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Stansert Katzen L, Skeen S, Dippenaar E, Laurenzi C, Notholi V, le Roux K, Rotheram-Borus MJ, le Roux I, Mbewu N, Tomlinson M. Are we listening to community health workers? Experiences of the community health worker journey in rural South Africa. Res Nurs Health 2022; 45:380-389. [PMID: 35184308 PMCID: PMC9271365 DOI: 10.1002/nur.22220] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/13/2021] [Accepted: 02/01/2022] [Indexed: 08/20/2023]
Abstract
Access to healthcare in developing countries remains a challenge. As a result, task-shifting to community health workers (CHWs) is increasingly used to mitigate healthcare worker shortages. Although there is solid evidence of CHW program effectiveness, less is known about CHWs' experiences of becoming and then working daily as CHWs-information that should play an important role in the design of CHW programs. We examined the experiences of a group of CHWs working in a government-run CHW program in South Africa's rural Eastern Cape Province. Semistructured qualitative interviews (N = 9) and focus groups (N = 2) focusing on motivations for becoming a CHW and experiences of working as CHWs were conducted and thematically analyzed. Three themes were identified: (1) becoming a CHW, (2) facing challenges in the field, and (3) gaining community acceptance through respect and legitimacy. In this study, CHWs were motivated by altruism and a desire to help their community. They faced a range of challenges such as limited training, lack of supervision, equipment shortages, logistical issues, and clinics with limited services. Respect and legitimacy through community acceptance and trust is crucial for effective CHW work. CHWs in this study described how confidentiality and their own persistence facilitated the process of gaining respect and legitimacy. CHWs have a unique knowledge of contexts and requirements for successful programs and greater efforts are needed to include their perspectives to improve and develop programs. Recognition is needed to acknowledge the significant personal input required by CHWs for programs to be successful.
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Affiliation(s)
- Linnea Stansert Katzen
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Sarah Skeen
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Elaine Dippenaar
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Christina Laurenzi
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Vuyolwethu Notholi
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Karl le Roux
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
- Department of Family Medicine, Walter Sisulu University, Mthatha, South Africa
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, California, USA
| | - Ingrid le Roux
- Philani Maternal, Child Health and Nutrition Trust, Cape Town, South Africa
| | - Nokwanele Mbewu
- Philani Maternal, Child Health and Nutrition Trust, Cape Town, South Africa
| | - Mark Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
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Okyere E, Ward PR, Marfoh K, Mwanri L. Incentives management among health workers in primary health-care facilities: addressing important issues in rural Ghana. J Health Organ Manag 2022; ahead-of-print. [PMID: 35443126 DOI: 10.1108/jhom-08-2021-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study seeks to explore health workers' perceptions and experiences on incentives for motivating and retaining them in primary health-care facilities in rural Ghana. DESIGN/METHODOLOGY/APPROACH Phenomenological research design was used to explore health workers' experiences and perceptions on their incentive packages. Sixty-eight in-depth interviews were conducted with health-care workers in primary health-care facilities and analyzed using thematic analysis approach. FINDINGS The findings show health-care workers' perceptions on their incentives, ranging from low awareness, unfair distribution, favoritism, means of punishment and incentives regarded unattractive. The preferred incentive packages identified were salary increase, housing availability, recognition, adequate supplies, and risk and responsibility allowances. Health-care workers suggested for the modification of incentives including vehicle importation waiver, reduction in study leave years and opportunity to pursue desired courses. ORIGINALITY/VALUE The findings suggest that incentives that align with health-care workers' preferences can potentially improve their motivation and influence retention. Health-care workers' concern on incentives having been used as favors and punishment as well as unfair distribution should be addressed by health managers and policymakers, to achieve the desired purpose of motivating and retaining them in rural areas. Appropriate internal monitoring mechanisms are needed for incentives regulation and to improve health workers' retention in rural Ghana.
