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Ghafoori B, Triliva S, Chrysikopoulou P, Vavvos A. Psychological adaptation among health care workers who work with trauma-exposed refugees in Greece. J Trauma Stress 2024; 37:483-491. [PMID: 38374536 DOI: 10.1002/jts.23022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 02/21/2024]
Abstract
Greek health care workers (HCWs) working with refugee and asylum-seeker populations may be at risk of trauma exposure and related distress. The current study sought to further understand the factors that may promote or hinder psychological adaptation among HCWs working with trauma-exposed refugee populations in Greece. Participants were HCWs (N = 20) who completed semistructured interviews. Thematic analysis procedures identified three main themes: vicarious traumatization, (b) mismatch of expectations, and (c) difficulty coping. Our study findings highlight the need to provide adequate training, supervision, and mental health support for HCWs to prevent mental health issues in this population. Additional studies are necessary to understand the long-term consequences of working with refugee populations and explore ways to assist HCWs with self-care.
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Affiliation(s)
- Bita Ghafoori
- Department of Advanced Studies in Education and Counseling, California State University Long Beach, Long Beach, California, USA
| | - Sofia Triliva
- Department of Psychology, University of Crete, Rethimno, Greece
| | | | - Andreas Vavvos
- Department of Psychology, University of Crete, Rethimno, Greece
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Closser S, Sultan M, Tikkanen R, Singh S, Majidulla A, Maes K, Gerber S, Rosenthal A, Palazuelos D, Tesfaye Y, Finley E, Abesha R, Keeling A, Justice J. Breaking the silence on gendered harassment and assault of community health workers: an analysis of ethnographic studies. BMJ Glob Health 2023; 8:bmjgh-2023-011749. [PMID: 37208121 DOI: 10.1136/bmjgh-2023-011749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/21/2023] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION Across a variety of settings, women in tenuous financial circumstances are drawn to community health work as a way to advance themselves in the context of limited employment options. Female Community Health Workers (CHWs) are often preferred because they can more easily access mothers and children; at the same time, gender norms are at the heart of many of the challenges and inequities that these workers encounter. Here, we explore how these gender roles and a lack of formal worker protections leave CHWs vulnerable to violence and sexual harassment, common occurrences that are frequently downplayed or silenced. METHODS We are a group of researchers who work on CHW programmes in a variety of contexts globally. The examples here are drawn from our ethnographic research (participant observation and in-depth interviews). RESULTS CHW work creates job opportunities for women in contexts where such opportunities are extremely rare. These jobs can be a lifeline for women with few other options. Yet the threat of violence can be very real: women may face violence from the community, and some experience harassment from supervisors within health programmes. CONCLUSION Taking gendered harassment and violence seriously in CHW programmes is critical for research and practice. Fulfilling CHWs' vision of health programmes that value them, support them and give them opportunities may be a way for CHW programmes to lead the way in gender-transformative labour practices.
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Affiliation(s)
- Svea Closser
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Marium Sultan
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Roosa Tikkanen
- Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Trøndelag, Norway
| | - Shalini Singh
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Arman Majidulla
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kenneth Maes
- Anthropology, Oregon State University, Corvallis, Oregon, USA
| | - Sue Gerber
- Independent Consultant, Truchas, New Mexico, USA
| | - Anat Rosenthal
- Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Southern, Israel
| | - Daniel Palazuelos
- Blavatnik Institute of Global Health and Social Medicine, Harvard University, Cambridge, Massachusetts, USA
| | | | - Erin Finley
- Psychiatry and Behavioral Sciences, UT Health San Antonio, San Antonio, Texas, USA
| | - Roza Abesha
- Independent Consultant, Gondar, Amhara, Ethiopia
| | | | - Judith Justice
- Institute for Health and Aging, University of California at San Francisco, Berkeley, California, USA
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Rotheram-Borus MJ, le Roux KW, Norwood P, Stansert Katzen L, Snyman A, le Roux I, Dippenaar E, Tomlinson M. The effect of supervision on community health workers' effectiveness with households in rural South Africa: A cluster randomized controlled trial. PLoS Med 2023; 20:e1004170. [PMID: 36862754 PMCID: PMC9980736 DOI: 10.1371/journal.pmed.1004170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 01/06/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Community health workers (CHWs) can supplement professional medical providers, especially in rural settings where resources are particularly scarce. Yet, outcomes of studies evaluating CHWs effectiveness have been highly variable and lack impact when scaled nationally. This study examines if child and maternal outcomes are better when existing government CHWs, who are perinatal home visitors, receive ongoing enhanced supervision and monitoring, compared to standard care. METHODS AND FINDINGS A cluster randomized controlled effectiveness trial was conducted comparing outcomes over 2 years when different supervision and support are provided. Primary health clinics were randomized by clinic to receive monitoring and supervision from either (1) existing supervisors (Standard Care (SC); n = 4 clinics, 23 CHWs, 392 mothers); or (2) supervisors from a nongovernmental organization that provided enhanced monitoring and supervision (Accountable Care [AC]; n = 4 clinic areas, 20 CHWs, 423 mothers). Assessments were conducted during pregnancy and at 3, 6, 15, and 24 months post-birth with high retention rates (76% to 86%). The primary outcome was the number of statistically significant intervention effects among 13 outcomes of interest; this approach allowed us to evaluate the intervention holistically while accounting for correlation among the 13 outcomes and considering multiple comparisons. The observed benefits were not statistically significant and did not show the AC's efficacy over the SC. Only the antiretroviral (ARV) adherence effect met the significance threshold established a priori (SC mean 2.3, AC mean 2.9, p < 0.025; 95% CI = [0.157, 1.576]). However, for 11 of the 13 outcomes, we observed an improvement in the AC compared to the SC. While the observed outcomes were not statistically significant, benefits were observed for 4 outcomes: increasing breastfeeding for 6 months, reducing malnutrition, increasing ARV adherence, and improving developmental milestones. The major study limitation was utilizing existing CHWs and being limited to a sample of 8 clinics. There were no major study-related adverse events. CONCLUSIONS Supervision and monitoring were insufficient to improve CHWs' impact on maternal and child outcomes. Alternative strategies for staff recruitment and narrowing the intervention outcomes to the specific local community problems are needed for consistently high impact. TRIAL REGISTRATION Clinicaltrials.gov, NCT02957799.
