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Stansert Katzen L, Reid S, Laurenzi C, Tomlinson M. From the periphery to inclusion within the health system: promoting community health worker empowerment as a way forward. BMC PRIMARY CARE 2024; 25:272. [PMID: 39060967 PMCID: PMC11282798 DOI: 10.1186/s12875-024-02523-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Community health worker programmes have the potential to contribute critically towards universal health coverage. However, CHWs globally have often continued to operate on the periphery of the health care system, viewed as a non-essential cadre. This results in a workforce that often remains disempowered and under-supported. This paper presents evidence from a study conducted in a rural part of South Africa, to better understand issues of CHW prioritisation, integration, and empowerment. METHODS We applied an analytical lens based on empowerment theory and conducted a secondary analysis of qualitative data emerging from a sub-study of a cRCT evaluating the effectiveness of supportive supervision for CHWs within a large-scale national CHW programme. The cRCT was conducted between 2017 and 2022, and 39 CHWs were included in the study. RESULTS We organised our findings across the four domains of structural empowerment; information, resources, support, and opportunity, and mapped these domains against the domains of psychological empowerment. Our findings show how CHWs are still working in the periphery of the healthcare system. Without sufficient prioritisation, high level-support from national and district governments, and sufficient investments in programmatic domains-such as training, equipment, and supportive supervision-it is likely that the CHW cadre will continue to be seen as informal health care workers. CONCLUSIONS CHW empowerment could be a lever to potentially transform the current health system towards universal coverage; however, this process can only happen with sufficient high-level prioritization and investment.
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Affiliation(s)
- Linnea Stansert Katzen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, 6023 Clinical Building, Francie van Zijl Drive, Tygerberg Campus, Cape Town, Tygerberg, 7505, South Africa.
- Swedesd, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Steve Reid
- Department of Family, Community and Emergency Care, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa
| | - Christina Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, 6023 Clinical Building, Francie van Zijl Drive, Tygerberg Campus, Cape Town, Tygerberg, 7505, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, 6023 Clinical Building, Francie van Zijl Drive, Tygerberg Campus, Cape Town, Tygerberg, 7505, South Africa
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
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Maluleke NP. A call for linguistic and culturally congruent family-centred early hearing detection and intervention programmes in South Africa. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2024; 71:e1-e4. [PMID: 38572898 PMCID: PMC11019058 DOI: 10.4102/sajcd.v71i1.992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 04/05/2024] Open
Abstract
Early Hearing Detection and Intervention (EHDI) programmes are recognised as the standard of care for newborns and infants presenting with hearing impairment, globally. However, widespread implementation of these programmes is far from being realised and faces numerous challenges within the South African context. The United Nations' sustainable development goal 3.8 and South Africa's national development plan seek to achieve equitable access to healthcare service, including EHDI. However, healthcare access is a complex concept which encompasses the dimensions: availability, affordability, acceptability and accommodation in healthcare. South Africa has made great progress towards universal implementation of EHDI programmes. Despite this progress, availability and affordability of these programmes are limited and their acceptability has received limited research focus in this context. Furthermore, accommodation of caregivers, as co-drivers of EHDI programmes and ensuring that EHDI programmes are linguistically and culturally congruent have also been overlooked within the South African context.Contribution: Increased robust efforts in improving access through availability and affordability of EHDI programmes are warranted in South Africa. However, improving access to these programmes through availability and affordability initiatives alone will not result in a pragmatic improvement in their accessibility. Acceptability of these programmes and accommodations such as involving caregivers and family members of children with hearing impairment as equal partners in EHDI programmes and being cognisant of their linguistic and cultural needs must be considered.
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Affiliation(s)
- Ntsako P Maluleke
- Department of Audiology, Faculty of Humanities, University of the Witwatersrand, Johannesburg.
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Dougherty L, Mathur S, Gul X, Spielman K, Tripathi V, Wakefield C, Silva M. Methods and Measures to Assess Health Care Provider Behavior and Behavioral Determinants in Reproductive, Maternal, Newborn, and Child Health: A Rapid Review. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200407. [PMID: 38035722 PMCID: PMC10698233 DOI: 10.9745/ghsp-d-22-00407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 06/23/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Health care provider behavior is the outcome of a complex set of factors that are both internal and external to the provider. Social and behavior change (SBC) programs are increasingly engaging providers and introducing strategies to improve their service delivery. However, there is limited understanding of methods and measures applied to assess provider behavioral outcomes and strengthen provider behavior change programming. METHODS Using PubMed, we conducted a rapid review of published research on behaviors of health workers providing reproductive, maternal, newborn, and child health services in low- and middle-income countries (2010-2021). Information on study identifiers (e.g., type of provider), select domains from Green and Kreuter's PRECEDE-PROCEED framework (e.g., predisposing factors such as attitudes), study characteristics (e.g., study type and design), and evidence of theory-driven research were extracted from a final sample of articles (N=89) and summarized. RESULTS More than 80% of articles were descriptive/formative and examined knowledge, attitudes, and practice, mostly related to family planning. Among the few evaluation studies, training-focused interventions to increase provider knowledge or improve competency in providing a health service were dominant. Research driven by behavioral theory was observed in only 3 studies. Most articles (75%) focused on the quality of client-provider interaction, though topics and modes of measurement varied widely. Very few studies incorporated a validated scale to measure underlying constructs, such as attitudes and beliefs, and how these may be associated with provider behaviors. CONCLUSION A need exists for (1) theory-driven approaches to designing and measuring provider behavior change interventions and (2) measurement that addresses important internal and structural factors related to a provider's behavior (beyond knowledge-enhancing training approaches). Additional investment in implementation research is also needed to better understand which SBC approaches are shifting provider behavior and improving client-provider interactions. Finally, theory-driven approaches could help develop empirically measurable and comparable outcomes.
