1
|
Adsul N, Tyagi J, Bhaumik S. Community health workers for health systems resilience during COVID-19: protocol for qualitative evidence synthesis. BMJ Open 2024; 14:e074920. [PMID: 38531568 PMCID: PMC10973548 DOI: 10.1136/bmjopen-2023-074920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 10/16/2023] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION COVID-19 exposed the fragility of health systems, where even the most basic health services in high-income and low-income and middle-income nations could not withstand the health systems shock due to the pandemic. Community health workers (CHWs) can contribute to improving the resilience of health systems, specifically to withstand shocks and emergencies and to avoid disruptions of routine service delivery. We aim to explore and understand the 'individual' and 'systems-level' resilience factors that shaped the involvement of CHWs in the COVID-19 response. METHODS AND ANALYSIS We will search five electronic databases (PubMed, Cochrane Library, EMBASE, CINAHL and SciELO (Spanish)) and conduct citation screening to identify studies on CHWs' response during the COVID-19 pandemic. Two review authors will independently screen the studies for inclusion and to extract data. The software Rayyan will be used to assist in screening the relevant literature. A thematic analysis approach will be followed to analyse and synthesise the qualitative evidence. The quality of the included studies will be critically assessed using the Critical Skills Appraisal Programme Tool. We will use the GRADE CERQual(Grading of Recommendations, Assessment, Development, and Evaluations - Confidence in the Evidence from Reviews of Qualitative Research) approach to assess certainty in the synthesised findings of the qualitative evidence. ETHICS AND DISSEMINATION This study will be conducted on published evidence, with no living participants; thus, no ethical approval is required. The final review will be submitted and published in a peer-reviewed journal. We will also develop a policy brief to communicate the review findings to the stakeholders.
Collapse
Affiliation(s)
- Neha Adsul
- Meta-research and Evidence Synthesis Unit, The George Institute for Global Health India, New Delhi, India
| | - Jyoti Tyagi
- Meta-research and Evidence Synthesis Unit, The George Institute for Global Health India, New Delhi, India
| | - Soumyadeep Bhaumik
- Meta-research and Evidence Synthesis Unit, The George Institute for Global Health India, New Delhi, India
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Kallon LH, Raven J, Wurie HR, Mansour W. From policy to practice: a qualitive study exploring the role of community health workers during the COVID-19 response in Sierra Leone. BMC Health Serv Res 2023; 23:1228. [PMID: 37946253 PMCID: PMC10634028 DOI: 10.1186/s12913-023-10272-6] [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: 06/06/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, community health workers (CHWs) were required to help their communities respond to the outbreak in Sierra Leone. The Government of Sierra Leone released a policy that provided an interim guidance on the specific role of CHWs during the pandemic including support required to maintain continuity of routine and essential services during the COVID-19 response. This study explores how CHWs adapted their roles during the COVID-19 pandemic in Sierra Leone and the support they received from families, communities, and the health system. METHODS A qualitative exploratory study was conducted in two districts in Sierra Leone. We conducted eight key informant interviews with district and community level managers and leaders and four focus group discussions with CHWs. Thematic data analysis and synthesis were guided by the interim guidance released by the Government of Sierra Leone at the onset of the COVID-19 pandemic and supported by NVivo 11. RESULTS CHWs quickly took on COVID-19 frontline roles which included surveillance, contact tracing, social mobilization, and provision of psychosocial support. CHWs were trusted with these responsibilities as they were recognized as being knowledgeable about the community, were able to communicate effectively with community members and had experience of dealing with other outbreaks. Despite the release of the interim guidance aimed to optimize CHW contribution, motivate CHWs, ensure continuity of core and essential community-based services alongside COVID-19 services, CHWs faced many challenges in their work during the pandemic including heavy workload, low financial remuneration, lack of mental health support, and shortages of protective equipment, communication and transportation allowances. However, they were generally satisfied with the quality of the training and supervision they received. Support from families and communities was mixed, with some CHWs experiencing stigma and discrimination. CONCLUSION During the COVID-19 pandemic, CHWs played a critical role in Sierra Leone. Although, a policy was released by the government to guide their role during the crisis, it was not fully implemented. This resulted in CHWs being overworked and under supported. It is important that CHWs are provided with the necessary training, tools and support to take on their vital roles in managing health crises at the community level. Strengthening the capacity of CHWs will not only enhance pandemic response, but also lay the foundation for improved primary health care delivery and community resilience in the face of future health emergencies.