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Affiliation(s)
- Mary Jane Rotheram-Borus
- Dept. of Psychiatry and Biobehavioral Sciences, Semel Institute, University of CA, Los Angeles, California, United States of America
| | - Karl W. le Roux
- Institute for Life Course Health Research, Dept. of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- Dept. of Family Medicine, Walter Sisulu University, Mthatha, South Africa
- Primary Health Care Directorate, Old Main Building, Groote Schuur Hospital, Cape Town, South Africa
- Zithulele Training and Research Centre, Zithulele Hospital, Mqanduli District, Eastern Cape, South Africa
| | - Peter Norwood
- Dept. of Psychiatry and Biobehavioral Sciences, Semel Institute, University of CA, Los Angeles, California, United States of America
| | - Linnea Stansert Katzen
- Institute for Life Course Health Research, Dept. of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Andre Snyman
- Zithulele Training and Research Centre, Zithulele Hospital, Mqanduli District, Eastern Cape, South Africa
| | - Ingrid le Roux
- Philani Maternal, Child Health and Nutrition Trust, Khayelitsha, Cape Town, South Africa
| | - Elaine Dippenaar
- Zithulele Training and Research Centre, Zithulele Hospital, Mqanduli District, Eastern Cape, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Dept. of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
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Ndu M, Andoniou E, McNally S, Olea Popelka F, Tippett M, Nouvet E. The experiences and challenges of community health volunteers as agents for behaviour change programming in Africa: a scoping review. Glob Health Action 2022; 15:2138117. [PMID: 36314363 PMCID: PMC9629118 DOI: 10.1080/16549716.2022.2138117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Community health volunteers are considered a vital part of the community health structure in Africa. Despite this vital role in African health systems, very little is known about the community health volunteers’ day-to-day lived experiences providing services in communities and supporting other health workers. This scoping review aims to advance understanding of the day-to-day experiences of community health volunteers in Africa. In doing so, this review draws attention to these under-considered actors in African health systems and identifies critical factors and conditions that represent challenges to community health volunteers’ work in this context. Ultimately, our goal is to provide a synthesis of key challenges and considerations that can inform efforts to reduce attrition and improve the sustainability of community health volunteers in Africa. This scoping review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews checklist to achieve the objectives. A comprehensive search of six databases returned 2140 sources. After screening, 31 peer-reviewed studies were selected for final review. Analytical themes were generated based on the reviewers’ extraction of article data into descriptive themes using an inductive approach. In reviewing community health volunteers’ accounts of providing health services, five key challenges become apparent. These are: (1) challenges balancing work responsibilities with family obligations; (2) resource limitations; (3) exposure to stigma and harassment; (4) gendered benefits and risks; and (5) health-system level challenges. This scoping review highlights the extent of challenges community health volunteers must navigate to provide services in communities. Sustained commitment at the national and international level to understand the lived experiences of community health volunteers and mitigate common stressors these health actors face could improve their performance and inform future programs.
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Affiliation(s)
- Mary Ndu
- Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Ellena Andoniou
- Faculty of Health Science, Western University, London, ON, Canada
| | - Sorcha McNally
- Faculty of Health Science, Western University, London, ON, Canada
| | - Francisco Olea Popelka
- Department of Pathology and Laboratory Medicine, Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Marisa Tippett
- Research & Scholarly Communications Librarian, Western Libraries, Western University, London, ON, Canada
| | - Elysée Nouvet
- Faculty of Health Science, Western University, London, ON, Canada
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Ruit C, Breckenridge A. South African community health workers' pursuit of occupational security. GENDER WORK AND ORGANIZATION 2022. [DOI: 10.1111/gwao.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Catherine Ruit
- Health and Society, Health and Exercise Physiology 033F Hellferich Hall Ursinus College Collegeville Pennsylvania USA
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Jensen N, Lund C, Abrahams Z. Exploring effort-reward imbalance and professional quality of life among health workers in Cape Town, South Africa: a mixed-methods study. Glob Health Res Policy 2022; 7:7. [PMID: 35227327 PMCID: PMC8885139 DOI: 10.1186/s41256-022-00242-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the context of a growing appreciation for the wellbeing of the health workforce as the foundation of high-quality, sustainable health systems, this paper presents findings from two complementary studies to explore occupational stress and professional quality of life among health workers that were conducted in preparation for a task-shifting intervention to improve antenatal mental health services in Cape Town. METHODS This mixed-methods, cross-sectional study was conducted in public sector Midwife Obstetric Units and associated Non-Profit Organisations in Cape Town. Semi-structured interviews and a quantitative survey were conducted among facility-and community-based professional and lay health workers. The survey included demographic as well as effort-reward imbalance (ERI) and professional quality of life (PROQOL) questionnaires to examine overall levels of work-related psychosocial stress and professional quality of life, as well as differences between lay and professional health workers. Qualitative data was analysed using a thematic content analysis approach. Quantitative data was analysed using STATA 12. RESULTS Findings from 37 qualitative interviews highlighted the difficult working conditions and often limited reward and support structures experienced by health workers. Corroborating these findings, our quantitative survey of 165 professional and lay health workers revealed that most health workers experienced a mismatch between efforts spent and rewards gained at work (61.1% of professional and 70.2% of lay health workers; p = 0.302). There were few statistically significant differences in ERI and PROQOL scores between professional and lay health workers. Although Compassion Satisfaction was high for all health worker groups, lay health workers also showed elevated levels of burnout and compassion fatigue, with community-based health workers particularly affected. CONCLUSIONS Findings of this study add to the existing evidence base on adverse working conditions faced by South African public-sector health workers that should be taken into consideration as national and local governments seek to 're-engineer' South Africa's Primary Health Care system. Furthermore, they also highlight the importance of taking into consideration the wellbeing of health workers themselves to develop interventions that can sustainably foster resilient and high-quality health systems.