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Affiliation(s)
- Eunice Okyere
- Department of Public Health, College of Medicine Nursing and Health Sciences-Tamavua Campus, Fiji National University, Suva, Fiji
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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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Esau N, English R, Shung-King M. An assessment of a 'training-of-trainers programme for clinic committees' in a South African district: a qualitative exploratory study. BMC Health Serv Res 2020; 20:1101. [PMID: 33256722 PMCID: PMC7702689 DOI: 10.1186/s12913-020-05921-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 11/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background In South Africa (SA), clinics and community health centres are the predominant primary level health care facilities in the public health sector. As part of legislated health governance requirements, clinic committees (referring to those for clinics and community health centres) were established to provide management oversight and bring to bear the perspectives and participation of communities at Primary Health Care (PHC) facilities. Clinic committees need training in order to better understand their roles. Facilitators in a district of SA were trained through a designated programme, called the ‘PHC Facility Governance Structures Trainer-of-Facilitator (ToF) Learning Programme‘, in preparation for the training of clinic committees. This paper explores how the programme had evolved and was experienced by the trained facilitators, in a district in SA. Methods We employed a retrospective qualitative case study design, guided by the Illuminative Evaluation Framework, with the training programme in the selected district as the case. The study assessed whether the intended aims of the training programme were clearly conveyed by the trainers, and how participants understood and subsequently conveyed the training programme intentions to the clinic committees. Key informant interviews and focus group discussions were conducted with trainers and managers, complemented by a review of relevant policy and legislative documents, and published literature. Study participants were purposively selected based on their involvement in the development, facilitation or training of the programme. Thirteen individuals participated in the study, and 23 (national, provincial and partner) documents were reviewed. Results Despite the different perceptions and understandings of the ToF Learning Programme, its overall aims were achieved. Trainers’ capacity was strengthened and clinic committees were trained accordingly. The training programme holds promise for possible national scale-up. The high quality of the interactive posters can be considered equally valuable as a training tool as the training manuals. Conclusions Trainers’ capacity was strengthened and clinic committees were trained accordingly, despite deviations in implementation of the original training approach and plan.
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Affiliation(s)
- Natasha Esau
- Health Systems Trust, 1 Maryvale Road, Westville, PO box 784, Durban, 3630, South Africa. .,Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Falmouth Road, Observatory, Cape Town, 7925, South Africa.
| | - René English
- Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Private 1243 Bag X1, Matieland, Stellenbosch, 7602, South Africa
| | - Maylene Shung-King
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Falmouth Road, Observatory, Cape Town, 7925, South Africa
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Hill Z, Scheelbeek P, Hamza Y, Amare Y, Schellenberg J. Are We Using the Right Approach to Change Newborn Care Practices in the Community? Qualitative Evidence From Ethiopia and Northern Nigeria. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:383-395. [PMID: 32709596 PMCID: PMC7541120 DOI: 10.9745/ghsp-d-19-00410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 06/12/2020] [Indexed: 11/25/2022]
Abstract
In Ethiopia, high community-level exposure to consistent messages and the perceptions of community health workers and relationships with them drove newborn care behavior change. In Nigeria, exposure to messages was limited, community health workers were less trusted, and behavior change was reported less frequently. Changing behaviors is usually a core component of the role of community health workers (CHWs), but little is known about the mechanisms through which they change behavior. We collected qualitative data from 8 sites in Ethiopia and northern Nigeria where CHWs were active to understand how they change newborn care behaviors. In each country, we conducted 12 narrative interviews and 12–13 in-depth interviews with recent mothers and 4 focus group discussions each with mothers, fathers, grandmothers, and CHWs. We identified 2 key mechanisms of behavior change. The first was linked to the frequency and consistency of hearing messages that led to a perception that change had occurred in community-wide behaviors, collective beliefs, and social expectations. The second was linked to trust in the CHW, obligation, and hierarchy. We found little evidence that constructs that often inform the design of counseling approaches, such as knowledge of causality and perceived risks and benefits, were mechanisms of change.
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Affiliation(s)
| | | | | | - Yared Amare
- Consultancy for Social Development, Addis Ababa, Ethiopia
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Tuyisenge G, Crooks VA, Berry NS. Using an ethics of care lens to understand the place of community health workers in Rwanda's maternal healthcare system. Soc Sci Med 2020; 264:113297. [PMID: 32841903 DOI: 10.1016/j.socscimed.2020.113297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/28/2020] [Accepted: 08/12/2020] [Indexed: 11/17/2022]
Abstract
This study explores the informal care roles involved in the delivery of maternal health services by Rwanda's elected maternal community health workers. We conducted semi-structured interviews with 20 such workers in five Rwandan districts to explore their understandings of why they were elected for this voluntary position; what motivates them to fulfill their responsibilities; and their experiences of providing maternal health services in a resource-limited context. Thematically exploring the findings using an ethics of care lens, we highlight how responsibility, vulnerability and mutuality inform the place of these workers' roles in the maternal care system and their villages. We conclude by acknowledging the significant responsibilities assigned by these works and that the burden that may result from taking on such care may negatively affect the sustainability of this initiative.
