys Nsona
- IMCI, Malawi Ministry of Health, Lilongwe, Central Region, Malawi
| | - Ikechi Ogbonnaya
- Department of Health, Planning, Research & Statistics, Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Pascal Ngoy
- PROSANI, USAID, Washington, District of Columbia, USA
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Tiittanen U, Turjamaa R. Social Inclusion and Communality of Volunteering: A Focus Group Study of Older People’s Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095141. [PMID: 35564534 PMCID: PMC9103720 DOI: 10.3390/ijerph19095141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/16/2022] [Accepted: 04/22/2022] [Indexed: 02/05/2023]
Abstract
The aim of this qualitative study was to describe the factors that motivate older people to volunteer and how volunteering influences their social inclusion and communality. Data were collected using focus group interviews in 2020–2021 from older people aged 65–81 years (n = 38) who had experience of volunteering in the community. The data were analyzed using inductive content analysis. Based on the results, the experiences described by older people who participate in volunteering consisted of factors encouraging older people to volunteer and depended on the activation, support, and motivation of volunteer operators. The support provided by the health care services and volunteer action organization for volunteers was a key factor in encouraging older people to participate in volunteering. Moreover, volunteering impacted the communality of volunteers in several ways, influencing social capital. The sense of communality was enhanced by the way in which volunteering was carried out, including collaboration with health care services and associations. In order to strengthen the importance of volunteering in society, there is a need for close collaboration between voluntary organizations and health care service providers to develop volunteering because health care organizations cannot respond to all of the challenges faced by the ageing population.
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Affiliation(s)
| | - Riitta Turjamaa
- Unit of Continuous Learning, Savonia University of Applied Sciences, 70210 Kuopio, Finland
- Department of Nursing Science, University of Eastern Finland, 70210 Kuopio, Finland
- Correspondence:
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Okyere E, Ward PR, Marfoh K, Mwanri L. Incentives management among health workers in primary health-care facilities: addressing important issues in rural Ghana. J Health Organ Manag 2022; ahead-of-print. [PMID: 35443126 DOI: 10.1108/jhom-08-2021-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study seeks to explore health workers' perceptions and experiences on incentives for motivating and retaining them in primary health-care facilities in rural Ghana. DESIGN/METHODOLOGY/APPROACH Phenomenological research design was used to explore health workers' experiences and perceptions on their incentive packages. Sixty-eight in-depth interviews were conducted with health-care workers in primary health-care facilities and analyzed using thematic analysis approach. FINDINGS The findings show health-care workers' perceptions on their incentives, ranging from low awareness, unfair distribution, favoritism, means of punishment and incentives regarded unattractive. The preferred incentive packages identified were salary increase, housing availability, recognition, adequate supplies, and risk and responsibility allowances. Health-care workers suggested for the modification of incentives including vehicle importation waiver, reduction in study leave years and opportunity to pursue desired courses. ORIGINALITY/VALUE The findings suggest that incentives that align with health-care workers' preferences can potentially improve their motivation and influence retention. Health-care workers' concern on incentives having been used as favors and punishment as well as unfair distribution should be addressed by health managers and policymakers, to achieve the desired purpose of motivating and retaining them in rural areas. Appropriate internal monitoring mechanisms are needed for incentives regulation and to improve health workers' retention in rural Ghana.