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Affiliation(s)
- N Jensen
- Department of Global Health and Social Medicine, King's College London, London, UK.
| | - C Lund
- Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's Global Health Institute, King's College London, London, UK
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Z Abrahams
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
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Ogutu M, Muraya K, Mockler D, Darker C. Factors influencing the performance of community health volunteers working within urban informal settlements in low- and middle-income countries: a qualitative meta-synthesis review. HUMAN RESOURCES FOR HEALTH 2021; 19:144. [PMID: 34838044 PMCID: PMC8626887 DOI: 10.1186/s12960-021-00691-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND There is limited information on community health volunteer (CHV) programmes in urban informal settlements in low- and middle-income countries (LMICs). This is despite such settings accounting for a high burden of disease. Many factors intersect to influence the performance of CHVs working in urban informal settlements in LMICs. This review was conducted to identify both the programme level and contextual factors influencing performance of CHVs working in urban informal settlements in LMICs. METHODS Four databases were searched for qualitative and mixed method studies focusing on CHVs working in urban and peri-urban informal settlements in LMICs. We focused on CHV programme outcome measures at CHV individual level. A total of 13 studies met the inclusion criteria and were double read to extract relevant data. Thematic coding was conducted, and data synthesized across ten categories of both programme and contextual factors influencing CHV performance. Quality was assessed using both the Critical Appraisal Skills Programme (CASP) and the Mixed Methods Assessment Tool (MMAST); and certainty of evidence evaluated using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach. RESULTS Key programme-level factors reported to enhance CHV performance in urban informal settlements in LMICs included both financial and non-financial incentives, training, the availability of supplies and resources, health system linkage, family support, and supportive supervision. At the broad contextual level, factors found to negatively influence the performance of CHVs included insecurity in terms of personal safety and the demand for financial and material support by households within the community. These factors interacted to shape CHV performance and impacted on implementation of CHV programmes in urban informal settlements. CONCLUSION This review identified the influence of both programme-level and contextual factors on CHVs working in both urban and peri-urban informal settlements in LMICs. The findings suggest that programmes working in such settings should consider adequate remuneration for CHVs, integrated and holistic training, adequate supplies and resources, adequate health system linkages, family support and supportive supervision. In addition, programmes should also consider CHV personal safety issues and the community expectations.
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Affiliation(s)
- Michael Ogutu
- Health Systems & Research Ethics Department, KEMRI-Wellcome Trust Research Programme, P.O Box 43640-00100, Nairobi, Kenya
- Trinity Centre for Global Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Kui Muraya
- Health Systems & Research Ethics Department, KEMRI-Wellcome Trust Research Programme, P.O Box 43640-00100, Nairobi, Kenya
| | - David Mockler
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Catherine Darker
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Laurenzi CA, Skeen S, Rabie S, Coetzee BJ, Notholi V, Bishop J, Chademana E, Tomlinson M. Balancing roles and blurring boundaries: Community health workers' experiences of navigating the crossroads between personal and professional life in rural South Africa. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1249-1259. [PMID: 32885519 DOI: 10.1111/hsc.13153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/24/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
As demand for health services grows, task-shifting to lay health workers has become an attractive solution to address shortages in human resources. Community health workers (CHWs), particularly in low-resource settings, play critical roles in promoting equitable healthcare among underserved populations. However, CHWs often shoulder additional burdens as members of the same communities in which they work. We examined the experiences of a group of CHWs called Mentor Mothers (MMs) working in a maternal and child health programme, navigating the crossroads between personal and professional life in the rural Eastern Cape, South Africa. Semi-structured qualitative interviews (n = 10) were conducted by an experienced isiXhosa research assistant, asking MMs questions about their experiences working in their own communities, and documenting benefits and challenges. Interviews were transcribed and translated into English and thematically coded. Emergent themes include balancing roles (positive, affirming aspects of the role) and blurring boundaries (challenges navigating between professional and personal obligations). While many MMs described empowering clients to seek care and drawing strength from being seen as a respected health worker, others spoke about difficulties in adequately addressing clients' needs, and additional burdens they adopted in their personal lives related to the role. We discuss the implications of these findings, on an immediate level (equipping CHWs with self-care and boundary-setting skills), and an intermediate level (introducing opportunities for structured debriefings and emphasising supportive supervision). We also argue that, at a conceptual level, CHW programmes should provide avenues for professionalisation and invest more up-front in their workforce selection, training and support.
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Affiliation(s)
- Christina A Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Stephan Rabie
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Bronwynè J Coetzee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Vuyolwethu Notholi
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | | | | | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University Belfast, Belfast, United Kingdom
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Mahilall R, Swartz L. Spiritual Care: Motivations and Experiences through the Lenses and Voices of a Cohort of Spiritual Care Workers at an Established Hospice in Cape Town, South Africa. JOURNAL OF RELIGION AND HEALTH 2021; 60:2906-2924. [PMID: 33755819 PMCID: PMC7985573 DOI: 10.1007/s10943-021-01232-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
While palliative care is beginning to gain prominence in South Africa, spiritual care remains less understood. Spiritual care is less prioritised and, consequently, this service, if offered, is mostly entrusted to volunteers. It therefore becomes prudent to understand who these volunteers are, what motivates them to volunteer, and how they see spiritual care being sustainable in the future. A cohort of spiritual care workers from a prominent hospice in Cape Town, South Africa, participated in this qualitative study. The participants made suggestions about formalising spiritual care as well as making a call for a basic entry requirement into spiritual care work.
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Affiliation(s)
- Ronita Mahilall
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7700, South Africa.
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7700, South Africa
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Bellerose M, Alva S, Magalona S, Awoonor-Williams K, Sacks E. Supervision of community health nurses in Ghana: a mixed-methods study on experiences and mentorship needs. Health Policy Plan 2021; 36:720-727. [PMID: 33351910 DOI: 10.1093/heapol/czaa167] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
Adequate supervision is critical to maintain the performance of health workers who provide essential maternal and child health services in low-resource areas. Supportive supervision emphasizing problem-solving, skill development and mentorship has been shown to improve the motivation and effectiveness of health workers, especially at the community level, but it is not always routinely provided. Previous studies have assessed the uptake of supportive supervision among volunteer health workers and paid health centre staff, but less is known about the supervision experiences of paid community-based staff, such as community health nurses (CHNs) in Ghana. This mixed-methods study explores the frequency and content of CHN supervision in five districts in the Greater Accra and Volta regions of Ghana. We analysed quantitative data from 197 satisfaction surveys and qualitative data from 29 in-depth interviews (IDIs) and four focus group discussions (FGDs) with CHNs. While the majority of CHNs received supervision at least monthly, they reported that supervision was primarily focused on meeting clinical targets (48%) rather than on handling specific cases or patients (23%). Over a third (34%) of CHNs did not agree that supervisors help them with job-related challenges and nearly half (43%) were unsatisfied with their jobs. When asked about their mentorship needs, CHNs reported wanting feedback on how to improve their job performance (40%) and encouragement (30%). There were only slight variations in the frequency and content of supervision based on type of supervisor. During IDIs and FGDs, CHNs offered ideas for how to improve supervision, including more frequent field visits so that supervisors could see the on-the-ground realities of their work, greater respect and positive reinforcement. Overall, CHN motivation and job satisfaction may be strengthened by aligning supervision more closely with the principles of supportive supervision.