Collapse
Affiliation(s)
- Lansana Hassim Kallon
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joanna Raven
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Haja Ramatulai Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Wesam Mansour
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| |
Collapse
|
3
|
Makate M, Makate C. Leaving No Women Behind: Evaluating the Impact of the COVID-19 Pandemic on Livelihood Outcomes in Kenya and Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5048. [PMID: 36981957 PMCID: PMC10049247 DOI: 10.3390/ijerph20065048] [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: 02/17/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
The SARS-CoV-2 pandemic has revolutionised our lives, bringing with it the twin crises of illness and the need for an optimal mix of policies to alleviate its impact on the population. There needs to be more evidence on the effects of the pandemic on livelihood outcomes, including an understanding of whether female-headed families in low-income countries fare worse than their male-headed counterparts during pandemics. Using high-frequency phone surveys conducted in Ethiopia and Kenya, we examine the aggregate impact of the pandemic on income and consumption losses, as well as food insecurity. The empirical analysis estimates linear probability models that relate livelihood outcomes with household headship and other socioeconomic characteristics as controls. Overall, the pandemic increased the likelihood of food insecurity while decreasing income and consumption, particularly among female-headed households. In Kenya, living in a female-headed home increased the possibility of an adult going without food by about 10%, an adult skipping a meal by about 9.9%, and a child missing a meal by about 17% in the seven days preceding the telephone survey. In Ethiopia, living in a female-headed household increased the likelihood of an adult going hungry, skipping a meal, and running out of food by about 24.35%, 18.9%, and 26.7%, respectively. Salient pre-existing socioeconomic inequalities further exacerbated the effects of the pandemic on livelihoods. The findings have important implications for public policy and preparations by governments and other organisations interested in developing suitable gender-sensitive measures to lessen the impact of future pandemics in low- and middle-income countries.
Collapse
Affiliation(s)
- Marshall Makate
- Curtin School of Population Health, Curtin University, Kent Street, Perth 6102, Australia
| | - Clifton Makate
- School of Economics and Business, Norwegian University of Life Sciences, P.O. Box 5003, 1432 Ås, Norway
| |
Collapse
|
4
|
Health system response to COVID-19 among primary health care units in Ethiopia: A qualitative study. PLoS One 2023; 18:e0281628. [PMID: 36763695 PMCID: PMC9916627 DOI: 10.1371/journal.pone.0281628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 01/28/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION There was limited data on the experiences and roles of sub-national health systems in the response against COVID-19 in Ethiopia. This study explored how sub-national primary health care units and coordinating bodies in Ethiopia responded to COVID-19 during the first 6 months of pandemic. METHODS We conducted a qualitative study with descriptive phenomenological design using 59 key informants that were purposively selected. The interviews included leaders across Ethiopia's 10 regions and 2 administrative cities. Data were collected using a semi-structured interview guide that was translated into a local language. The interviews were conducted in person or by phone. Coding and categorizing led to the development of themes and subthemes. Data were analyzed using thematic analysis. RESULTS Local administrators across different levels took the lead in responding to COVID-19 by organizing multisectoral planning and monitoring committees at regional, zonal and woreda (district) levels. Health leaders reacted to the demand for an expanded workforce by reassigning health professionals to COVID-19 surveillance and case management activities, adding COVID-19-related responsibilities to their workloads, temporarily blocking leave, and hiring new staff on contractual basis. Training was prioritized for: rapid response teams, laboratory technicians, healthcare providers assigned to treatment centers where care was provided for patients with COVID-19, and health extension workers. COVID-19 supplies and equipment, particularly personal protective equipment, were difficult to obtain at the beginning of the pandemic. Health officials used a variety of means to equip and protect staff, but the quantity fell short of their needs. Local health structures used broadcast media, print materials, and house-to-house education to raise community awareness about COVID-19. Rapid response teams took the lead in case investigation, contact tracing, and sample collection. The care for mild cases was shifted to home-based isolation as the number of infections increased and space became limited. However, essential health services were neglected at the beginning of the pandemic while the intensity of local multisectoral response (sectoral engagement) declined as the pandemic progressed. CONCLUSIONS Local government authorities and health systems across Ethiopia waged an early response to the pandemic, drawing on multisectoral support and directing human, material, and financial resources toward the effort. But, the intensity of the multisectoral response waned and essential services began suffering as the pandemic progressed. There is a need to learn from the pandemic and invest in the basics of the health system-health workers, supplies, equipment, and infrastructure-as well as coordination of interventions.