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Affiliation(s)
| | - Valorie A Crooks
- Department of Geography, Simon Fraser University, Burnaby, Canada.
| | - Nicole S Berry
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
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Dassah E, Aldersey H, McColl MA, Davison C. Factors affecting access to primary health care services for persons with disabilities in rural areas: a "best-fit" framework synthesis. Glob Health Res Policy 2018; 3:36. [PMID: 30603678 PMCID: PMC6305566 DOI: 10.1186/s41256-018-0091-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/03/2018] [Indexed: 12/14/2022] Open
Abstract
Background Access to primary health care (PHC) is a fundamental human right and central in the performance of health care systems, however persons with disabilities (PWDs) generally experience greater barriers in accessing PHC than the general population. These problems are further exacerbated for those with disabilities in rural areas. Understanding PHC access for PWDs is particularly important as such knowledge can inform policies, clinical practice and future research in rural settings. Methods We conducted a synthesis of published literature to explore the factors affecting access to PHC for PWDs in rural areas globally. Using an adapted keyword search string we searched five databases (CINAHL, EMBASE, Global Health, Medline and Web of Science), key journals and the reference lists of included articles. We imported the articles into NVivo and conducted deductive (framework) analysis by charting the data into a rural PHC access framework. We subsequently conducted inductive (thematic) analysis. Results We identified 36 studies that met our inclusion criteria. A majority (n = 26) of the studies were conducted in low-and middle-income countries. We found that PWDs were unable to access PHC due to obstacles including the interplay of four major factors; availability, acceptability, geography and affordability. In particular, limited availability of health care facilities and services and perceived low quality of care meant that those in need of health care services frequently had to travel for care. The barrier of geographic distance was worsened by transportation problems. We also observed that where health services were available most people could not afford the cost. Conclusion Our synthesis noted that modifying the access framework to incorporate relationships among the barriers might help better conceptualize PHC access challenges and opportunities in rural settings. We also made recommendations for policy development, practice consideration and future research that could lead to more equitable access to health care. Importantly, there is the need for health policies that aim address rural health problems to consider all the dimensions and their interactions. In terms of practice, the review also highlights the need to provide in-service training to health care providers on how to enhance their communication skills with PWDs. Future research should focus on exploring access in geographical contexts with different health care systems, the perspectives of health care providers and how PWDs respond to access problems in rural settings. Electronic supplementary material The online version of this article (10.1186/s41256-018-0091-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ebenezer Dassah
- 1School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston, Ontario K7L 3N6 Canada
| | - Heather Aldersey
- 1School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston, Ontario K7L 3N6 Canada
| | - Mary Ann McColl
- 1School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston, Ontario K7L 3N6 Canada
| | - Colleen Davison
- 2Department of Public Health Sciences, Queen's University, Carruthers Hall, 62 Fifth Field Company Lane, Kingston, Ontario K7L 3N6 Canada
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Mohajer N, Singh D. Factors enabling community health workers and volunteers to overcome socio-cultural barriers to behaviour change: meta-synthesis using the concept of social capital. HUMAN RESOURCES FOR HEALTH 2018; 16:63. [PMID: 30463573 PMCID: PMC6249815 DOI: 10.1186/s12960-018-0331-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/06/2018] [Indexed: 05/30/2023]
Abstract
BACKGROUND Community-based health workers and volunteers are not just low-level health workforce; their effectiveness is also due to their unique relationship with the community and is often attributed to social capital, an area not well studied or acknowledged in the literature. METHODS A qualitative meta-synthesis was conducted using the SPIDER framework and based on critical interpretive synthesis. The protocol was registered with PROSPERO, ID = CRD42018084130. This article reports on the qualitative data extracted from the final 33 articles selected from 147 full-text articles on social capital and community-based health systems. RESULTS Three constructs were identified that enable community health workers to bring about changes in behaviour in the community: seeing their role as a service or a calling motivated by altruistic values, accompanying community members on their journey and the aim of the journey being empowerment rather than health. Community health workers feel under-resourced to provide for expectations from the community, to fulfil their non-health needs, to meet the expectations of their employers and to be able to deliver health services. CONCLUSION The dichotomy of needs between the community and health services can be resolved if policy makers and programme designers examine the possibility of two cadres of community-based health workforce: full-time workers and part-time volunteers, with clear scopes of practice and supervision. Community health workers would primarily be concerned with task shifting roles demanded by programmes, and volunteers can focus on the wider empowerment-based needs of communities.