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Affiliation(s)
- Meghan Bellerose
- Department of Population and Family Health, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY 10032, USA
| | - Soumya Alva
- John Snow Inc, 2733 Crystal Dr 4th floor, Arlington, VA 22202, USA
| | - Sophia Magalona
- Department of Population, Family, and Reproductive Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Koku Awoonor-Williams
- Division of Policy Planning Monitoring and Evaluation, Ghana Health Service, Accra, Ghana
| | - Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, North Wolfe Street, E8011, Baltimore, MD 21205, USA
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Bellerose M, Awoonor-Williams K, Alva S, Magalona S, Sacks E. 'Let me move to another level': career advancement desires and opportunities for community health nurses in Ghana. Glob Health Promot 2021; 29:88-96. [PMID: 34269105 DOI: 10.1177/17579759211027426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Career advancement and continued education are critical components of health worker motivation and retention. Continuous advancement also builds health system capacity by ensuring that leaders are those with experience and strong performance records. To understand more about the satisfaction, desires, and career opportunities available to community health nurses (CHNs) in Ghana, we conducted 29 in-depth interviews and four focus group discussions across five predominantly rural districts. Interview transcripts and summary notes were coded in NVivo based on pre-defined and emergent codes using thematic content analysis. Frustration with existing opportunities for career advancement and continued education emerged as key themes. Overall, the CHNs desired greater opportunities for career development, as most aspired to return to school to pursue higher-level health positions. While workshops were available to improve CHNs knowledge and skills, they were infrequent and irregular. CHNs wanted greater recognition for their work experience in the form of respect from leaders within the Ghana Health System and credit towards future degree programs. CHNs are part of a rapidly expanding cadre of salaried community-based workers in sub-Saharan Africa, and information about their experiences and needs can be used to shape future health policy and program planning.
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Affiliation(s)
- Meghan Bellerose
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, NY, USA
| | - Koku Awoonor-Williams
- Former Director, Division of Policy Planning Monitoring and Evaluation, Ghana Health Service, Accra, Ghana
| | | | - Sophia Magalona
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore MD, USA
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12
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Dodd W, Kipp A, Nicholson B, Lau LL, Little M, Walley J, Wei X. Governance of community health worker programs in a decentralized health system: a qualitative study in the Philippines. BMC Health Serv Res 2021; 21:451. [PMID: 33980209 PMCID: PMC8114679 DOI: 10.1186/s12913-021-06452-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/26/2021] [Indexed: 12/22/2022] Open
Abstract
Background Community health worker (CHW) programs are an important resource in the implementation of universal health coverage (UHC) in many low- and middle-income countries (LMICs). However, in countries with decentralized health systems like the Philippines, the quality and effectiveness of CHW programs may differ across settings due to variations in resource allocation and local politics. In the context of health system decentralization and the push toward UHC in the Philippines, the objective of this study was to explore how the experiences of CHWs across different settings were shaped by the governance and administration of CHW programs. Methods We conducted 85 semi-structured interviews with CHWs (n = 74) and CHW administrators (n = 11) in six cities across two provinces (Negros Occidental and Negros Oriental) in the Philippines. Thematic analysis was used to analyze the qualitative data with specific attention to how the experiences of participants differed within and across geographic settings. Results Health system decentralization contributed to a number of variations across settings including differences in the quality of human resources and the amount of financial resources allocated to CHW programs. In addition, the quality and provider of CHW training differed across settings, with implications for the capacity of CHWs to address specific health needs in their community. Local politics influenced the governance of CHW programs, with CHWs often feeling pressure to align themselves politically with local leaders in order to maintain their employment. Conclusions The functioning of CHW programs can be challenged by health system decentralization through the uneven operationalization of national health priorities at the local level. Building capacity within local governments to adequately resource CHWs and CHW programs will enhance the potential of these programs to act as a bridge between the local health needs of communities and the public health system. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06452-x.
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Affiliation(s)
- Warren Dodd
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. W, Waterloo, Ontario, N2L 3G1, Canada.
| | - Amy Kipp
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. W, Waterloo, Ontario, N2L 3G1, Canada
| | - Bethany Nicholson
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. W, Waterloo, Ontario, N2L 3G1, Canada
| | | | - Matthew Little
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Eluka NN, Morrison SD, Sienkiewicz HS. "The Wheel of My Work": Community Health Worker Perspectives and Experiences with Facilitating Refugee Access to Primary Care Services. Health Equity 2021; 5:253-260. [PMID: 33937612 PMCID: PMC8082038 DOI: 10.1089/heq.2020.0150] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Community health workers (CHWs) are trusted community leaders and public health workers dedicated to promoting the health and well-being of community members. CHWs, who share similar language and culture, work with refugee communities that are often missed in traditional U.S. health systems. CHWs help refugees gain access to health care through culturally appropriate strategies. However, the scope of their study as cultural brokers with regard to refugee health access is largely unknown in the peer-reviewed literature. This qualitative research study used a constructivist grounded approach to examine the extent to which CHWs helped refugee clients gain access to the health care system. Methods: Data were collected through interviews with a purposeful sample of 10 CHW participants affiliated with a primary care access program in Greensboro, North Carolina. Results: The diagram derived from this study provided a schema that allowed for an improved understanding of CHW perspectives and experiences when connecting refugee clients to the health care system. Conclusions: Further research incorporating CHW voices is recommended because CHWs are instrumental in improving the health and well-being of refugees.