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Affiliation(s)
- Eunice Okyere
- Department of Public Health, College of Medicine Nursing and Health Sciences-Tamavua Campus, Fiji National University, Suva, Fiji
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Effectiveness of four interventions in improving community health workers' performance in western Kenya: a quasi-experimental difference-in-differences study using a longitudinal data. Prim Health Care Res Dev 2022; 23:e20. [PMID: 35331360 PMCID: PMC8991856 DOI: 10.1017/s1463423622000135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Community health workers (CHWs) are up-front health workers delivering the most effective life-saving health services to communities. They are the key driver to achieve Universal Health Coverage. However, maintaining CHWs’ performance is one of the challenges in sustaining their effectiveness. This article assessed the effectiveness of the four interventions and their combinations on the CHWs’ performance in terms of health knowledge, job satisfaction, and household coverage. Methods: We used the longitudinal survey data collected in western Kenya. Our study participants were the representative of all CHWs working in the four districts, Kenya. The four types of interventions were composed of a basic core intervention (i.e., refresher training with/without defaulter tracing) and three supplementary interventions (i.e., provision of a bicycle, frequent supportive supervision, and financial incentives). We performed the three fixed-effect models to assess the effectiveness of the four interventions and their combinations on the three performance indicators. Results: Three single and combination interventions significantly increased CHWs’ health knowledge: refresher training only [Coef.: 48.43, 95% CI: 42.09–54.76, P < 0.001]; refresher training plus defaulter-tracing [Coef.: 38.80, 95% CI: 32.71–44.90, P < 0.001]; combination of refresher training plus defaulter-tracing and frequent supervision [Coef.: 17.02, 95% CI: 7.90–26.15, P < 0.001]. Financial support was the only intervention that significantly increased job satisfaction among CHWs [Coef.: 4.97, 95% CI: 0.20–9.75, P = 0.041]. There was no single intervention that significantly increased household coverage. Yet, the combinations of the interventions significantly increased household coverage. Conclusions: There was no single intervention to improve all the aspects of CHWs’ performance. The refresher training significantly improved their health knowledge, while financial incentive enhanced the level of their job satisfaction. The combinations of regular refresher training and other intervention(s) are the recommended as the effective interventions in improving and further sustaining CHWs’ performance.
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Mbachu C, Etiaba E, Ebenso B, Ogu U, Onwujekwe O, Uzochukwu B, Manzano A, Mirzoev T. Village health worker motivation for better performance in a maternal and child health programme in Nigeria: A realist evaluation. J Health Serv Res Policy 2022; 27:222-231. [PMID: 35089105 PMCID: PMC9277337 DOI: 10.1177/13558196211055323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Community health workers play an important role in linking communities with
formal health service providers, thereby improving access to and utilization
of health care. A novel cadre of community health workers known as village
health workers (VHWs) were recruited to create demand for maternal health
services in the Nigerian Subsidy Reinvestment Programme (SURE-P/MCH). In
this study, we investigated the role of contextual factors and underlying
mechanisms motivating VHWs. Methods We used realist evaluation to understand the impact of a multi-intervention
maternal and child health programme on VHW motivation using Anambra State as
a case study. Initial working theories and logic maps were developed through
literature review and stakeholder engagement; programme theories were
developed and tested using focus group discussions and in-depth interviews
with various stakeholder groups. Interview transcripts were analysed through
an integrated approach of Context, Mechanism and Outcomes (CMO)
categorisation and connecting, and matching of patterns of CMO
configurations. Motivation theories were used to explain factors that
influence VHW motivation. Explanatory configurations are reported in line
with RAMESES reporting standards. Results The performance of VHWs in the SURE-P maternal and child health programme was
linked to four main mechanisms of motivation: feelings of confidence, sense
of identity or feeling of acceptance, feeling of happiness and
hopefulness/expectation of valued outcome. These mechanisms were triggered
by interactions of programme-specific contexts and resources such as
training and supervision of VHWs by skilled health workers, provision of
first aid kits and uniforms, and payments of a monthly stipend. The monthly
payment was considered to be the most important motivational factor by VHWs.
VHWs used a combination of innovative approaches to create demand for
maternity services among pregnant women, and their performance was
influenced by health system factors such as organisational capacity and
culture, and societal factors such as relationship with the community and
community support. Conclusion This paper highlights important contextual factors and mechanisms for VHW
motivation that can be applied to other interventions that seek to
strengthen community engagement and demand creation in primary health care.
Future research on how to sustain VHW motivation is also required.
