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Gebretnsae H, Ayele BG, Hadgu T, Haregot E, Gebremedhin A, Michael E, Abraha M, Datiko DG, Jerene D. Implementation status of household contact tuberculosis screening by health extension workers: assessment findings from programme implementation in Tigray region, northern Ethiopia. BMC Health Serv Res 2020; 20:72. [PMID: 32005226 PMCID: PMC6995142 DOI: 10.1186/s12913-020-4928-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 01/23/2020] [Indexed: 01/04/2023] Open
Abstract
Background In the Tigray region of Ethiopia, Health Extension Workers (HEWs) conduct Tuberculosis (TB) screening for all household (HH) contacts. However, there is limited evidence on implementation status of HH contact TB screening by HEWs. The aim of this program assessment was to describe the implementation status and associated factors of HH contact TB screening by HEWs. Methods This programme assessment was conducted in three randomly selected districts from March to April 2018. Data was collected by using pre-tested structured questionnaire. Descriptive statistics was carried out using frequency tables. Logistic regression analysis was done to identify factors associated with HH contacts screening by HEWs. Results In this programme assessment a total of HHs of 411 index TB cases were included. One-fifth (21.7%) of index TB cases had at least one HH contact screened for TB by HEWs. Having TB treatment supporter (TTS) during intensive phase of index TB case (AOR = 2.55, 95% CI: 1.06–6.01), health education on TB to HH contacts by HEWs (AOR = 4.28, 95% CI: 2.04–9.00), HH visit by HEWs within 6 months prior to the programme assessment (AOR = 5.84, 95% CI: 2.81–12.17) and discussions about TB activities by HEWs with Women Development Army (WDA) leaders (AOR = 9.51, 95% CI: 1.49–60.75) were significantly associated with household contact TB screening by HEWs. Conclusions Our finding revealed that the proportion of HH contact TB screened by HEWs was low. Therefore, HEWs should routinely visit HHs of index TB cases and provide regular health education to improve contact screening practice. In addition, it is highly recommended to strengthen HEWs regular discussion about TB activities with WDA leaders and TB TTS.
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Affiliation(s)
| | | | - Tsegay Hadgu
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | - Esayas Haregot
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | | | | | | | - Degue Jerene
- USAID/Challenge TB project, Addis Ababa, Ethiopia
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Onazi O, Adejumo AO, Redwood L, Okorie O, Lawal O, Azuogu B, Gidado M, Daniel OJ, Mitchell EMH. Community health care workers in pursuit of TB: Discourses and dilemmas. Soc Sci Med 2020; 246:112756. [PMID: 31954279 DOI: 10.1016/j.socscimed.2019.112756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 12/13/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Abstract
Community-led tuberculosis (TB) active case finding is widely promoted, heavily funded, but many efforts fail to meet expectations. The underlying reasons why TB symptom screening programs underperform are poorly understood. This study examines Nigerian stakeholders' insights to characterize the mechanisms, enabling structures and influences that lead programs to succeed or fail. Eight focus group discussions were held with Community Health Workers (CWs) from four models of community-based TB screening and referral. In-depth interviews were conducted with 2 State TB program managers, 8 Community based organizations (CBOs), and 6 state TB and Leprosy Local Government supervisors. Transcripts were coded using Framework Analysis to assess how divergent understandings of CWs' roles, expectations, as well as design, political and structural factors contributed to the observed underperformance. Altruism, religious faith, passion, and commitment to the health and well-being of their communities were reasons CWs gave for starting TB symptom screening and referral. Yet politicized or donor-driven CWs' selection processes at times yielded implementers without a firm grounding in TB or the social, cultural, and physical terrain. CWs encountered suspicion, stigma, and hostility in both health facilities and communities. As the interface between the TB program and communities, CWs often bore the brunt of frustrations with inadequate TB services and CBO/iNGO collaboration. Some CWs expended their own social and financial capital to cover gaps in the active case finding (ACF) programs and public health services or curtailed their screening activities. Effective community-led TB active case finding is challenging to design, implement and sustain. Contrary to conventional wisdom, CWs did not experience it as inherently empowering. Sustainable, supportive models that combine meaningful engagement for communities with effective program stewardship and governance are needed. Crucially effective and successful implementation of community-based TB screening and referral requires a functional public health system to which to refer.