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Affiliation(s)
- Nicole Mohajer
- School of Public Health, College of Health and Medical Sciences, Haramaya University, P.O. BOX 138, 3020, Dire Dawa, Ethiopia.
| | - Debra Singh
- Child and Adolescent Health Service, Health Department, Government of Western Australia, 189 Royal Street, East Perth, WA, 6004, Australia
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Cerón A, Ruano AL, Sánchez S, Chew AS, Díaz D, Hernández A, Flores W. Abuse and discrimination towards indigenous people in public health care facilities: experiences from rural Guatemala. Int J Equity Health 2016; 15:77. [PMID: 27177690 PMCID: PMC4866428 DOI: 10.1186/s12939-016-0367-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background Health inequalities disproportionally affect indigenous people in Guatemala. Previous studies have noted that the disadvantageous situation of indigenous people is the result of complex and structural elements such as social exclusion, racism and discrimination. These elements need to be addressed in order to tackle the social determinants of health. This research was part of a larger participatory collaboration between Centro de Estudios para la Equidad y Gobernanza en los Servicios de Salud (CEGSS) and community based organizations aiming to implement social accountability in rural indigenous municipalities of Guatemala. Discrimination while seeking health care services in public facilities was ranked among the top three problems by communities and that should be addressed in the social accountability intervention. This study aimed to understand and categorize the episodes of discrimination as reported by indigenous communities. Methods A participatory approach was used, involving CEGSS’s researchers and field staff and community leaders. One focus group in one rural village of 13 different municipalities was implemented. Focus groups were aimed at identifying instances of mistreatment in health care services and documenting the account of those who were affected or who witnessed them. All of the 132 obtained episodes were transcribed and scrutinized using a thematic analysis. Results Episodes described by participants ranged from indifference to violence (psychological, symbolic, and physical), including coercion, mockery, deception and racism. Different expressions of discrimination and mistreatment associated to poverty, language barriers, gender, ethnicity and social class were narrated by participants. Conclusions Addressing mistreatment in public health settings will involve tackling the prevalent forms of discrimination, including racism. This will likely require profound, complex and sustained interventions at the programmatic and policy levels beyond the strict realm of public health services. Future studies should assess the magnitude of the occurrence of episodes of maltreatment and racism within indigenous areas and also explore the providers’ perceptions about the problem.
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Affiliation(s)
- Alejandro Cerón
- Center for the Study of Equity and Governance in Health Systems (CEGSS), Guatemala, Guatemala. .,University of Denver, Denver, CO, 80208, USA.
| | - Ana Lorena Ruano
- Center for the Study of Equity and Governance in Health Systems (CEGSS), Guatemala, Guatemala
| | - Silvia Sánchez
- Center for the Study of Equity and Governance in Health Systems (CEGSS), Guatemala, Guatemala
| | - Aiken S Chew
- Center for the Study of Equity and Governance in Health Systems (CEGSS), Guatemala, Guatemala
| | - Diego Díaz
- Center for the Study of Equity and Governance in Health Systems (CEGSS), Guatemala, Guatemala
| | - Alison Hernández
- Center for the Study of Equity and Governance in Health Systems (CEGSS), Guatemala, Guatemala
| | - Walter Flores
- Center for the Study of Equity and Governance in Health Systems (CEGSS), Guatemala, Guatemala
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Bhatnagar A, Gupta S, Alonge O, George AS. Primary health care workers' views of motivating factors at individual, community and organizational levels: a qualitative study from Nasarawa and Ondo states, Nigeria. Int J Health Plann Manage 2016; 32:217-233. [DOI: 10.1002/hpm.2342] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 01/25/2016] [Accepted: 02/01/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Aarushi Bhatnagar
- Department of International Health, Johns Hopkins Bloomberg School of Public Health; Baltimore USA
| | - Shivam Gupta
- Department of International Health, Johns Hopkins Bloomberg School of Public Health; Baltimore USA
| | - Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health; Baltimore USA
| | - Asha S. George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health; Baltimore USA