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Affiliation(s)
- Chinyere Mbachu
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Enyi Etiaba
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Bassey Ebenso
- School of Sociology and Social Policy, 150514University of Leeds, Leeds, UK
| | - Udochukwu Ogu
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Benjamin Uzochukwu
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Ana Manzano
- School of Sociology and Social Policy, 150514University of Leeds, Leeds, UK
| | - Tolib Mirzoev
- Nuffield Centre for International Health and Development, 150514University of Leeds, Leeds, UK.,Faculty of Public Health and Policy, 150514London School of Hygiene & Tropical Medicine, London, UK
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Masunaga Y, Muela Ribera J, Jaiteh F, de Vries DH, Peeters Grietens K. Village health workers as health diplomats: negotiating health and study participation in a malaria elimination trial in The Gambia. BMC Health Serv Res 2022; 22:54. [PMID: 35016656 PMCID: PMC8753917 DOI: 10.1186/s12913-021-07431-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although many success stories exist of Village Health Workers (VHWs) improving primary health care, critiques remain about the medicalisation of their roles in disease-specific interventions. VHWs are placed at the bottom of the health system hierarchy as cheap and low-skilled volunteers, irrespective of their highly valued social and political status within communities. In this paper, we shed light on the political role VHWs play and investigate how this shapes their social and medical roles, including their influence on community participation.
Method
The study was carried out within the context of a malaria elimination trial implemented in rural villages in the North Bank of The Gambia between 2016 and 2018. The trial aimed to reduce malaria prevalence by treating malaria index cases and their potentially asymptomatic compound members, in which VHWs took an active role advocating their community and the intervention, mobilising the population, and distributing antimalarial drugs. Mixed-methods research was used to collect and analyse data through qualitative interviews, group discussions, observations, and quantitative surveys.
Results and discussion
We explored the emic logic of participation in a malaria elimination trial and found that VHWs played a pivotal role in representing their community and negotiating with the Medical Research Council to bring benefits (e.g. biomedical care service) to the community. We highlight this representative role of VHWs as ‘health diplomats’, valued and appreciated by community members, and potentially increasing community participation in the trial. We argue that VHWs aspire to be politically present and be part of the key decision-makers in the community through their health diplomat role.
Conclusion
It is thus likely that in the context of rural Gambia, supporting VHWs beyond medical roles, in their social and political roles, would contribute to the improved performance of VHWs and to enhanced community participation in activities the community perceive as beneficial.
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Adhikari TB, Gyawali B, Rijal A, Sapkota A, Högman M, Karki A, Sigsgaard T, Neupane D, Kallestrup P. Community-based management of chronic obstructive pulmonary disease in Nepal-Designing and implementing a training program for Female Community Health Volunteers. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000253. [PMID: 36962198 PMCID: PMC10021247 DOI: 10.1371/journal.pgph.0000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 02/13/2022] [Indexed: 11/19/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in Nepal. Female community health volunteers (FCHVs) have proven effective in the delivery of reproductive, maternal, and child health services in Nepal and recently in the prevention and management of hypertension and type 2 diabetes. Evidence on their roles in COPD management is not yet available. The aim of this study was to develop, implement, and evaluate a training program for FCHVs regarding COPD prevention and management. The training program was part of a cluster-randomized trial of a 12-month intervention to improve COPD outcomes in a semi-urban area of Western Nepal. A six-day workshop consisting of thirty hours of training was developed for FCHVs. Training materials incorporated introduction to COPD, risk factors and symptoms, COPD status assessment guide for FCHVs, guidance on breathing techniques, and exercises for people living with COPD. Pre- and post-test questionnaires were administered to assess the change in knowledge of FCHVs, post training skills assessment followed by semi-structured interviews assessed FCHVs' satisfaction with the training program. The findings of the pre- and post- test assessments showed a significant improvement in FCHVs' COPD-related knowledge from a median (interquartile range) score of 12 (3-16) before to 21 (21-22) (p<0.001) after the training program. The qualitative assessment revealed the feasibility of FCHVs' training on COPD and their acceptability to deliver the intervention package within the community. It also indicated that implementing future training with an extended period and a few days break in-between could enhance the effectiveness. Training of FCHVs in COPD management is feasible and leads to improvement in knowledge. The motivation shown by FCHVs to deliver the intervention could inform and guide community programs and policies for COPD prevention and management in Nepal and similar settings.