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Affiliation(s)
- Nneze N. Eluka
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Sharon D. Morrison
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina, USA
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Kigozi G, Heunis C, Engelbrecht M. Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa. BMC Health Serv Res 2020; 20:882. [PMID: 32943026 PMCID: PMC7499870 DOI: 10.1186/s12913-020-05612-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 07/31/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND South Africa faces a chronic shortage of professional health workers. Accordingly, community health workers (CHWs) are being employed to mitigate the ongoing health workforce deficiencies. As increased access to quality service delivery hinges upon their motivation, this study explored CHWs' motivation to deliver systematic household contact tuberculosis (TB) investigation (SHCI). METHODS In 2017, a cross-sectional survey was conducted among CHWs in the Mangaung Metropolitan District, Free State Province. Exploratory factor analysis was performed on a 30-item scale to determine the dimensions underlying CHW motivation. Items with factor loadings of 0.4 and above were retained. Descriptive and inferential analyses were used to determine CHW motivation levels. Multiple linear regression analysis was used to investigate the determinants of CHW motivation. RESULTS Out of 235 participants, 89.2% were female. Participants' median age was 39 (inter-quartile range: 33-45) years. CHW motivation was defined by 16 items across three dimensions - intrinsic job satisfaction, burnout and team commitment, together explaining 56.04% of the total variance. The derived scale showed satisfactory internal consistency (Cronbach's alpha: 0.81), with a mean motivation score of 52.26 (standard deviation [sd]: 5.86) out of 64. Statistically significant differences were observed between formal CHWs - those with at least phase 1 standardised accredited training, and informal CHWs - those without such accredited training regarding team commitment scores (17.82 [sd: 2.48] vs. 17.07 [sd: 2.82]; t(233) = 2.157; p = 0.013). CHW age (β = 0.118, p = 0.029), location (β = 1.737, p = 0.041), length of service (β = - 0.495, p < 0.001), attendance of TB SHCI training (β = 1.809, p = 0.036), and TB SHCI competence (β = 0.706, p < 0.001), contributed statistically significantly to CHW motivation. CONCLUSION CHW motivation to perform TB SHCI was both intrinsic and extrinsic. The high overall mean score implies that the CHWs were well-motivated to perform TB SHCI. To ensure sustained improved access to quality TB SHCI service provision, programme managers in the Free State and similar settings could potentially use the tool derived from this study to monitor and inform CHW motivation interventions. Interventions should pay close attention to the CHWs' formalisation, competence and training.
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Affiliation(s)
- Gladys Kigozi
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa.
| | - Christo Heunis
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Michelle Engelbrecht
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
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15
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le Roux KW, Almirol E, Rezvan PH, le Roux IM, Mbewu N, Dippenaar E, Stansert-Katzen L, Baker V, Tomlinson M, Rotheram-Borus MJ. Community health workers impact on maternal and child health outcomes in rural South Africa - a non-randomized two-group comparison study. BMC Public Health 2020; 20:1404. [PMID: 32943043 PMCID: PMC7496216 DOI: 10.1186/s12889-020-09468-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home visits by paraprofessional community health workers (CHWs) has been shown to improve maternal and child health outcomes in research studies in many countries. Yet, when these are scaled or replicated, efficacy disappears. An effective CHW home visiting program in peri-urban Cape Town found maternal and child health benefits over the 5 years point but this study examines if these benefits occur in deeply rural communities. METHODS A non-randomized, two-group comparison study evaluated the impact of CHW in the rural Eastern Cape from August 2014 to May 2017, with 1310 mother-infant pairs recruited in pregnancy and 89% were reassessed at 6 months post-birth. RESULTS Home visiting had limited, but important effects on child health, maternal wellbeing and health behaviors. Mothers reported fewer depressive symptoms, attended more antenatal visits and had better baby-feeding practices. Intervention mothers were significantly more likely to exclusively breastfeed for 6 months (OR: 1.8; 95% CI: 1.1, 2.9), had lower odds of mixing formula with baby porridge (regarded as detrimental) (OR: 0.4; 95% CI: 0.2, 0.8) and were less likely to consult traditional healers. Mothers living with HIV were more adherent with co-trimoxazole prophylaxis (p < 0.01). Intervention-group children were significantly less likely to be wasted (OR: 0.5; 95% CI 0.3-0.9) and had significantly fewer symptoms of common childhood illnesses in the preceding two weeks (OR: 0.8; 95% CI: 0.7,0.9). CONCLUSION The impact of CHWs in a rural area was less pronounced than in peri-urban areas. CHWs are likely to need enhanced support and supervision in the challenging rural context.
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Affiliation(s)
- Karl W le Roux
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
- Zithulele Training and Research Centre, Zithulele Hospital, Ginyintsimbi Village, Eastern Cape, South Africa
- Family Medicine Department, Walter Sisulu University, Mthatha, South Africa
- Primary Healthcare Directorate, University of Cape Town, Cape Town, South Africa
| | - Ellen Almirol
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA, 90024-6521, USA
| | - Panteha Hayati Rezvan
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA, 90024-6521, USA
| | - Ingrid M le Roux
- Philani Maternal, Child Health and Nutrition Trust, Site C, Khayelitsha, Cape Town, South Africa
| | - Nokwanele Mbewu
- Philani Maternal, Child Health and Nutrition Trust, Site C, Khayelitsha, Cape Town, South Africa
| | - Elaine Dippenaar
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Linnea Stansert-Katzen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
- Zithulele Training and Research Centre, Zithulele Hospital, Ginyintsimbi Village, Eastern Cape, South Africa
| | - Venetia Baker
- Zithulele Training and Research Centre, Zithulele Hospital, Ginyintsimbi Village, Eastern Cape, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - M J Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA, 90024-6521, USA.
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Lappeman M, Swartz L. ‘I Don't Want to See that the People Are Suffering’: Nurses in an Impoverished Community Talk About Caring for Women Following Stillbirths. BRITISH JOURNAL OF PSYCHOTHERAPY 2020. [DOI: 10.1111/bjp.12543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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van de Ruit C. Unintended Consequences of Community Health Worker Programs in South Africa. QUALITATIVE HEALTH RESEARCH 2019; 29:1535-1548. [PMID: 31274060 DOI: 10.1177/1049732319857059] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Task shifting from trained clinicians to community health workers (CHWs) is a central, primary health care strategy advocated by global health policy planners in resource-poor settings where trained health professionals are scarce. The evidence base for the efficacy of these programs, however, is limited-in particular, research that identifies their potential unintended consequences. Based on sustained ethnographic study of CHWs working for AIDS projects in South Africa at the height of the country's AIDS epidemic, this article identifies how structural and local factors produced unintended consequences for CHW programs. These consequences were (a) CHWs moonlighting for multiple organizations, (b) CHWs freelancing in communities without regulation, and (c) adverse patient outcomes resulting from uncoordinated care. These consequences stemmed from structural elements of a bureaucratically weak health system and from local grassroots dynamics that jeopardized long-term CHW program sustainability and eroded national health goals.