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Nzioki JM, Onyango RO, Ombaka JH. Efficiency and factors influencing efficiency of Community Health Strategy in providing Maternal and Child Health services in Mwingi District, Kenya: an expert opinion perspective. Pan Afr Med J 2015; 20:88. [PMID: 26090046 PMCID: PMC4450026 DOI: 10.11604/pamj.2015.20.88.4711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 01/24/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Community Health Strategy (CHS) is a new Primary Health Care (PHC) model in Kenya, designed to provide PHC services in Kenya. In 2011, CHS was initiated in Mwingi district as one of the components of APHIA plus kamili program. The objectives of this study was to evaluate the efficiency of the CHS in providing MCH services in Mwingi district and to establish the factors influencing efficiency of the CHS in providing MCH services in the district. Methods This was a qualitative study. Fifteen Key informants were sampled from key stakeholders. Sampling was done using purposive and maximum variation sampling methods. Semi-structured in-depth interviews were used for data collection. Data was managed and analyzed using NVIVO. Framework analysis and quasi statistics were used in data analysis. Results Expert opinion data indicated that the CHS was efficient in providing MCH services. Factors influencing efficiency of the CHS in provision of MCH services were: challenges facing Community Health Workers (CHWs), Social cultural and economic factors influencing MCH in the district, and motivation among CHWs. Conclusion Though CHS was found to be efficient in providing MCH services, this was an expert opinion perspective, a quantitative Cost Effectiveness Analysis (CEA) to confirm these findings is recommended. To improve efficiency of the CHS in the district, challenges facing CHWs and Social cultural and economic factors that influence efficiency of the CHS in the district need to be addressed.
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Affiliation(s)
| | | | - James Herbert Ombaka
- Department of Biomedical Sciences and Technology, Maseno University, Kisumu, Kenya
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12
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Ruano AL, Sánchez S, Jerez FJ, Flores W. Making the post-MDG global health goals relevant for highly inequitable societies: findings from a consultation with marginalized populations in Guatemala. Int J Equity Health 2014; 13:57. [PMID: 25301549 PMCID: PMC4283118 DOI: 10.1186/1475-9276-13-57] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 06/10/2014] [Indexed: 11/23/2022] Open
Abstract
Introduction The United Nations presented a set of Millennium Development Goals that aimed to improve social and economic development and eradicate poverty by 2015. Most low and middle-income countries will not meet these goals and today there is a need to set new development agenda, especially when it comes to health. The paper presents the findings from a community consultation process carried out within the Goals and Governance for Global Health (GO4Health) research consortium in Guatemala, which aims to identify community needs and expectations around public policies and health services. Methods Through a participative and open consultation process with experts, civil society organizations and members of the research team, the municipalities of Tectitan and Santa Maria Nebaj were selected. A community consultation process was undertaken with community members and community leaders. Group discussions and in-depth interviews were conducted and later analyzed using thematic analysis, a qualitative method that can be used to analyze data in a way that allows for the identification of recurrent patterns that can be grouped into categories and themes, was used. Findings Following the Go4Health framework’s domains for understanding health-related needs, the five themes identified were health, social determinants of health, essential health needs and their provision, roles and responsibilities of relevant stakeholders and community participation in decision-making. Participants reported high levels of discrimination related to ethnicity, to being poor and to living in rural areas. Ethnicity played a major role in how community members feel they are cared for in the health system. Conclusion Achieving health goals in a context of deep-rooted inequality and marginalization requires going beyond the simple expansion of health services and working with developing trusting relationships between health service providers and community members. Involving community members in decision-making processes that shape policies will contribute to a larger process of community empowerment and democratization. Still, findings from the region show that tackling these issues may prove complicated and require going beyond the health system, as this lack of trust and discrimination has permeated to all public policies that deal with indigenous and rural populations.
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Affiliation(s)
- Ana Lorena Ruano
- Center for International Health, University of Bergen, Bergen, Norway.