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Affiliation(s)
| | | | - Xaher Gul
- Pathfinder International, Karachi, Pakistan
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Katzen LS, Skeen S, Dippenaar E, Laurenzi C, Notholi V, le Roux K, le Roux I, WaluWalu N, Mbewu N, Borus MJR, Tomlinson M. Community Health Workers' experiences of a package providing increased support and supervision - a qualitative study of a home visiting model in rural South Africa. RESEARCH SQUARE 2023:rs.3.rs-3333610. [PMID: 37841874 PMCID: PMC10571624 DOI: 10.21203/rs.3.rs-3333610/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Deploying Community Health Workers is a crucial strategy to improve health at a community level in low and middle income countries. While there is substantial evidence for CHW effectiveness, there is a need for more research on the mechanisms through which these programs work. Understanding CHWs experiences of how programmes function is important. This article examines CHW's experiences of three key programmatic domains; training, logistical support and supervision. Data were gathered using a qualitative study embedded within a cluster randomized controlled trial of an enhanced supervision package delivered to government-employed CHWs in the rural Eastern Cape, South Africa. We interviewed CHWs (n = 16) and two supervisors. Three overarching areas and five sub-themes emerged from our interviews. CHW knowledge and confidence increased through additional training, that CHW motivation and community acceptance improved because of added logistical support, and that CHW supervision led to improved sense of accountability, feelings of respect, and sense of being supported. Our findings highlight the importance of a functional support system within which CHWs can operate, in a context where most CHWs operate in isolation and without support. CHWs receiving supportive supervision reported positive impacts on their motivation and ability to carry out their work effectively.
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Petersen Williams P, Erasmus J, Myers B, Nadkarni A, Fuhr DC. Community-based counselling programme for pregnant women with alcohol problems in Cape Town, South Africa: a qualitative study of the views of pregnant women and healthcare professionals. Front Psychiatry 2023; 14:1203835. [PMID: 37484680 PMCID: PMC10357510 DOI: 10.3389/fpsyt.2023.1203835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction South Africa lacks services to detect and address alcohol use during pregnancy, particularly outside of health-care facilities. This study aimed to explore pregnant women and healthcare providers' perceptions of the acceptability, feasibility and appeal of a community-based counselling programme for pregnant women with alcohol problems. Methods Twenty-eight in-depth interviews with pregnant women who drink, Community Health Workers (CHWs) and antenatal service providers were conducted. Transcribed interviews were analyzed thematically using a combined deductive and inductive approach. Results Women reported feeling uncomfortable seeking help for their alcohol use at antenatal clinics, limiting usefulness of current support services. All stakeholders perceived a community-based intervention to be acceptable and feasible as it could be integrated with other CHW-delivered services. Participants thought an intervention should facilitate early linkage to antenatal services and should include partners or family members. The feasibility of an intervention may depend on the relationship between CHWs and clinic-based antenatal staff, and their relationships with pregnant women. Clinic and community challenges to implementation were raised. Clinic-level challenges included shortage of space, staff capacity, high number of pregnant women, long waiting times, financial burden of having to travel to a clinic, lack of comfort and privacy and staff attitudes. Community-level challenges included crime, lack of privacy, lack of attention given competing interests in the home, fear due to abuse, and stigma and discrimination from other community members. Suggestions for overcoming these challenges were provided. Conclusion Findings provide essential information to facilitate the adaptation of a community-based alcohol counselling programme for greater acceptability, feasibility and cultural appropriateness for the South African context. Intensive training, supervision and support is required to ensure the programme is delivered as planned.