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Affiliation(s)
| | - Adedeji Olusola Adejumo
- Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Ikeja Lagos, Nigeria.
| | | | - Onuka Okorie
- Abia State TB and Leprosy Control Programme, Abia State, Nigeria
| | - Oyewole Lawal
- Oyo State TB and Leprosy Control Programme Oyo State, Nigeria
| | - Benedict Azuogu
- Department of Community Medicine, Ebonyi State University, Abakaliki, Nigeria
| | | | - Olusoji James Daniel
- Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital Sagamu, Ogun State, Nigeria
| | - Ellen M H Mitchell
- Department of Public Health, Institute of Tropical Medicine Antwerp, Belgium
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Reuter A, Hughes J, Furin J. Challenges and controversies in childhood tuberculosis. Lancet 2019; 394:967-978. [PMID: 31526740 DOI: 10.1016/s0140-6736(19)32045-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 01/03/2023]
Abstract
Children bear a substantial burden of suffering when it comes to tuberculosis. Ironically, they are often left out of the scientific and public health advances that have led to important improvements in tuberculosis diagnosis, treatment, and prevention over the past decade. This Series paper describes some of the challenges and controversies in paediatric tuberculosis, including the epidemiology and treatment of tuberculosis in children. Two areas in which substantial challenges and controversies exist (ie, diagnosis and prevention) are explored in more detail. This Series paper also offers possible solutions for including children in all efforts to end tuberculosis, with a focus on ensuring that the proper financial and human resources are in place to best serve children exposed to, infected with, and sick from all forms of tuberculosis.
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Affiliation(s)
- Anja Reuter
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - Jennifer Hughes
- Desmond Tutu Tuberculosis Center, Stellenbosch University, Stellenbosch, South Africa
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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A model for point of care testing for non-communicable disease diagnosis in resource-limited countries. GLOBAL HEALTH EPIDEMIOLOGY AND GENOMICS 2019; 4:e7. [PMID: 31555457 PMCID: PMC6749552 DOI: 10.1017/gheg.2019.6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 08/15/2019] [Accepted: 08/18/2019] [Indexed: 12/29/2022]
Abstract
Non-communicable disease diagnosis frequently relies on biochemical measurements but laboratory infrastructure in low-income settings is often insufficient and distances to clinics may be vast. We present a model for point of care (POC) epidemiology as used in our study of chronic disease in the Haiti Health Study, in rural and urban Haiti. Point of care testing (POCT) of creatinine, cholesterol, and hemoglobin A1c as well as physical measurements of weight, height, and waist circumference allowed for diagnosis of diabetes, chronic kidney disease, dyslipidemias, and obesity. Methods and troubleshooting techniques for the data collection of this study are presented. We discuss our method of community-health worker (CHW) training, community engagement, study design, and field data collection. We also discuss the machines used and our quality control across CHWs and across geographical regions. Pitfalls tended to include equipment malfunction, transportation issues, and cultural differences. May this paper provide information for those attempting to perform similar diagnostic and screening studies using POCT in resource poor settings.
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Ramathebane MM, Makatjane TJ, Thetsane RM, Mokhethi M. Assessment of tuberculosis knowledge among Lesotho village health workers and utilisation of their tuberculosis services by the communities they serve. Afr J Prim Health Care Fam Med 2019; 11:e1-e7. [PMID: 31368320 PMCID: PMC6676932 DOI: 10.4102/phcfm.v11i1.1944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/13/2019] [Accepted: 03/27/2019] [Indexed: 12/02/2022] Open
Abstract
Background The role of village health workers (VHWs), among other roles is to educate communities about tuberculosis (TB), TB screening and its treatment. The knowledge of TB among VHWs is crucial because they will carry out their role at the community well and this will impact the overall outcome of TB treatment. Aim The study is aimed at assessing the knowledge of TB among VHWs and households at the village level and the utilisation of VHWs’ TB services. Setting The study took place in 19 health centres from 10 districts of Lesotho. Methods The study used a cross-sectional descriptive design. Three study populations were interviewed, two at the household level (2040 households, 8295 individuals) and one at the clinic level (723 VHW). Results Overall, TB knowledge among VHWs for the majority of clinics except two was inadequate (below mean of 31.5). The utilisation of VHWs’ TB services among community members was also low. Conclusion Low utilisation of VHWs’ TB services by community members emanated from inadequate TB knowledge of VHWs. Regular refresher training among VHWs is recommended as the way forward in order to keep VHWs abreast with new TB developments.