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Mulumba M, Nantaba J, Brolan CE, Ruano AL, Brooker K, Hammonds R. Perceptions and experiences of access to public healthcare by people with disabilities and older people in Uganda. Int J Equity Health 2014; 13:76. [PMID: 25928896 PMCID: PMC4188877 DOI: 10.1186/s12939-014-0076-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 08/20/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction In the year 2000, a set of eight Millennium Development Goals (MDGs) were presented as a way to channel global efforts into the reduction of poverty and the promotion of social development. A global discussion regarding how to renew these goals is underway and it is in this context that the Goals and Governance for Global Health (Go4Health) research consortium conducted consultations with marginalized communities in Asia, Latin America, the Pacific and Africa as a way to include their voices in world’s new development agenda. The goal of this paper is to present the findings of the consultations carried out in Uganda with two groups within low-resource settings: older people and people living with disabilities. Methods This qualitative study used focus group discussions and key informant interviews with older people in Uganda’s Kamwenge district, and with persons with disabilities from the Gulu region. Thematic analysis was performed and emerging categories and themes identified and presented in the findings. Findings Our findings show that a sense of community marginalization is present within both older persons and persons living with disabilities. These groups report experiencing political sidelining, discrimination and inequitable access to health services. This is seen as the key reason for their poor health. Clinical services were found to be of low quality with little or no access to facilities, trained personnel, and drugs and there are no rehabilitative or mental health services available. Conclusion Uganda must fulfil its international obligations and take progressive measures to meet the right to health for all its peoples, but especially allocate its limited resources to proactively support its most marginalized citizens. The growing impetus within post-2015 development negotiations to redress in-country health and other inequalities through a comprehensive systems approach is of importance in the Ugandan development context. This approach reflects the participant’s perspectives, which also calls for a more equitable approach to health and development as opposed to a narrow, vertical focus on specific population groups, as was the case with the MDGs.
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Affiliation(s)
- Moses Mulumba
- Center for Health, Human Rights and Development, Kampala, Uganda.
| | - Juliana Nantaba
- Center for Health, Human Rights and Development, Kampala, Uganda.
| | - Claire E Brolan
- School of Population Health, The University of Queensland, Brisbane, Australia.
| | - Ana Lorena Ruano
- Department of Global Public Health and Primary Care, Center for International Health, University of Bergen, Centro de Estudios para la Equidad y Gobernanza en los Sistemas de Salud, Bergen, Guatemala, Guatemala.
| | - Katie Brooker
- Queensland Centre for Intellectual and Developmental Disability, The University of Queensland, Brisbane, Australia.
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Daniels K, Odendaal WA, Nkonki L, Hongoro C, Colvin CJ, Lewin S. Incentives for lay health workers to improve recruitment, retention in service and performance. Hippokratia 2014. [DOI: 10.1002/14651858.cd011201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Karen Daniels
- Medical Research Council of South Africa; Health Systems Research Unit; PO Box 19070 Tygerberg South Africa 7505
| | - Willem A Odendaal
- Medical Research Council of South Africa; Health Systems Research Unit; PO Box 19070 Tygerberg South Africa 7505
| | - Lungiswa Nkonki
- Medical Research Council of South Africa; Health Systems Research Unit; PO Box 19070 Tygerberg South Africa 7505
- Stellenbosch University; Centre for Health Systems and Services Research and Development; Cape Town South Africa
| | - Charles Hongoro
- Medical Research Council of South Africa; Health Systems Research Unit; PO Box 19070 Tygerberg South Africa 7505
- Human Sciences Research Council; Health Systems Financing, Population Health, Health Systems and Innovation Programme; Cape Town South Africa
| | - Christopher J Colvin
- School of Public Health and Family Medicine, University of Cape Town; Centre for Infectious Disease Epidemiology and Research (CIDER); 7 Alfred St., Observatory 7925 Cape Town South Africa
| | - Simon Lewin
- Medical Research Council of South Africa; Health Systems Research Unit; PO Box 19070 Tygerberg South Africa 7505
- Norwegian Knowledge Centre for the Health Services; Global Health Unit; Box 7004 St Olavsplass Oslo Norway N-0130
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15
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Zulu JM, Kinsman J, Michelo C, Hurtig AK. Hope and despair: community health assistants' experiences of working in a rural district in Zambia. HUMAN RESOURCES FOR HEALTH 2014; 12:30. [PMID: 24886146 PMCID: PMC4065545 DOI: 10.1186/1478-4491-12-30] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 04/29/2014] [Indexed: 05/16/2023]
Abstract
BACKGROUND In order to address the challenges facing the community-based health workforce in Zambia, the Ministry of Health implemented the national community health assistant strategy in 2010. The strategy aims to address the challenges by creating a new group of workers called community health assistants (CHAs) and integrating them into the health system. The first group started working in August 2012. The objective of this paper is to document their motivation to become a CHA, their experiences of working in a rural district, and how these experiences affected their motivation to work. METHODS A phenomenological approach was used to examine CHAs' experiences. Data collected through in-depth interviews with 12 CHAs in Kapiri Mposhi district and observations were analysed using a thematic analysis approach. RESULTS Personal characteristics such as previous experience and knowledge, passion to serve the community and a desire to improve skills motivated people to become CHAs. Health systems characteristics such as an inclusive work culture in some health posts motivated CHAs to work. Conversely, a non-inclusive work culture created a social structure which constrained CHAs' ability to learn, to be innovative and to effectively conduct their duties. Further, limited supervision, misconceptions about CHA roles, poor prioritisation of CHA tasks by some supervisors, as well as non- and irregular payment of incentives also adversely affected CHAs' ability to work effectively. In addition, negative feedback from some colleagues at the health posts affected CHA's self-confidence and professional outlook. In the community, respect and support provided to CHAs by community members instilled a sense of recognition, appreciation and belonging in CHAs which inspired them to work. On the other hand, limited drug supplies and support from other community-based health workers due to their exclusion from the government payroll inhibited CHAs' ability to deliver services. CONCLUSIONS Programmes aimed at integrating community-based health workers into health systems should adequately consider multiple incentives, effective management, supervision and support from the district. These should be tailored towards enhancing the individual, health system and community characteristics that positively impact work motivation at the local level if such programmes are to effectively contribute towards improved primary healthcare.