Collapse
|
5
|
Haldane V, Dodd W, Kipp A, Ferrolino H, Wilson K, Servano D, Lau LL, Wei X. Extending health systems resilience into communities: a qualitative study with community-based actors providing health services during the COVID-19 pandemic in the Philippines. BMC Health Serv Res 2022; 22:1385. [PMID: 36411439 PMCID: PMC9677893 DOI: 10.1186/s12913-022-08734-4] [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: 03/25/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Amidst ongoing calls for increased health systems resilience, gaps remain in our understanding of how health systems can reach further into communities to ensure resilient service delivery. Indeed, public health emergencies caused by infectious hazards reveal both the value and vulnerability of the workforce delivering health services in communities. This study explores ways in which a non-governmental organization (NGO) in the Philippines protected their frontline workforce during the first year of the COVID-19 pandemic. METHODS Guided by a qualitative descriptive approach, 34 in-depth interviews were conducted with community-based health actors employed by the NGO between June 2020 and February 2021. Data analysis was guided by an iterative deductive and inductive approach. RESULTS We identified four key activities that enabled the NGO and their staff to provide health and social services in communities in a safe and consistent manner as part of the organization's pandemic response. These include (1) ensuring adequate personal protective equipment (PPE) and hygiene supplies; (2) providing contextualized and role-specific infection prevention and control (IPC) training; (3) ensuring access to testing for all staff; and (4) providing support during quarantine or isolation. CONCLUSION Learning from the implementation of these activities offers a way forward toward health emergency preparedness and response that is crucially needed for NGOs to safely leverage their workforce during pandemics. Further, we describe how community-based health actors employed by NGOs can contribute to broader health systems resilience in the context of health emergency preparedness and response.
Collapse
Affiliation(s)
- Victoria Haldane
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College St, M5T 3M7 Toronto, ON Canada
| | - Warren Dodd
- grid.46078.3d0000 0000 8644 1405School of Public Health Sciences, University of Waterloo, 200 University Ave West, N2L 3G1 Waterloo, ON Canada
| | - Amy Kipp
- grid.46078.3d0000 0000 8644 1405School of Public Health Sciences, University of Waterloo, 200 University Ave West, N2L 3G1 Waterloo, ON Canada
| | - Hannah Ferrolino
- International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Centre, Exchange Road, Metro Manila, 1605 Pasig City, Philippines
| | - Kendall Wilson
- International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Centre, Exchange Road, Metro Manila, 1605 Pasig City, Philippines
| | - Danilo Servano
- grid.46078.3d0000 0000 8644 1405School of Public Health Sciences, University of Waterloo, 200 University Ave West, N2L 3G1 Waterloo, ON Canada
| | - Lincoln L. Lau
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College St, M5T 3M7 Toronto, ON Canada ,grid.46078.3d0000 0000 8644 1405School of Public Health Sciences, University of Waterloo, 200 University Ave West, N2L 3G1 Waterloo, ON Canada ,International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Centre, Exchange Road, Metro Manila, 1605 Pasig City, Philippines
| | - Xiaolin Wei
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College St, M5T 3M7 Toronto, ON Canada
| |
Collapse
|
6
|
Mishra BK, Kanungo S, Patel K, Swain S, Dwivedy S, Panda S, Karna S, Bhuyan D, Som M, Merta BR, Bhattacharya D, Kshatri JS, Palo SK, Pati S. Resolution of Resilience: Empirical Findings on the Challenges Faced and the Mitigation Strategies Adopted by Community Health Workers (CHWs) to Provide Maternal and Child Health (MCH) Services during the COVID-19 Pandemic in the Context of Odisha, India. Healthcare (Basel) 2022; 10:healthcare10010088. [PMID: 35052251 PMCID: PMC8775981 DOI: 10.3390/healthcare10010088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/14/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Community health workers (CHW) faced increased challenges in delivering maternal and child health services during the current COVID-19 pandemic. In addition to routine services, they were also engaged in pandemic management. In view of a dearth of evidence, the current study explores the challenges faced by CHWs while rendering maternal and child health services. A qualitative study through in-depth interviews (IDI) and focus group discussions (FGD) in six districts of Odisha was conducted from February to April 2021. Data were analyzed using MAXQDA software. Personal-level challenges, like lack of family support, stress, and fear of contracting COVID-19; facility-level challenges, like transportation problems and inadequate personal protective measures; and community-level challenges, like stigma, resistance, and lack of community support were major hindrances in provisioning routine MCH services. Prevailing myths and misconceptions concerning COVID-19 were factors behind stigma and resistance. Sharing experiences with family, practicing yoga and pranayam, engaging ambulance bikes, financial assistance to mothers, counseling people, and involving community leaders were some effective strategies to address these challenges. Development and implementation of appropriate strategy guidelines for addressing the challenges of frontline warriors will improve their work performance and achieve uninterrupted MCH services during pandemics or similar health emergencies.