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Millum J, Campbell M, Luna F, Malekzadeh A, Karim QA. Ethical challenges in global health-related stigma research. BMC Med 2019; 17:84. [PMID: 31030670 PMCID: PMC6487527 DOI: 10.1186/s12916-019-1317-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is critically important to conduct research on stigmatized conditions, to include marginalized groups that experience stigma, and to develop interventions to reduce stigma. However, such research is ethically challenging. Though superficial reference is frequently made to these widely acknowledged challenges, few publications have focused on ethical issues in research on stigmatized groups or conditions. In fact, a brief literature review found only two such publications. MAIN TEXT At a recent Science of Stigma Reduction workshop comprising 60 stigma researchers from the USA and low and middle-income countries, the need for more robust and critical discussion of the ethics of the research was highlighted. In this paper we describe, illustrate through cases, and critically examine key ethical challenges that are more likely to arise because a research study focuses on health-related stigma or involves stigmatized groups or conditions. We examine the ethics of this research from two perspectives. First, through the lens of overprotection, where we discuss how the perception of stigma can impede ethical research, disrespect research participants, and narrow the research questions. Second, through the lens of research risks, where we consider how research with stigmatized populations can unintentionally result in harms. Research-related harms to participants include potential breaches of confidentiality and the exacerbation of stigma. Potential harms also extend to third parties, including families and populations who may be affected by the dissemination of research results. CONCLUSIONS Research with stigmatized populations and on stigmatized conditions should not be impeded by unnecessary or inappropriate protective measures. Nevertheless, it may entail different and greater risks than other health research. Investigators and research ethics committees must be particularly attentive to these risks and how to manage them.
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Affiliation(s)
- Joseph Millum
- Clinical Center Department of Bioethics, National Institutes of Health, 10/1C118, 10 Center Drive, Bethesda, MD, 20892, USA. .,Fogarty International Center, National Institutes of Health, 31 Center Dr, Bethesda, MD, 20892, USA.
| | - Megan Campbell
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Florencia Luna
- CONICET, Programa de Bioética, FLACSO Argentina, Tucumán 1966, C1050AAN, Caba, Argentina
| | - Arianne Malekzadeh
- Fogarty International Center, National Institutes of Health, 31 Center Dr, Bethesda, MD, 20892, USA
| | - Quarraisha Abdool Karim
- Centre for the AIDS Program of Research in South Africa, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Congella, 4013, South Africa
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Ajuebor O, Cometto G, Boniol M, Akl EA. Stakeholders' perceptions of policy options to support the integration of community health workers in health systems. HUMAN RESOURCES FOR HEALTH 2019; 17:13. [PMID: 30777095 PMCID: PMC6379925 DOI: 10.1186/s12960-019-0348-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/25/2019] [Indexed: 06/01/2023]
Abstract
BACKGROUND Community health workers (CHWs) are an important component of the health workforce in many countries. The World Health Organization (WHO) has developed a guideline to support the integration of CHWs into health systems. This study assesses stakeholders' valuation of outcomes of interest, acceptability and feasibility of policy options considered for the CHW guideline development. METHODS A cross-sectional mixed methods (quantitative and qualitative) study targeting stakeholders involved directly or indirectly in country implementation of CHW programmes was conducted in 2017. Data was collected from 96 stakeholders from five WHO regions using an online questionnaire. A Likert scale (1 to 9) was used to grade participants' assessments of the outcomes of interest, and the acceptability and feasibility of policy options were considered. RESULTS All outcomes of interest were considered by at least 90% of participants as 'important' or 'critical'. Most critical outcomes were 'improved quality of CHW health services' and 'increased health service coverage' (91.5% and 86.2% participants judging them as 'critical' respectively). Out of 40 policy options, 35 were considered as 'definitely acceptable' and 36 'definitely feasible' by most participants. The least acceptable option (37% of participants rating 'definitely not acceptable') was the selection of candidates based on age. The least feasible option (29% of participants rating 'definitely not feasible') was the selection of CHWs with a minimum of secondary education. CONCLUSION Outcomes of interest and policy options proposed were rated highly by most stakeholders. This finding helps to reinforce their usefulness in meeting the expectations of the CHW guideline end-users to properly integrate CHWs into health systems.