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Bellas HC, Jatobá A, Bulhões B, Koster I, Arcuri R, Burns C, Grindrod K, de Carvalho PVR. Effects of Urban Violence on Primary Healthcare: The Challenges of Community Health Workers in Performing House Calls in Dangerous Areas. J Community Health 2019; 44:569-576. [DOI: 10.1007/s10900-019-00657-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jackson R, Kilsby D, Hailemariam A. Gender exploitative and gender transformative aspects of employing Health Extension Workers under Ethiopia's Health Extension Program. Trop Med Int Health 2019; 24:304-319. [PMID: 30582264 DOI: 10.1111/tmi.13197] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To apply a gender lens to Ethiopia's Health Extension Program and the role of Health Extension Workers (HEWs). METHODS Interviews with 45 HEWs and four focus group discussions with 14 of the same HEWS from three regions in rural Ethiopia: Afar Region; Tigray Region (Adwa Woreda); and two locations in Southern Nations, Nationalities and People's Region (Aleta Wondo Woreda and Kafa Zone). Two focus group discussions were conducted in Afar Region with 17 Women Extension Workers employed by Afar Pastoralist Development Association. RESULTS Using the Gender Equality Continuum as a gender analysis tool, we found that Ethiopia's Health Extension Program is gender aware by directly linking improved health outcomes for women and their empowerment. However, for HEWs who inhabit a gendered space and place from home to district health centres, there can be unexpected consequences that accommodate existing gender inequalities, are blind to them and perhaps even generate new forms of exploitation. CONCLUSIONS The Health Extension Program could have more transformative outcomes for HEWs and also for communities if changing gender norms was given more attention and constraints to gender equality were reduced. Community Health Worker (CHW) programs should focus on better understanding on the role of gender for CHWs across health systems.
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Affiliation(s)
- Ruth Jackson
- School of Humanities and Social Sciences, Deakin University, Geelong, Australia
| | - Di Kilsby
- Gender and Social Inclusion Consultancy, Melbourne, Australia
| | - Assefa Hailemariam
- Center for Population Studies, Addis Ababa University, Addis Ababa, Ethiopia
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Paid staff or volunteers - does it make a difference? The impact of staffing on child outcomes for children attending community-based programmes in South Africa and Malawi. Glob Health Action 2018; 10:1381462. [PMID: 29214899 PMCID: PMC5727430 DOI: 10.1080/16549716.2017.1381462] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Globally, and in low and middle income countries (LMIC) specifically, there is a critical shortage of workers. The use of volunteers to support such care delivery systems has been examined, there is scant literature on the impact of volunteers on child outcome in high human immunodeficiency virus (HIV)-affected communities. Objectives: To examine the differential impact of paid versus volunteer workforce in Community Based Organisations (CBOs) providing care to children and families affected by the HIV epidemic in South Africa and Malawi on child outcomes over time. Methods: This study compared child outcomes for 989 consecutive children attending CBOs (0.7% refusal) at baseline and 854 at follow-up (86.3% response rate). Results: Children attending CBOs with paid staff had higher self-esteem, fewer emotional/behavioural problems and less perceived stigma. Likewise, children attending CBOs with paid staff had fewer educational risks, and 20 heightened cognitive performance, and the digit-span memory test. After controlling for outcome at baseline, gender, age, HIV status, and disability, attending a CBO with paid staff remained a significant independent predictor of higher self-esteem scores, less perceived stigma, as well as fewer educational risks and better performance on the drawing test. We found no associations between CBO attendance – paid or volunteer – and children’s depressive and trauma symptoms. Conclusions: Our findings show that in order to most optimally impact on child outcome 30 community-based workers (CBWs) should ideally be paid with trained staff. Specialised input for more severe child difficulties is needed.
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Greer AM, Pauly B, Scott A, Martin R, Burmeister C, Buxton J. Paying people who use illicit substances or ‘peers’ participating in community-based work: a narrative review of the literature. DRUGS-EDUCATION PREVENTION AND POLICY 2018. [DOI: 10.1080/09687637.2018.1494134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Alissa Merielle Greer
- BC Centre for Disease Control, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Bernadette Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Alex Scott
- Vancouver Coastal Health, Vancouver, Canada
| | - Ruth Martin
- College of Health Disciplines, University of British Columbia, Vancouver, Canada
| | | | - Jane Buxton
- BC Centre for Disease Control, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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22
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Manderson L, Levine S. Southward Focused: Medical Anthropology in South Africa. AMERICAN ANTHROPOLOGIST 2018. [DOI: 10.1111/aman.13097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Lenore Manderson
- University of the Witwatersrand; South Africa, and Brown University USA
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Morton D, Mayekiso T, Cunningham P. Structural barriers to South African volunteer home-based caregivers providing quality care: the need for a policy for caregivers not affiliated to primary healthcare clinics. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 17:47-53. [PMID: 29504501 DOI: 10.2989/16085906.2017.1397719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Community home-based care (CHBC) is a critical component of non-formal care in communities in Africa that have a high prevalence of HIV and tuberculosis (TB). Community carers consisting primarily of volunteers are critical role players in African healthcare systems and particularly in South Africa's strategy to fight HIV and AIDS. This paper explores the structural barriers volunteer caregivers need to overcome to provide quality CHBC. The researchers used two focus group discussions with key informants (each with four participants), and semi-structured interviews with six key informants to collect data relating to the meaning of quality CHBC. The data were coded using Tesch's data analysis technique. A major theme that emerged from the results was "Addressing structural challenges to improve the quality of CHBC". Subthemes underpinning this theme were: 1) lack of standardised training of volunteer caregivers; 2) the need for a scope of practice, parameters and legal boundaries; 3) lack of monitoring and evaluation (M&E) of CHBC; and 4) the importance of mentoring and supervision in CHBC. CHBC policy should address the need for standardised training programmes for caregivers, so that they are equipped with multiple skills. Furthermore CHBC policy must emphasise mentoring as well as M&E to encourage quality care. Finally, the policy should provide a clear scope of practice for caregivers to regulate their competencies and boundaries.