Collapse
Affiliation(s)
- Bijaya Kumar Mishra
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (B.K.M.); (S.K.); (K.P.); (S.S.); (S.D.); (S.P.); (S.K.); (D.B.); (D.B.); (J.S.K.)
| | - Srikanta Kanungo
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (B.K.M.); (S.K.); (K.P.); (S.S.); (S.D.); (S.P.); (S.K.); (D.B.); (D.B.); (J.S.K.)
| | - Kripalini Patel
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (B.K.M.); (S.K.); (K.P.); (S.S.); (S.D.); (S.P.); (S.K.); (D.B.); (D.B.); (J.S.K.)
| | - Swagatika Swain
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (B.K.M.); (S.K.); (K.P.); (S.S.); (S.D.); (S.P.); (S.K.); (D.B.); (D.B.); (J.S.K.)
| | - Subhralaxmi Dwivedy
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (B.K.M.); (S.K.); (K.P.); (S.S.); (S.D.); (S.P.); (S.K.); (D.B.); (D.B.); (J.S.K.)
| | - Subhashree Panda
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (B.K.M.); (S.K.); (K.P.); (S.S.); (S.D.); (S.P.); (S.K.); (D.B.); (D.B.); (J.S.K.)
| | - Sonam Karna
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (B.K.M.); (S.K.); (K.P.); (S.S.); (S.D.); (S.P.); (S.K.); (D.B.); (D.B.); (J.S.K.)
| | - Dinesh Bhuyan
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (B.K.M.); (S.K.); (K.P.); (S.S.); (S.D.); (S.P.); (S.K.); (D.B.); (D.B.); (J.S.K.)
| | - Meena Som
- United Nation Children’s Fund, Surya Nagar, Bhubaneswar 751003, India; (M.S.); (B.R.M.)
| | - Brajesh Raj Merta
- United Nation Children’s Fund, Surya Nagar, Bhubaneswar 751003, India; (M.S.); (B.R.M.)
| | - Debdutta Bhattacharya
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (B.K.M.); (S.K.); (K.P.); (S.S.); (S.D.); (S.P.); (S.K.); (D.B.); (D.B.); (J.S.K.)
| | - Jaya Singh Kshatri
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (B.K.M.); (S.K.); (K.P.); (S.S.); (S.D.); (S.P.); (S.K.); (D.B.); (D.B.); (J.S.K.)
| | - Subrata Kumar Palo
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (B.K.M.); (S.K.); (K.P.); (S.S.); (S.D.); (S.P.); (S.K.); (D.B.); (D.B.); (J.S.K.)
- Correspondence: (S.K.P.); (S.P.)
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (B.K.M.); (S.K.); (K.P.); (S.S.); (S.D.); (S.P.); (S.K.); (D.B.); (D.B.); (J.S.K.)