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Affiliation(s)
- Onyema Ajuebor
- Health Workforce Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
| | - Giorgio Cometto
- Health Workforce Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
| | - Mathieu Boniol
- Health Workforce Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
| | - Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Mutiso VN, Gitonga I, Musau A, Musyimi CW, Nandoya E, Rebello TJ, Pike KM, Ndetei DM. A step-wise community engagement and capacity building model prior to implementation of mhGAP-IG in a low- and middle-income country: a case study of Makueni County, Kenya. Int J Ment Health Syst 2018; 12:57. [PMID: 30356953 PMCID: PMC6191998 DOI: 10.1186/s13033-018-0234-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/06/2018] [Indexed: 12/26/2022] Open
Abstract
Background The World Health Organization developed the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) as guidelines for innovative utilization of available resources in low- and middle-income countries (LMICs) in order to accelerate the reduction of the mental health treatment gap. The mhGAP-IG calls for each country to contextualize the guide to their social, cultural and economic context. The objective of this paper is to describe a model for a stepwise approach for implementation of mhGAP-IG in a rural Kenyan setting using existing formal and informal community resources and health systems. Methods We conducted an analysis of mental health services in Makueni County, one of the 47 counties in Kenya, in order to understand the existing gaps and opportunities in a low-resource setting. We conducted stakeholder analysis and engagement through interactive dialogue in order for them to appreciate the importance of mental health to their communities. Through the process of participatory Theory of Change, the stakeholders gave their input on the process between the initiation and the end of the process for community mental health development, with the aim of achieving buy-in and collective ownership of the whole process. We adapted the mhGAP-IG to the local context and trained local human resources in skills necessary for the implementation of mhGAP-IG and for monitoring and evaluating the process using instruments with good psychometric properties that have been used in LMICs. Results We were able to demonstrate the feasibility of implementing the mhGAP-IG using existing and trained community human resources using a multi-stakeholder approach. We further demonstrated the feasibility to transit seamlessly from research to policy and practice uptake using our approach. Conclusions An inclusive model for low resource settings is feasible and has the potential to bridge the gap between research, policy and practice. A major limitation of our study is that we did not engage a health economist from the beginning in order to determine the cost-effectiveness of our proposed model, occasioned by lack of resources to hire a suitable one.
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya
| | - Abednego Musau
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya
| | - Eric Nandoya
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya
| | | | - Kathleen M Pike
- 2Global Mental Health Program, Columbia University, New York, USA
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya.,3University of Nairobi, Nairobi, Kenya
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Naidoo N, Zuma N, Khosa NS, Marincowitz G, Railton J, Matlakala N, Jobson GA, Igumbor JO, McIntyre JA, Struthers HE, Peters RPH. Qualitative assessment of facilitators and barriers to HIV programme implementation by community health workers in Mopani district, South Africa. PLoS One 2018; 13:e0203081. [PMID: 30161208 PMCID: PMC6117027 DOI: 10.1371/journal.pone.0203081] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/14/2018] [Indexed: 11/18/2022] Open
Abstract
South Africa has implemented a community-based HIV programme (CBHP) in its primary healthcare (PHC) re-engineering strategy that aims to improve public healthcare delivery. This CBHP is delivered by ward-based outreach teams (WBOTs); provision of community HIV services comprises an important component of this programme. We conducted an exploratory study to determine the facilitators and barriers to successful implementation of this CBHP in rural Mopani District, South Africa. Focus group discussions were conducted with the community health workers (CHWs) and PHC nurses; participant interviews were conducted with community members who access these health services, community leaders, and social workers. We conducted a thematic content analysis and based on the key themes reported, we identified the Consolidated Framework for Implementation Research, consisting of five domains, as the most appropriate model to interpret our findings. First, in terms of intervention characteristics, community members generally valued the HIV services provided, but the variable needs impacted on programme implementation. Outer setting challenges include inability to meet the need of patients as a result of stigma, non-disclosure of HIV status and social factors. In terms of the inner setting, CHWs were grateful for the equipment and training received but expressed the need for better support of management and the provision of additional resources. With regard to characteristics of the implementers, the CHWs expressed the desire for further training despite reporting having sufficient knowledge to conduct their HIV work. Finally, in terms of the implementation process, the importance of relationship building between CHWs and community members was emphasised. In conclusion, these data underline the positive receipt and potential of the CBHP in this rural district and identify areas to further strengthen the programme. The success and sustainability of the CBHP requires ongoing commitment of resources, training, supervision, and organisational support in order to operate effectively and efficiently.