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Affiliation(s)
- David Morton
- a Department of Nursing Science , Nelson Mandela University , Port Elizabeth , South Africa
| | - Thoko Mayekiso
- b Vice Chancellor's Office , University of Mpumalanga , Mbombela , South Africa
| | - Peter Cunningham
- c Department of Sociology and Anthropology , Nelson Mandela University , Port Elizabeth , South Africa
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Sibeko G, Milligan PD, Roelofse M, Molefe L, Jonker D, Ipser J, Lund C, Stein DJ. Piloting a mental health training programme for community health workers in South Africa: an exploration of changes in knowledge, confidence and attitudes. BMC Psychiatry 2018; 18:191. [PMID: 29898705 PMCID: PMC6001068 DOI: 10.1186/s12888-018-1772-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 06/05/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is a shortage of trained mental health workers in spite of the significant contribution of psychiatric disorders to the global disease burden. Task shifting, through the delegation of health care tasks to less specialised health workers such as community health workers (CHWs), is a promising approach to address the human resource shortage. CHWs in the Western Cape province of South Africa provide comprehensive chronic support which includes that for mental illness, but have thus far not received standardized mental health training. It is unknown whether a structured mental health training programme would be acceptable and feasible, and result improved knowledge, confidence and attitudes amongst CHWs. METHODS We developed and piloted a mental health training programme for CHWs, in line with the UNESCO guidelines; the WHO Mental Health Gap Action Programme and the South African National framework for CHW training. In our quasi-experimental (before-after) cohort intervention study we measured outcomes at the start and end of training included: 1) Mental health knowledge, measured through the use of case vignettes and the Mental Health Knowledge Schedule; 2) confidence, measured with the Mental Health Nurse Clinical Confidence Scale; and 3) attitudes, measured with the Community Attitudes towards the Mentally Ill Scale. Knowledge measures were repeated 3 months later. Acceptability data were obtained from daily evaluation questionnaires and a training evaluation questionnaire, while feasibility was measured by participant attendance at training sessions. RESULTS Fifty-eight CHWs received the training, with most (n = 56, 97.0%) attending at least 7 of the 8 sessions. Most participants (n = 29, 63.04%) demonstrated significant improvement in knowledge, which was sustained at 3-months. There was significant improvement in confidence, along with changes in attitude, indicating improved benevolence, reduced social restrictiveness, and increased tolerance to rehabilitation of the mentally ill in the community but there was no change in authoritarian attitudes. The training was acceptable and feasible. CONCLUSIONS Mental health training was successful in improving knowledge, confidence and attitudes amongst trained CHWs. The training was acceptable and feasible. Further controlled studies are required to evaluate the impact of such training on patient health outcomes. TRIAL REGISTRATION PACTR PACTR201610001834198 , Registered 26 October 2016.
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Affiliation(s)
- Goodman Sibeko
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Peter D. Milligan
- 0000 0004 1937 1151grid.7836.aDepartment of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Marinda Roelofse
- 0000 0004 0635 5945grid.467135.2Western Cape Department of Health, Western Cape Province, South Africa
| | - Lezel Molefe
- 0000 0004 0635 5945grid.467135.2Western Cape Department of Health, Western Cape Province, South Africa
| | - Deborah Jonker
- 0000 0004 1937 1151grid.7836.aDepartment of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jonathan Ipser
- 0000 0004 1937 1151grid.7836.aDepartment of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Crick Lund
- 0000 0004 1937 1151grid.7836.aDepartment of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa ,0000 0001 2322 6764grid.13097.3cCentre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Dan J. Stein
- 0000 0004 1937 1151grid.7836.aDepartment of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa ,0000 0000 9155 0024grid.415021.3South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
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Steege R, Taegtmeyer M, McCollum R, Hawkins K, Ormel H, Kok M, Rashid S, Otiso L, Sidat M, Chikaphupha K, Datiko DG, Ahmed R, Tolhurst R, Gomez W, Theobald S. How do gender relations affect the working lives of close to community health service providers? Empirical research, a review and conceptual framework. Soc Sci Med 2018; 209:1-13. [PMID: 29777956 DOI: 10.1016/j.socscimed.2018.05.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/26/2018] [Accepted: 05/02/2018] [Indexed: 11/18/2022]
Abstract
Close-to-community (CTC) providers have been identified as a key cadre to progress universal health coverage and address inequities in health service provision due to their embedded position within communities. CTC providers both work within, and are subject to, the gender norms at community level but may also have the potential to alter them. This paper synthesises current evidence on gender and CTC providers and the services they deliver. This study uses a two-stage exploratory approach drawing upon qualitative research from the six countries (Bangladesh, Indonesia, Ethiopia, Kenya, Malawi, Mozambique) that were part of the REACHOUT consortium. This research took place from 2013 to 2014. This was followed by systematic review that took place from January-September 2017, using critical interpretive synthesis methodology. This review included 58 papers from the literature. The resulting findings from both stages informed the development of a conceptual framework. We present the holistic conceptual framework to show how gender roles and relations shape CTC provider experience at the individual, community, and health system levels. The evidence presented highlights the importance of safety and mobility at the community level. At the individual level, influence of family and intra-household dynamics are of importance. Important at the health systems level, are career progression and remuneration. We present suggestions for how the role of a CTC provider can, with the right support, be an empowering experience. Key priorities for policymakers to promote gender equity in this cadre include: safety and well-being, remuneration, and career progression opportunities. Gender roles and relations shape CTC provider experiences across multiple levels of the health system. To strengthen the equity and efficiency of CTC programmes gender dynamics should be considered by policymakers and implementers during both the conceptualisation and implementation of CTC programmes.
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Affiliation(s)
- Rosalind Steege
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK.
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK
| | - Rosalind McCollum
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK
| | - Kate Hawkins
- Pamoja Communications, UK Bishopstone, 36 Crescent Road, Worthing BN11 1RL, UK
| | - Hermen Ormel
- Royal Tropical Institute, KIT Health, P.O. Box 95001, 1090 HA, Amsterdam, The Netherlands
| | - Maryse Kok
- Royal Tropical Institute, KIT Health, P.O. Box 95001, 1090 HA, Amsterdam, The Netherlands
| | - Sabina Rashid
- James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Lilian Otiso
- LVCT Health, Research and Strategic Information Department, P.O Box 19835- 00202, Nairobi, Kenya
| | - Mohsin Sidat
- University Eduardo Mondlane, Department of Community Health, P.O. Box 257, Maputo, Mozambique
| | - Kingsley Chikaphupha
- Research for Equity and Community Health (REACH) Trust, P.O. Box 1597, Lilongwe, Malawi
| | | | - Rukhsana Ahmed
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK; Eijkman Institute for Molecular Biology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia, Jalan Diponegoro 69, Jakarta, 10430, Indonesia
| | - Rachel Tolhurst
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK
| | - Woedem Gomez
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK
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Trafford Z, Swartz A, Colvin CJ. "Contract to Volunteer": South African Community Health Worker Mobilization for Better Labor Protection. New Solut 2017; 27:648-666. [PMID: 29153037 DOI: 10.1177/1048291117739529] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In this paper, we explore the increasing activity around labor rights for South African community health workers (CHWs). Contextualizing this activity within broader policy and legal developments, we track the emergence of sporadic mobilizations for decent work (supported by local health activist organizations) and subsequently, the formation of a CHW union. The National Union of Care Workers of South Africa (NUCWOSA) was inaugurated in 2016, hoping to secure formal and secure employment through government and the consequent labor and occupational health protections. Various tensions were observed during fieldwork in the run up to NUCWOSA's formation and raise important questions about representation, legitimacy, and hierarchies of power. We close by offering suggestions for future research in this developing space.