- Correspondence: (S.K.P.); (S.P.)
| |
Collapse
|
7
|
Méllo LMBDDE, Santos RCD, Albuquerque PCD. Agentes Comunitárias de Saúde na pandemia de Covid-19: scoping review. SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-11042022e125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Este artigo teve por objetivo sistematizar e analisar a literatura que aborda o trabalho das Agentes Comunitárias de Saúde (ACS) no enfrentamento da pandemia de Covid-19. Trata-se de uma revisão de escopo, realizada na Embase, Lilacs, SciELO, Medline e Cochrane Library. Envolve publicações no período de janeiro a dezembro de 2020, tendo os estudos selecionados sido submetidos à análise, considerando as seguintes categorias: práticas, formação, condições de trabalho e legitimidade. Foram incluídos 29 estudos na revisão cujo cenário de atuação das ACS foram países da África, América do Sul, América do Norte, Ásia e Europa. Os resultados revelaram enfoques diversificados de práticas nos países estudados que envolvem ações de cuidado, vigilância, comunicação e educação em saúde, práticas administrativas, articulação intersetorial e mobilização social. A formação recebida parece não corresponder ao rol de práticas e impacto esperado do trabalho das ACS. As condições de trabalho continuam precarizadas com alguns incentivos extras sendo ofertados em diferentes cenários. O reconhecimento e a legitimidade perante as autoridades sanitárias revelam a disputa em torno do próprio rumo dos modelos de atenção à saúde e abrangência dos sistemas de proteção social nos diversos países.
Collapse
|
8
|
Méllo LMBDDE, Santos RCD, Albuquerque PCD. Community Health Workers in the Covid-19 pandemic: scoping review. SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-11042022e125i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT This paper aimed to systematize and analyze the literature that addresses the role of Community Health Workers (CHWs) in addressing the Covid-19 pandemic. This scoping review was conducted in the Embase, Lilacs, SciELO, Medline, and Cochrane Virtual Libraries databases. It includes publications from January to December 2020, and the selected studies were submitted to analysis, considering the following categories: practices, training, working conditions, and legitimacy. Twenty-nine studies were included in the review whose CHW performance backdrops were African, South American, North American, Asian, and European countries. The results revealed diversified approaches to practice in the countries studied that involve care, surveillance, health communication, education, administrative, intersectoral articula- tion, and social mobilization actions. The training received does not seem to correspond to the list of practices and expected impact of the CHWs. Working conditions remain substandard, with some extra incentives offered in different backdrops. The recognition and legitimacy before the health authorities reveal the dispute over the direction of health care models and the scope of social protection systems in different countries.
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Masis L, Gichaga A, Zerayacob T, Lu C, Perry HB. Community health workers at the dawn of a new era: 4. Programme financing. Health Res Policy Syst 2021; 19:107. [PMID: 34641893 PMCID: PMC8506106 DOI: 10.1186/s12961-021-00751-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This is the fourth of our 11-paper supplement on "Community Health Workers at the Dawn of New Era". Here, we first make the case for investing in health programmes, second for investing in human resources for health, third for investing in primary healthcare (PHC) workers, and finally for investing in community health workers (CHWs). METHODS Searches of peer-reviewed journals and the grey literature were conducted with a focus on community health programme financing. The literature search was supplemented with a search of the grey literature for information about national health sector plans, community health strategies/policies, and costing information from databases of various countries' ministries of health, and finally a request for information from in-country partners. RESULTS The global shortage of human resources for health is projected to rise to 18 million health workers by 2030, with more acute shortages in Africa and South Asia. CHWs have an important role to play in mitigating this shortage because of their effectiveness (when properly trained and supported) and the feasibility of their deployment. Data are limited on the costs of current CHW programmes and how they compare to government and donor expenditures for PHC and for health services more broadly. However, available data from 10 countries in Africa indicate that the median per capita cost of CHW programmes is US$ 4.77 per year and US$ 2574 per CHW, and the median monthly salary of CHWs in these same countries is US$ 35 per month. For a subset of these countries for which spending for PHC is available, governments and donors spend 7.7 times more on PHC than on CHW programming, and 15.4 times more on all health expenditures. Even though donor funding for CHW programmes is a tiny portion of health-related donor support, most countries rely on donor support for financing their CHW programmes. CONCLUSION The financing of national CHW programmes has been a critical element that has not received sufficient emphasis in the academic literature on CHW programmes. Increasing domestic government funding for CHW programmes is a priority. In order to ensure growth in funding for CHW programmes, it will be important to measure CHW programme expenditures and their relationship to expenditures for PHC and for all health-related expenditures.