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Affiliation(s)
- Nireshni Naidoo
- Anova Health Institute, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Gert Marincowitz
- Mopani DCST, Department of Health, Limpopo Province, Giyani, South Africa
| | - Jean Railton
- Anova Health Institute, Johannesburg, South Africa
| | | | | | - Jude O. Igumbor
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - James A. McIntyre
- Anova Health Institute, Johannesburg, South Africa
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Helen E. Struthers
- Anova Health Institute, Johannesburg, South Africa
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Remco P. H. Peters
- Anova Health Institute, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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Mundeva H, Snyder J, Ngilangwa DP, Kaida A. Ethics of task shifting in the health workforce: exploring the role of community health workers in HIV service delivery in low- and middle-income countries. BMC Med Ethics 2018; 19:71. [PMID: 29973217 PMCID: PMC6032788 DOI: 10.1186/s12910-018-0312-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 06/28/2018] [Indexed: 12/02/2022] Open
Abstract
Background Task shifting is increasingly used to address human resource shortages impacting HIV service delivery in low- and middle-income countries. By shifting basic tasks from higher- to lower-trained cadres, such as Community Health Workers (CHWs), task shifting can reduce overhead costs, improve community outreach, and provide efficient scale-up of essential treatments like antiretroviral therapies. Although there is rich evidence outlining positive outcomes that CHWs bring into HIV programs, important questions remain over their place in service delivery. These challenges often reflect concerns over whether CHWs can mitigate HIV through a means that does not overlook the ethical and practical constraints that undergird their work. Ethical and practical guidance thus needs to become the cornerstone of CHW deployment. This paper analyzes such challenges through the lens of Ethical Principlism. Methods We examined papers identifying substantive and ethical challenges impacting CHWs as they provide HIV services in low- and middle-income contexts. To do this, we analyzed papers written in English and published from year 2000 or later. These articles were identified using MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar databases. In total, 465 articles were identified, 78 of which met our inclusion criteria. Article reference lists and grey literature were also examined. Results CHWs experience specific challenges while carrying out their duties, such as conducting emotionally- and physically-demanding tasks with often inadequate training, supervision and compensation. CHWs have also been poorly integrated into health systems, which not only impacts quality of care, but can hinder their prospects for promotion and lead to CHW disempowerment. As we argue, these challenges can be addressed if a set of ethical principles is prioritized, which specifically entail the principles of respect for persons, justice, beneficence, proportionality and cultural humility. Conclusions CHWs play a crucial role in HIV service delivery, yet the ethical challenges that can accompany their work cannot be overlooked. By prioritizing ethical principles, policymakers and program implementers can better ensure that CHWs are combatting HIV through a means that does not exploit or take their critical role within service delivery for granted.
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Affiliation(s)
- Hayley Mundeva
- Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Jeremy Snyder
- Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - David Paul Ngilangwa
- Amref Health Africa Tanzania, Ali Hassan Mwinyi Road, Plot 1019, P.O. Box 2773, Dar es Salaam, Tanzania
| | - Angela Kaida
- Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
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Odusanya OO, Akinyinka MR, Oluwole EO, Odugbemi BA, Bakare OQ, Adeniran A. How does the public perceive healthcare workers in Lagos? A comparison of health workers in public and private health facilities. Niger Postgrad Med J 2018; 25:177-185. [PMID: 30264770 DOI: 10.4103/npmj.npmj_102_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The perception of healthcare workers (HCWs) by community members is dependent on the quality of services rendered by HCWs and contributes to utilisation. The objective of the study was to assess the perception of health workers in both public and private facilities by residents of Lagos State. MATERIALS AND METHODS A descriptive cross-sectional study was conducted using mixed-methods approach. Respondents (n = 2000) were selected using a multistaged sampling technique from four local government areas. An interviewer-administered, pre-tested questionnaire developed for the study was used for data collection and focus group discussions were held. Domains assessed included competence, work attitudes, interpersonal skills and unethical behaviour. A perception index was generated. Data were analysed using the Statistical Package for the Social Sciences version 22, with level of significance set at 0.05 for quantitative data and ATLAS.ti software (Scientific Software, Berlin; version 7) for qualitative data. RESULTS At least seven out of ten participants (>71%) perceived the HCWs highly in the areas of professional competence, attitude to work, responsiveness and interpersonal skills. Out of a maximum of 12, doctors had the highest mean perception index (10.6 ± 1.9), laboratory scientists had 10.1 ± 2.1, pharmacists had 10.0 ± 2.3 and nurses had 9.6 ± 2.7. A larger proportion of respondents had a significantly better perception of workers in private facilities more than those in government facilities. CONCLUSION Perception of health workers was high and was better in privately owned facilities. Periodic retraining of health workers and regular assessments of health facilities are recommended.