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Affiliation(s)
- Tara Ballav Adhikari
- COBIN Project, Nepal Development Society, Bharatpur, Chitwan, Nepal
- Department of Public Health, Section for Global Health, Aarhus University, Aarhus, Denmark
| | - Bishal Gyawali
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anupa Rijal
- Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Abhishek Sapkota
- COBIN Project, Nepal Development Society, Bharatpur, Chitwan, Nepal
| | - Marieann Högman
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Arjun Karki
- Department of Pulmonary, Critical Care and Sleep Medicine, HAMS Hospital, Kathmandu, Nepal
| | - Torben Sigsgaard
- Department of Public Health, Section for Environment, Occupation & Health, Aarhus University, Aarhus, Denmark
| | - Dinesh Neupane
- COBIN Project, Nepal Development Society, Bharatpur, Chitwan, Nepal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Per Kallestrup
- Department of Public Health, Section for Global Health, Aarhus University, Aarhus, Denmark
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Roy S, Pandya S, Hossain MI, Abuya T, Warren CE, Mitra P, Rob U, Hossain S, Agarwal S. Beyond Institutionalization: Planning for Sustained Investments in Training, Supervision, and Support of Community Health Worker Programs in Bangladesh. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:765-776. [PMID: 34933974 PMCID: PMC8691870 DOI: 10.9745/ghsp-d-21-00156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 08/10/2021] [Indexed: 11/15/2022]
Abstract
Institutionalizing community health workers (CHWs) is insufficient for improving program quality. Governments must plan for sustained investments for salaries and benefits, as well as systems enabling adaptive management of the CHW cadres. Greater coordination is needed at the global level to pool and align donor investments to support the ecosystem underlying CHW programs. Introduction: Methods: Results: Discussion:
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Affiliation(s)
| | - Shivani Pandya
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Paloma Mitra
- Krieger School of Arts and Sciences, The Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Smisha Agarwal
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Ishizumi A, Sutton R, Mansaray A, Parmley L, Eleeza O, Kulkarni S, Sesay T, Conklin L, Wallace AS, Akinjeji A, Toure M, Lahuerta M, Jalloh MF. Community Health Workers' Experiences in Strengthening the Uptake of Childhood Immunization and Malaria Prevention Services in Urban Sierra Leone. Front Public Health 2021; 9:767200. [PMID: 34938707 PMCID: PMC8687740 DOI: 10.3389/fpubh.2021.767200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Community health workers (CHWs) play an integral role in Sierra Leone's health systems strengthening efforts. Our goal was to understand CHWs' experiences of providing immunization and malaria prevention services in urban settings and explore opportunities to optimize their contributions to these services. Methods: In 2018, we conducted an exploratory qualitative assessment in the Western Area Urban district, which covers most of the capital city of Freetown. We purposively selected diverse health facilities (i.e., type, ownership, setting) and recruited CHWs through their supervisors. We conducted eight focus group discussions (FGD) with CHWs, which were audio-recorded. The topics explored included participants' background, responsibilities and priorities of urban CHWs, sources of motivation at work, barriers to CHWs' immunization and malaria prevention activities, and strategies used to address these barriers. The local research team transcribed and translated FGDs into English; then we used qualitative content analysis to identify themes. Results: Four themes emerged from the qualitative content analysis: (1) pride, compassion, recognition, and personal benefits are important motivating factors to keep working as CHWs; (2) diverse health responsibilities and competing priorities result in overburdening of CHWs; (3) health system- and community-level barriers negatively affect CHWs' activities and motivation; (4) CHWs use context-specific strategies to address challenges in their work but require further support. Conclusion: Focused support for CHWs is needed to optimize their contributions to immunization and malaria prevention activities. Such interventions should be coupled with systems-level efforts to address the structural barriers that negatively affect CHWs' overall work and motivation, such as the shortage of work supplies and the lack of promised financial support.