Collapse
Affiliation(s)
- Lizah Masis
- Financing Alliance for Health, Nairobi, Kenya
| | | | | | - Chunling Lu
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Henry B Perry
- Department of International Health, Health Systems Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| |
Collapse
|
11
|
Brown Wilson J, Deckert A, Shah R, Kyei N, Copeland Dahn L, Doe-Rogers R, Hinneh AB, Johnson LW, Natt GD, Verdier JA, Vosper A, Louis VR, Dambach P, Thomas-Connor I. COVID-19-related knowledge, attitudes and practices: a mixed-mode cross-sectional survey in Liberia. BMJ Open 2021; 11:e049494. [PMID: 34315797 PMCID: PMC8318717 DOI: 10.1136/bmjopen-2021-049494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To examine the knowledge, attitudes and practices (KAP) of COVID-19 of rural and urban residents in Liberia to inform the development of local social and behaviour change communication strategies. DESIGN Cross-sectional, mixed-mode (online and telephone) survey using non-probability sampling. SETTING All 15 counties in Liberia with a focus on Maryland County. PARTICIPANTS From 28 May to 28 June 2020, data were collected from a total of 431 adults aged 18 years and older (telephone 288 (66.8%); online 143 (33.2%)) out of a total of 741 contacts. MAIN OUTCOME MEASURES KAP scores. Frequencies and proportions were calculated, followed by univariate and multivariable analyses to examine the association between KAP scores and the sociodemographic variables. RESULTS Around 69% of the online survey respondents were younger than 35 years of age, compared with 56% in the telephone interviews. The majority (87%) of online respondents had completed tertiary education, compared with 77% of the telephone respondents. Male participants, on average, achieved higher knowledge (52%) and attitude scores (72%), in contrast to females (49% and 67%, respectively). Radio (71%) was the most cited source for COVID-19 information, followed by social media (63%). After controlling for sociodemographic variables, adaptive regression modelling revealed that survey mode achieved 100% importance for predicting knowledge and practice levels with regard to COVID-19. CONCLUSIONS The survey population demonstrated moderate COVID-19 knowledge, with significant differences between survey mode and educational level. Correct knowledge of COVID-19 was associated with appropriate practices in Maryland County. Generalisation of survey findings must be drawn carefully owing to the limitations of the sampling methods. Yet, given the differences in knowledge gaps between survey modes, sex, education, occupation and place of residence, it is recommended that information is tailored to different audiences.
Collapse
Affiliation(s)
| | - Andreas Deckert
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Rupal Shah
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Nicholas Kyei
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | | | | | | | | | - Gudgy Dweh Natt
- Public Health, William VS Tubman University, Harper, Liberia
| | | | | | - Valérie R Louis
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Peter Dambach
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | | |
Collapse
|
12
|
Gebremeskel AT, Otu A, Abimbola S, Yaya S. Building resilient health systems in Africa beyond the COVID-19 pandemic response. BMJ Glob Health 2021; 6:bmjgh-2021-006108. [PMID: 34183330 PMCID: PMC8245280 DOI: 10.1136/bmjgh-2021-006108] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/02/2021] [Indexed: 12/19/2022] Open
Affiliation(s)
- Akalewold T Gebremeskel
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Akaninyene Otu
- Department of Infection and Travel Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada .,The George Institute for Global Health, Imperial College London, London, UK
| |
Collapse
|
13
|
Chen N, Raghavan M, Albert J, McDaniel A, Otiso L, Kintu R, West M, Jacobstein D. The Community Health Systems Reform Cycle: Strengthening the Integration of Community Health Worker Programs Through an Institutional Reform Perspective. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:S32-S46. [PMID: 33727319 PMCID: PMC7971380 DOI: 10.9745/ghsp-d-20-00429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/07/2021] [Indexed: 11/15/2022]
Abstract
To develop guidance for governments and partners seeking to scale community health worker programs, we developed a conceptual framework, collected observations from the scale-up efforts of 7 countries, workshopped the framework with technical groups and with country stakeholders, and reviewed literature in the areas of health and policy reform, change management, institutional development, health systems, and advocacy. We observed that successful scale-up is a complex process of institutional reform. Successful scale-up: (1) depends on a carefully choreographed, problem-driven political process; (2) requires that scaled program models are drawn from solutions that are available in a given health system context and aligned with the resources, capabilities, and commitments of key health sector stakeholders; and (3) emerges from iterative cycles of learning and improvement, rather than a single, linear scale-up effort. We identify stages of the reform process associated with each of these 3 findings: problem prioritization, coalition building, solution gathering, design, program readiness, launch, governance, and management and learning. The resulting Community Health Systems Reform Cycle can be used by government, donors, and nongovernmental partners to prioritize and design community health worker scale-up efforts, diagnose challenges or gaps in successful scale-up and integration, and coordinate the contributions of diverse stakeholders.