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Affiliation(s)
- Olumuyiwa Omotola Odusanya
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Lagos, Nigeria
| | - Modupe Rebekah Akinyinka
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Lagos, Nigeria
| | - Esther Oluwakemi Oluwole
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Babatunde Adeniran Odugbemi
- Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Omowunmi Qubrat Bakare
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Lagos, Nigeria
| | - Adeyinka Adeniran
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Lagos, Nigeria
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Berrian AM, Smith MH, van Rooyen J, Martínez-López B, Plank MN, Smith WA, Conrad PA. A community-based One Health education program for disease risk mitigation at the human-animal interface. One Health 2018; 5:9-20. [PMID: 29270459 PMCID: PMC5734692 DOI: 10.1016/j.onehlt.2017.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/10/2017] [Accepted: 11/10/2017] [Indexed: 01/12/2023] Open
Abstract
The interface between humans, domestic animals, and wildlife has been implicated in the emergence of infectious diseases and the persistence of endemic human and animal diseases. For individuals who reside at this interface, particularly those in low-resource settings, the development of disease risk assessment and mitigation skills must be prioritized. Using a community engagement-One Health approach, we implemented a training program aimed at advancing these skills among agro-pastoralists living adjacent to conservation areas in South Africa. The program included professional development of local facilitators who then conducted workshops with community members. Workshops used a series of experiential, inquiry-based activities to teach participants the concepts of pathogen transmission and disease risk assessment and mitigation. The program was implemented over four weeks with 10 facilitators and 78 workshop participants. We conducted a within-subjects experimental study using a mixed methods design to evaluate the program in terms of facilitator and participant One Health knowledge and practices. Quantitative data included pre/post written assessments; qualitative data included focus group discussions, semi-structured interviews, and pre/post photographs. Mean post-test scores of facilitators increased by 17% (p = 0.0078). For workshop participants, improvements in knowledge were more likely for females than males (OR = 7.315, 95% CI = 2.258-23.705, p = 0.0009) and participants with a higher versus lower education level, albeit borderline non-significant (OR = 4.781, 95% CI = 0.942-24.264, p = 0.0590). Qualitative analysis revealed the implementation of risk mitigation strategies by 98% (60/61) of workshop participants during the three-month follow-up and included improved personal and domestic hygiene practices and enhanced animal housing. Although further evaluation is recommended, this program may be appropriate for consideration as a scalable approach by which to mitigate human and animal infectious disease risk in high-risk/low-resource communities.
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Affiliation(s)
- Amanda M. Berrian
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Martin H. Smith
- Department of Human Ecology/Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Jacques van Rooyen
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
- Centre for Veterinary Wildlife Studies, Faculty of Veterinary Science, University of Pretoria, Hans Hoheisen Wildlife Research Station, Orpen Gate, Kruger National Park, South Africa
| | - Beatriz Martínez-López
- Center for Animal Disease Modeling and Surveillance, Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Monica N. Plank
- Department of Human Ecology/Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Woutrina A. Smith
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Patricia A. Conrad
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, CA, USA
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Mercer T, Gardner A, Andama B, Chesoli C, Christoffersen-Deb A, Dick J, Einterz R, Gray N, Kimaiyo S, Kamano J, Maritim B, Morehead K, Pastakia S, Ruhl L, Songok J, Laktabai J. Leveraging the power of partnerships: spreading the vision for a population health care delivery model in western Kenya. Global Health 2018; 14:44. [PMID: 29739421 PMCID: PMC5941561 DOI: 10.1186/s12992-018-0366-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/01/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Academic Model Providing Access to Healthcare (AMPATH) has been a model academic partnership in global health for nearly three decades, leveraging the power of a public-sector academic medical center and the tripartite academic mission - service, education, and research - to the challenges of delivering health care in a low-income setting. Drawing our mandate from the health needs of the population, we have scaled up service delivery for HIV care, and over the last decade, expanded our focus on non-communicable chronic diseases, health system strengthening, and population health more broadly. Success of such a transformative endeavor requires new partnerships, as well as a unification of vision and alignment of strategy among all partners involved. Leveraging the Power of Partnerships and Spreading the Vision for Population Health. We describe how AMPATH built on its collective experience as an academic partnership to support the public-sector health care system, with a major focus on scaling up HIV care in western Kenya, to a system poised to take responsibility for the health of an entire population. We highlight global trends and local contextual factors that led to the genesis of this new vision, and then describe the key tenets of AMPATH's population health care delivery model: comprehensive, integrated, community-centered, and financially sustainable with a path to universal health coverage. Finally, we share how AMPATH partnered with strategic planning and change management experts from the private sector to use a novel approach called a 'Learning Map®' to collaboratively develop and share a vision of population health, and achieve strategic alignment with key stakeholders at all levels of the public-sector health system in western Kenya. CONCLUSION We describe how AMPATH has leveraged the power of partnerships to move beyond the traditional disease-specific silos in global health to a model focused on health systems strengthening and population health. Furthermore, we highlight a novel, collaborative tool to communicate our vision and achieve strategic alignment among stakeholders at all levels of the health system. We hope this paper can serve as a roadmap for other global health partners to develop and share transformative visions for improving population health globally.