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Affiliation(s)
- Zara Trafford
- 1 Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa
| | - Alison Swartz
- 1 Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa
| | - Christopher J Colvin
- 1 Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa
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Burkot C, Naidi L, Seehofer L, Miles K. Perceptions of incentives offered in a community-based malaria diagnosis and treatment program in the Highlands of Papua New Guinea. Soc Sci Med 2017; 190:149-156. [PMID: 28863338 DOI: 10.1016/j.socscimed.2017.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/20/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
Abstract
What motivates community-based health workers to provide care in rural and remote areas, often on a voluntary or casual basis, is a key question for program managers and public health officials. This paper examines how a range of incentives offered as part of the Marasin Stoa Kipa program, a community-based malaria diagnosis and treatment program that has been implemented since 2007 within a major oil and gas development area in Papua New Guinea, are perceived and critiqued by community-based health workers. Nineteen interviews and seven focus group discussions with the workers who deliver services and members of the communities served by the program, conducted between November 4 and 25, 2015, reveal a pattern of mixed motivations and changes in motivation over time. This can be attributed partly to the unique social and economic circumstances in which the program is operating. Changes in the burden of disease as well as in global and national health services policy with implications for local level program operations also had an impact, as did the nature of relationships between program managers, community-based health workers, and program beneficiaries. Overall, the findings suggest that while financial and in-kind incentives can be a useful tool to motivate voluntary or minimally-compensated community-based health workers, they must be carefully structured to align with local social, economic, and epidemiological realities over the long-term.
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Affiliation(s)
- Camilla Burkot
- Development Policy Centre, Crawford School of Public Policy, ANU College of Asia and the Pacific, The Australian National University, Building 132, Lennox Crossing, Acton, Canberra ACT 2601, Australia.
| | - Laura Naidi
- Papua New Guinea Institute of Medical Research, PO Box 60, Goroka, Eastern Highlands Province 441, Papua New Guinea
| | - Liesel Seehofer
- Oil Search Foundation, PO Box 842, Port Moresby, Papua New Guinea
| | - Kevin Miles
- Oil Search Foundation, PO Box 842, Port Moresby, Papua New Guinea
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Torres S, Balcázar H, Rosenthal LE, Labonté R, Fox D, Chiu Y. Community health workers in Canada and the US: working from the margins to address health equity. CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2016.1275523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sara Torres
- School of Social Work, Dalhousie University, Halifax, Canada
| | - Héctor Balcázar
- College of Science and Health, Charles R. Drew University of Medicine and Science, Los Angeles, USA
| | - Lee E. Rosenthal
- Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, USA
| | - Ronald Labonté
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Durrell Fox
- Massachusetts Department of Public Health’s Prevention and Wellness Trust Fund, Boston, USA
| | - Yvonne Chiu
- Multicultural Health Brokers Cooperative, Edmonton, Canada
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Akintola O, Chikoko G. Factors influencing motivation and job satisfaction among supervisors of community health workers in marginalized communities in South Africa. HUMAN RESOURCES FOR HEALTH 2016; 14:54. [PMID: 27601052 PMCID: PMC5013625 DOI: 10.1186/s12960-016-0151-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 08/25/2016] [Indexed: 05/19/2023]
Abstract
BACKGROUND Management and supervision of community health workers are factors that are critical to the success of community health worker programmes. Yet few studies have explored the perspectives of supervisors in these programmes. This study explored factors influencing motivations of supervisors in community health worker programmes. METHODS We conducted qualitative interviews with 26 programme staff providing supervision to community health workers in eight community-based organizations in marginalized communities in the greater Durban area of South Africa from July 2010 to September 2011. RESULTS Findings show that all the supervisors had previous experience working in the health or social services sectors and most started out as unpaid community health workers. Most of the participants were poor women from marginalized communities. Supervisors' activities include the management and supply of material resources, mentoring and training of community health workers, record keeping and report writing. Supervisors were motivated by intrinsic factors like making a difference and community appreciation and non-monetary incentives such as promotion to supervisory positions; acquisition of management skills; participation in capacity building and the development of programmes; and support for educational advancement like salary, bonuses and medical benefits. Hygiene factors that serve to prevent dissatisfaction are salaries and financial, medical and educational benefits attached to the supervisory position. Demotivating factors identified are patients' non-adherence to health advice and alienation from decision-making. Dissatisfiers include working in crime-prevalent communities, remuneration for community health workers (CHWs), problems with material and logistical resources, job insecurity, work-related stressors and navigating the interface between CHWs and management. While participants were dissatisfied with their low remuneration, they were not demotivated but continued to be motivated by intrinsic factors. Our findings suggest that CHWs' quest for remuneration and a career path continues even after they assume supervisory positions. Supervisors continue to be motivated to work in mid-level positions within the health and social services sectors. CONCLUSIONS Global efforts to develop and increase the sustainability of CHW programmes will benefit immensely from insights gained from an exploration of supervisors' perspectives. Further, national CHW programmes should be conceptualized with the dual purpose of building the capacity of CHWs to strengthen health systems and reducing unemployment especially in marginalized communities with high unemployment and low-skilled labour force.
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Affiliation(s)
- Olagoke Akintola
- School of Applied Human Sciences, University of KwaZulu-Natal, Mazisi Kunene Road, Glenwood, Durban 4041 South Africa
- School of Human and Social Development, Nipissing University, 100 College Drive, ON P1B 8L7 North Bay, Canada
| | - Gamuchirai Chikoko
- School of Applied Human Sciences, University of KwaZulu-Natal, Mazisi Kunene Road, Glenwood, Durban 4041 South Africa
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Orchard T, Salters K, Michelow W, Lepik K, Palmer A, Hogg R. “My job is to deal with what I can”: HIV care providers’ perspectives on adherence to HAART, addictions, and comprehensive care delivery in Vancouver, British Columbia. CRITICAL PUBLIC HEALTH 2015. [DOI: 10.1080/09581596.2015.1088641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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