Collapse
Affiliation(s)
- Nan Chen
- Last Mile Health, Washington, DC, USA.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Amadu I, Ahinkorah BO, Afitiri AR, Seidu AA, Ameyaw EK, Hagan JE, Duku E, Aram SA. Assessing sub-regional-specific strengths of healthcare systems associated with COVID-19 prevalence, deaths and recoveries in Africa. PLoS One 2021; 16:e0247274. [PMID: 33647032 PMCID: PMC7920381 DOI: 10.1371/journal.pone.0247274] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/04/2021] [Indexed: 01/15/2023] Open
Abstract
Introduction The coronavirus 2019 (COVID-19) has overwhelmed the health systems of several countries, particularly those within the African region. Notwithstanding, the relationship between health systems and the magnitude of COVID-19 in African countries have not received research attention. In this study, we investigated the relationship between the pervasiveness of the pandemic across African countries and their Global Health Security Index (GHSI) scores. Materials and methods The study included 54 countries in five regions viz Western (16); Eastern (18); Middle (8); Northern (7); and Southern (5) Africa. The outcome variables in this study were the total confirmed COVID-19 cases (per million); total recoveries (per million); and the total deaths (per million). The data were subjected to Spearman’s rank-order (Spearman’s rho) correlation to determine the monotonic relationship between each of the predictor variables and the outcome variables. The predictor variables that showed a monotonic relationship with the outcome were used to predict respective outcome variables using multiple regressions. The statistical analysis was conducted at a significance level of 0.05. Results Our results indicate that total number of COVID-19 cases (per million) has strong correlations (rs >0.5) with the median age; aged 65 older; aged 70 older; GDP per capita; number of hospital beds per thousand; Human Development Index (HDI); recoveries (per million); and the overall risk environment of a country. All these factors including the country’s commitments to improving national capacity were related to the total number of deaths (per million). Also, strong correlations existed between the total recoveries (per million) and the total number of positive cases; total deaths (per million); median age; aged 70 older; GDP per capita; the number of hospital beds (per thousand); and HDI. The fitted regression models showed strong predictive powers (R-squared>99%) of the variances in the total number of COVID-19 cases (per million); total number of deaths (per million); and the total recoveries (per million). Conclusions The findings from this study suggest that patient-level characteristics such as ageing population (i.e., 65+), poverty, underlying co-morbidities–cardiovascular disease (e.g., hypertension), and diabetes through unhealthy behaviours like smoking as well as hospital care (i.e., beds per thousand) can help explain COVID-19 confirmed cases and mortality rates in Africa. Aside from these, other determinants (e.g., population density, the ability of detection, prevention and control) also affect COVID-19 prevalence, deaths and recoveries within African countries and sub-regions.