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Affiliation(s)
- Joseph Mumba Zulu
- Department of Public Health, School of Medicine, University of Zambia, P.O. Box 50110, Lusaka, Zambia
- Umeå International School of Public Health (UISPH), Umeå University, Umeå SE 90185, Sweden
| | - John Kinsman
- Umeå International School of Public Health (UISPH), Umeå University, Umeå SE 90185, Sweden
| | - Charles Michelo
- Department of Public Health, School of Medicine, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Anna-Karin Hurtig
- Umeå International School of Public Health (UISPH), Umeå University, Umeå SE 90185, Sweden
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Greenspan JA, McMahon SA, Chebet JJ, Mpunga M, Urassa DP, Winch PJ. Sources of community health worker motivation: a qualitative study in Morogoro Region, Tanzania. HUMAN RESOURCES FOR HEALTH 2013; 11:52. [PMID: 24112292 PMCID: PMC3852396 DOI: 10.1186/1478-4491-11-52] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 09/14/2013] [Indexed: 05/13/2023]
Abstract
BACKGROUND There is a renewed interest in community health workers (CHWs) in Tanzania, but also a concern that low motivation of CHWs may decrease the benefits of investments in CHW programs. This study aimed to explore sources of CHW motivation to inform programs in Tanzania and similar contexts. METHODS We conducted semi-structured interviews with 20 CHWs in Morogoro Region, Tanzania. Interviews were digitally recorded, transcribed, and coded prior to translation and thematic analysis. The authors then conducted a literature review on CHW motivation and a framework that aligned with our findings was modified to guide the presentation of results. RESULTS Sources of CHW motivation were identified at the individual, family, community, and organizational levels. At the individual level, CHWs are predisposed to volunteer work and apply knowledge gained to their own problems and those of their families and communities. Families and communities supplement other sources of motivation by providing moral, financial, and material support, including service fees, supplies, money for transportation, and help with farm work and CHW tasks. Resistance to CHW work exhibited by families and community members is limited. The organizational level (the government and its development partners) provides motivation in the form of stipends, potential employment, materials, training, and supervision, but inadequate remuneration and supplies discourage CHWs. Supervision can also be dis-incentivizing if perceived as a sign of poor performance. CONCLUSIONS Tanzanian CHWs who work despite not receiving a salary have an intrinsic desire to volunteer, and their motivation often derives from support received from their families when other sources of motivation are insufficient. Policy-makers and program managers should consider the burden that a lack of remuneration imposes on the families of CHWs. In addition, CHWs' intrinsic desire to volunteer does not preclude a desire for external rewards. Rather, adequate and formal financial incentives and in-kind alternatives would allow already-motivated CHWs to increase their commitment to their work.
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Affiliation(s)
- Jesse A Greenspan
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Shannon A McMahon
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Joy J Chebet
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Maurus Mpunga
- Department of Labour Studies, Institute of Social Work, P.O. Box 3375, Dar es Salaam, Tanzania
| | - David P Urassa
- Muhimbili University of Health and Allied Sciences, P.O Box 65015, Dar es Salaam, Tanzania
| | - Peter J Winch
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA
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