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Affiliation(s)
- Tim Mercer
- Department of Population Health, The University of Texas at Austin Dell Medical School, 1701 Trinity St, Austin, TX, 78712, USA.
| | - Adrian Gardner
- Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr, Indianapolis, IN, 46202, USA.,Department of Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Benjamin Andama
- Academic Model Providing Access to Health Care (AMPATH), PO Box 4606 30100, Eldoret, Kenya
| | - Cleophas Chesoli
- Academic Model Providing Access to Health Care (AMPATH), PO Box 4606 30100, Eldoret, Kenya
| | - Astrid Christoffersen-Deb
- Department of Obstetrics and Gynaecology, University of Toronto Faculty of Medicine, 123 Edward Street, Suite 1200, Toronto, ON, M5G1E2, Canada.,Department of Reproductive Health, Moi University School of Medicine, Eldoret, Kenya
| | - Jonathan Dick
- Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr, Indianapolis, IN, 46202, USA.,Department of Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Robert Einterz
- Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Nick Gray
- Dow AgroSciences, 9330 Zionsville Rd, Indianapolis, IN, 46268, USA
| | - Sylvester Kimaiyo
- Department of Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Jemima Kamano
- Department of Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Beryl Maritim
- Academic Model Providing Access to Health Care (AMPATH), PO Box 4606 30100, Eldoret, Kenya
| | - Kirk Morehead
- Dow AgroSciences, 9330 Zionsville Rd, Indianapolis, IN, 46268, USA
| | - Sonak Pastakia
- Purdue University College of Pharmacy, 575 Stadium Mall Dr, West Lafayette, IN, 47907, USA.,Department of Pharmacology, Moi University School of Medicine, Eldoret, Kenya
| | - Laura Ruhl
- Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Dr, Indianapolis, IN, 46202, USA.,Department of Child Health and Paediatrics, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Julia Songok
- Department of Child Health and Paediatrics, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Jeremiah Laktabai
- Department of Family Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
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Naidoo N, Railton J, Jobson G, Matlakala N, Marincowitz G, McIntyre JA, Struthers HE, Peters RPH. Making ward-based outreach teams an effective component of human immunodeficiency virus programmes in South Africa. South Afr J HIV Med 2018; 19:778. [PMID: 29707389 PMCID: PMC5913767 DOI: 10.4102/sajhivmed.v19i1.778] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 02/12/2018] [Indexed: 11/02/2022] Open
Abstract
The implementation of ward-based outreach teams (WBOTs), comprised of community health workers (CHWs), is one of the three interventions of the South African National Department of Health's (NDoH) Primary Health Care (PHC) Re-engineering strategy for improving health outcomes. CHWs provide a necessary structure to contribute to successful implementation of the human immunodeficiency virus (HIV) programme in four ways: (1) prevention of HIV infection by health education, (2) linkage to care by health education and referrals, (3) adherence support and (4) identification of individuals who are failing treatment. However, CHW programme and HIV programme-specific barriers exist that need to be resolved in order to achieve maximum impact. These include a lack of stakeholder and community support for WBOTs, challenging work and operational environments, a lack of in-depth knowledge and skills, and socio-cultural barriers such as HIV-related stigma. Considering its promising structure, documentation of the WBOT contribution to healthcare overall, and the HIV programme in particular, is urgently warranted to successfully and sustainably incorporate it into the South African healthcare system.