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Affiliation(s)
- Atsuyoshi Ishizumi
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Roberta Sutton
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States
| | - Anthony Mansaray
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States
| | - Lauren Parmley
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States
| | - Oliver Eleeza
- ICAP at Columbia University, Mailman School of Public Health, Freetown, Sierra Leone
| | - Shibani Kulkarni
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tom Sesay
- Child Health and Immunization Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Laura Conklin
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Aaron S Wallace
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Adewale Akinjeji
- ICAP at Columbia University, Mailman School of Public Health, Freetown, Sierra Leone
| | - Mame Toure
- ICAP at Columbia University, Mailman School of Public Health, Freetown, Sierra Leone
| | - Maria Lahuerta
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States.,Department of Epidemiology, Mailman School of Public Health, New York, NY, United States
| | - Mohamed F Jalloh
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
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Shanthosh J, Durbach A, Joshi R. Charting the Rights of Community Health Workers in India: The Next Frontier of Universal Health Coverage. Health Hum Rights 2021; 23:225-238. [PMID: 34966238 PMCID: PMC8694295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Community health workers (CHWs) have the capacity to bring essential health services to under-resourced communities. Globally, CHWs have made significant contributions to poverty alleviation, increased food security, and reductions in health inequalities. India's one million accredited social health activists (ASHAs), the largest cohort of CHWs in the world, have been credited with increasing the rate of institutional deliveries and the uptake of vaccinations. ASHAs operate at the margins of health systems and the formal health workforce, often due to misperceptions of their skills and discrimination based on gender, socioeconomic status, education, and rurality. The "voluntary" nature of their work can entrench their precarious status, which is characterized by a lack of access to employment rights, adequate remuneration, and institutional support. This article argues that the prioritization of the labor rights of CHWs in the design and implementation of the World Health Organization's 2018 Guideline on Health Policy and System Support to Optimize Community Health Worker Programmes can serve to ensure safe working conditions and freedom from discrimination, coercion, and violence. It further argues that the resultant enhancement and protection of CHWs' rights and long-term security provides an essential pathway for harnessing their potential to transform universal health coverage.
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Affiliation(s)
- Janani Shanthosh
- Research fellow at the George Institute for Global Health, and academic lead of the Health and Human Rights Programme at the Australian Human Rights Institute, University of New South Wales, Australia
| | - Andrea Durbach
- Emeritus professor in the Faculty of Law, University of New South Wales Sydney, and former director of the Australian Human Rights Centre (now Institute), Australia
| | - Rohina Joshi
- Associate professor in the Faculty of Medicine, University of New South Wales Sydney, and Head of the Global Health Workforce Program at the George Institute for Global Health, Australia.,Please address correspondence to Rohina Joshi.
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Bogren M, Mwambali SN, Berg M. Contextual factors influencing a training intervention aimed at improved maternal and newborn healthcare in a health zone of the Democratic Republic of Congo. PLoS One 2021; 16:e0260153. [PMID: 34843565 PMCID: PMC8629278 DOI: 10.1371/journal.pone.0260153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Maternal and neonatal mortality and morbidity in the Democratic Republic of Congo (DRC) are among the highest worldwide. As part of a quality improvement programme in a health zone in the DRC aimed at contributing to reduced maternal and neonatal mortality and morbidity, a three-pillar training intervention around childbirth was developed and implemented in collaboration between Swedish and Congolese researchers and healthcare professionals. The aim of this study is to explore contextual factors influencing this intervention. Methods A qualitative research design was used, with data collected through focus group discussions (n = 7) with healthcare professionals involved in the intervention before and at the end (n = 9). Transcribed discussions were inductively analysed using content analysis. Results Three generic categories describe the contextual factors influencing the intervention: i) Incentives motivated participants’ efforts to begin a training programme; ii) Involving the local health authorities was important; and (iii) Having physical space, electricity, and equipment in place was crucial. Conclusions This study and similar ones highlight that incentives of various types are crucial contextual factors that influence training interventions, and have to be considered already in the planning of such interventions. One such factor is expectations of monetary incentives. To meet this in a small research project like ours would require a reduction of the scale and thus limit the implementation of new evidence-based knowledge into practice aimed at reducing maternal mortality and morbidity.
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Affiliation(s)
- Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Sylvie Nabintu Mwambali
- Faculty of Medicine and Community Health, Department of Obstetrics and Gynecology, Evangelical University of Africa, Bukavu, Democratic Republic of Congo
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Faculty of Medicine and Community Health, Department of Obstetrics and Gynecology, Evangelical University of Africa, Bukavu, Democratic Republic of Congo
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