Collapse
Affiliation(s)
- Iddrisu Amadu
- Africa Centre of Excellence in Coastal Resilience, University of Cape Coast, Cape Coast, Ghana
- Department of Fisheries and Aquatic Sciences, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Abdul-Rahaman Afitiri
- Department of Environmental Science, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Eric Duku
- Africa Centre of Excellence in Coastal Resilience, University of Cape Coast, Cape Coast, Ghana
- Department of Fisheries and Aquatic Sciences, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Simon Appah Aram
- College of Safety and Emergency Management Engineering, Taiyuan University of Technology, Taiyuan, Peoples Republic of China
| |
Collapse
|
15
|
Alhassan RK, Nutor JJ, Abuosi AA, Afaya A, Mohammed SS, Dalaba MA, Immurana M, Manyeh AK, Klu D, Aberese-Ako M, Doegah PT, Acquah E, Nketiah-Amponsah E, Tampouri J, Akoriyea SK, Amuna P, Ansah EK, Gyapong M, Owusu-Agyei S, Gyapong JO. Urban health nexus with coronavirus disease 2019 (COVID-19) preparedness and response in Africa: Rapid scoping review of the early evidence. SAGE Open Med 2021; 9:2050312121994360. [PMID: 33633859 PMCID: PMC7887690 DOI: 10.1177/2050312121994360] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/20/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus 2 also called coronavirus disease 2019 was first reported in the African continent on 14 February 2020 in Egypt. As at 18 December 2020, the continent reported 2,449,754 confirmed cases, 57,817 deaths and 2,073,214 recoveries. Urban cities in Africa have particularly suffered the brunt of coronavirus disease 2019 coupled with criticisms that the response strategies have largely been a 'one-size-fits-all' approach. This article reviewed early evidence on urban health nexus with coronavirus disease 2019 preparedness and response in Africa. METHODS A rapid scoping review of empirical and grey literature was done using data sources such as ScienceDirect, GoogleScholar, PubMed, HINARI and official websites of World Health Organization and Africa Centres for Disease Control and Prevention. A total of 26 full articles (empirical studies, reviews and commentaries) were synthesised and analysed qualitatively based on predefined inclusion criteria on publication relevance and quality. RESULTS Over 70% of the 26 articles reported on coronavirus disease 2019 response strategies across Africa; 27% of the articles reported on preparedness towards coronavirus disease 2019, while 38% reported on urbanisation nexus with coronavirus disease 2019; 40% of the publications were full-text empirical studies, while the remaining 60% were either commentaries, reviews or editorials. It was found that urban cities remain epicentres of coronavirus disease 2019 in Africa. Even though some successes have been recorded in Africa regarding coronavirus disease 2019 fight, the continent's response strategies were largely found to be a 'one-size-fits-all' approach. Consequently, adoption of 'Western elitist' mitigating measures for coronavirus disease 2019 containment resulted in excesses and spillover effects on individuals, families and economies in Africa. CONCLUSION Africa needs to increase commitment to health systems strengthening through context-specific interventions and prioritisation of pandemic preparedness over response. Likewise, improved economic resilience and proper urban planning will help African countries to respond better to future public health emergencies, as coronavirus disease 2019 cases continue to surge on the continent.
Collapse
Affiliation(s)
- Robert Kaba Alhassan
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Jerry John Nutor
- School of Nursing, University of California, San Francisco, CA, USA
| | - Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
| | - Agani Afaya
- School of Nursing, University of Health and Allied Sciences, Ho, Ghana
| | | | - Maxwel Ayindenaba Dalaba
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Mustapha Immurana
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Alfred Kwesi Manyeh
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Desmond Klu
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Matilda Aberese-Ako
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Phidelia Theresa Doegah
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Evelyn Acquah
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | | | - John Tampouri
- Ho Teaching Hospital (HTH), Ho, Ministry of Health, Ghana
| | | | - Paul Amuna
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Evelyn Kokor Ansah
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Margaret Gyapong
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Seth Owusu-Agyei
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - John Owusu Gyapong
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| |
Collapse
|
16
|
Abstract
Lauren Paremoer and colleagues call for action to create a fairer and more sustainable post-covid world
Collapse
Affiliation(s)
- Lauren Paremoer
- Political Studies, University of Cape Town, Cape Town, South Africa
| | - Sulakshana Nandi
- People's Health Movement, Delhi, India
- Public Health Resource Network Chhattisgarh, Raipur, India
| | - Hani Serag
- Center for Global and Community Health, University of Texas Medical Branch at Galveston
| | - Fran Baum
- People's Health Movement, Delhi, India
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| |
Collapse
|
17
|
Chattu VK, Pooransingh S. Strengthening African health systems through global health diplomacy. Health Promot Perspect 2020; 10:292. [PMID: 33312922 PMCID: PMC7723004 DOI: 10.34172/hpp.2020.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/10/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Vijay Kumar Chattu
- Division of Occupational Medicine, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada.,Institute of International Relations, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Shalini Pooransingh
- Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| |
Collapse
|