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Affiliation(s)
- Nireshni Naidoo
- Anova Health Institute, Johannesburg & Tzaneen, South Africa.,School of Public Health, University of the Witwatersrand, South Africa
| | - Jean Railton
- Anova Health Institute, Johannesburg & Tzaneen, South Africa
| | - Geoffrey Jobson
- Anova Health Institute, Johannesburg & Tzaneen, South Africa
| | | | - Gert Marincowitz
- Mopani DCST, Department of Health, Limpopo Province, South Africa
| | - James A McIntyre
- Anova Health Institute, Johannesburg & Tzaneen, South Africa.,School of Public Health & Family Medicine, University of Cape Town, South Africa
| | - Helen E Struthers
- Anova Health Institute, Johannesburg & Tzaneen, South Africa.,Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, South Africa
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Abstract
Supplemental Digital Content is available in the text Objectives: We aim to characterize the future noncommunicable disease (NCD) burden in Zimbabwe to identify future health system priorities. Methods: We developed an individual-based multidisease model for Zimbabwe, simulating births, deaths, infection with HIV and progression and key NCD [asthma, chronic kidney disease (CKD), depression, diabetes, hypertension, stroke, breast, cervical, colorectal, liver, oesophageal, prostate and all other cancers]. The model was parameterized using national and regional surveillance and epidemiological data. Demographic and NCD burden projections were generated for 2015 to 2035. Results: The model predicts that mean age of PLHIV will increase from 31 to 45 years between 2015 and 2035 (compared with 20–26 in uninfected individuals). Consequently, the proportion suffering from at least one key NCD in 2035 will increase by 26% in PLHIV and 6% in uninfected. Adult PLHIV will be twice as likely to suffer from at least one key NCD in 2035 compared with uninfected adults; with 15.2% of all key NCDs diagnosed in adult PLHIV, whereas contributing only 5% of the Zimbabwean population. The most prevalent NCDs will be hypertension, CKD, depression and cancers. This demographic and disease shift in PLHIV is mainly because of reductions in incidence and the success of ART scale-up leading to longer life expectancy, and to a lesser extent, the cumulative exposure to HIV and ART. Conclusion: NCD services will need to be expanded in Zimbabwe. They will need to be integrated into HIV care programmes, although the growing NCD burden amongst uninfected individuals presenting opportunities for additional services developed within HIV care to benefit HIV-negative persons.
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Mutiso VN, Musyimi CW, Nayak SS, Musau AM, Rebello T, Nandoya E, Tele AK, Pike K, Ndetei DM. Stigma-related mental health knowledge and attitudes among primary health workers and community health volunteers in rural Kenya. Int J Soc Psychiatry 2017; 63:508-517. [PMID: 28679343 DOI: 10.1177/0020764017716953] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The study was conducted in rural Kenya and assessed stigma in health workers from primary health facilities. AIMS This study compared variations in stigma-related mental health knowledge and attitudes between primary health workers (HWs) and community health volunteers (CHVs). METHODS Participants ( n = 44 HWs and n = 60 CHVs) completed the self-report Mental Health Knowledge Schedule and the Reported and Intended Behavior Scale, along with sociodemographic questions. Multiple regression models were used to assess predictors of mental health knowledge and stigmatizing behaviors. RESULTS HWs had significantly higher mean mental health knowledge scores than CHVs, p < .001, and significantly higher mean positive attitudes scores than CHVs, p = .042. When controlling for relevant covariates, higher positive attitudes was the only significant predictor of higher mental health knowledge, and self-rating of sense of belonging to the community and mental health knowledge remained the main predictors of positive attitudes. CONCLUSION Results suggest that stigma-related mental health knowledge and attitudes are associated, and interventions should target these areas with health workers. There is scope for intervention to increase knowledge and positive attitudes for individuals who feel a strong sense of community belonging. Future studies should test feasible ways to reduce stigma in this population.
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Affiliation(s)
| | - Christine W Musyimi
- 1 Africa Mental Health Foundation, Nairobi, Kenya.,2 Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sameera S Nayak
- 3 Columbia University Global Mental Health Program, New York, NY, USA
| | | | - Tahilia Rebello
- 3 Columbia University Global Mental Health Program, New York, NY, USA
| | | | | | - Kathleen Pike
- 3 Columbia University Global Mental Health Program, New York, NY, USA
| | - David M Ndetei
- 1 Africa Mental Health Foundation, Nairobi, Kenya.,4 University of Nairobi, Nairobi, Kenya
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