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Affiliation(s)
- Petal Petersen Williams
- Mental Health, Alcohol, Substance use and Tobacco Research Unit, South African Medical Research Unit, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Jodilee Erasmus
- Mental Health, Alcohol, Substance use and Tobacco Research Unit, South African Medical Research Unit, Cape Town, South Africa
| | - Bronwyn Myers
- Mental Health, Alcohol, Substance use and Tobacco Research Unit, South African Medical Research Unit, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Abhijit Nadkarni
- Centre for Global Mental Health (CGMH), Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Addictions Research Group, Sangath, Goa, India
| | - Daniela C. Fuhr
- Leibniz Institute of Prevention Research and Epidemiology, Bremen, Germany
- Health Sciences, University of Bremen, Bremen, Germany
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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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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7
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Malatji H, Griffiths F, Goudge J. Community-orientated primary health care: Exploring the interface between community health worker programmes, the health system and communities in South Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000881. [PMID: 36962793 PMCID: PMC10021906 DOI: 10.1371/journal.pgph.0000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023]
Abstract
Due to insufficient number of health workers and the evidence of the benefits of community health workers (CHWs), CHWs are being deployed to provide health care services to under-served communities. In this article, we explore to what extent the South African CHW programmes introduced between 2009 and 2011 are attuned to community needs, integrated into the healthcare system and community structures, and also implemented in accordance with community-orientated primary health care principles. Using a case study approach, we studied CHW teams in seven primary healthcare facilities located in semi-urban and rural areas of Gauteng and Mpumalanga provinces, South Africa. We collected data using in-depth interviews involving facility managers, CHW supervisors, community representatives and key informants, and focus groups and observations of CHWs. The implementation of community-orientated health interventions remains complex. In the different sites, there were efforts to integrate the views of stakeholders (e.g., political leaders) into the implementation of the CHW programmes. However, many residents were more concerned about access to housing than health services. The CHWs services' were found to be generally comprehensive, however inefficient training, supervision and mentorship limited their effectiveness. The multidisciplinary approach to care, as introduced by some sites, helped enhance the knowledge and skills of some of the CHWs on complex health topics. The roll out of community orientated primary health care services is crucial in a resource-constrained setting like South Africa. However, significant socio-economic issues disrupt community involvement and the effective provision of services. Governments need to provide sufficient funds for training, supervision, supplies and remuneration to help overcome these barriers.
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Affiliation(s)
- Hlologelo Malatji
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frances Griffiths
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jane Goudge
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Galle A, Moran AC, Bonet M, Graham K, Muzigaba M, Portela A, Day LT, Tuabu GK, Silva BDSÉ, Moller AB. Measures to assess quality of postnatal care: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001384. [PMID: 36963034 PMCID: PMC10021656 DOI: 10.1371/journal.pgph.0001384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/27/2023] [Indexed: 02/19/2023]
Abstract
High quality postnatal care is key for the health and wellbeing of women after childbirth and their newborns. In 2022, the World Health Organization (WHO) published global recommendations on maternal and newborn care for a positive postnatal care experience in a new WHO PNC guideline. Evidence regarding appropriate measures to monitor implementation of postnatal care (PNC) according to the WHO PNC guideline is lacking. This scoping review aims to document the measures used to assess the quality of postnatal care and their validity. The review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Five electronic bibliographic databases were searched together with a grey literature search. Two reviewers independently screened and appraised identified articles. All data on PNC measures were extracted and mapped to the 2022 WHO PNC recommendations according to three categories: i) maternal care, ii) newborn care, iii) health system and health promotion interventions. We identified 62 studies providing measures aligning with the WHO PNC recommendations. For most PNC recommendations there were measures available and the highest number of recommendations were found for breastfeeding and the assessment of the newborn. No measures were found for recommendations related to sedentary behavior, criteria to be assessed before discharge, retention of staff in rural areas and use of digital communication. Measure validity assessment was described in 24 studies (39%), but methods were not standardized. Our review highlights a gap in existing PNC measures for several recommendations in the WHO PNC guideline. Assessment of the validity of PNC measures was limited. Consensus on how the quality of PNC should be measured is needed, involving a selection of priority measures and the development of new measures as appropriate.
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Affiliation(s)
- Anna Galle
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Allisyn C Moran
- World Health Organization Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Mercedes Bonet
- World Health Organization Department of Sexual and Reproductive Health and Research, Development and Research Training in Human Reproduction (HRP), UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Geneva, Switzerland
| | - Katriona Graham
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, Ghent University, Belgium
| | - Moise Muzigaba
- World Health Organization Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Anayda Portela
- World Health Organization Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Louise Tina Day
- Department of Infectious Disease Epidemiology, Maternal Newborn Health Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Godwin Kwaku Tuabu
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, Ghent University, Belgium
| | - Bianca De Sá É Silva
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, Ghent University, Belgium
| | - Ann-Beth Moller
- World Health Organization Department of Sexual and Reproductive Health and Research, Development and Research Training in Human Reproduction (HRP), UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Geneva, Switzerland
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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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10
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Rizvi Jafree S, Khawar A, Momina AU, Khalid Mahmood Q. Infection preparedness of community health workers: implications for maternal and neonatal health services in Pakistan. Prim Health Care Res Dev 2022; 23:e27. [PMID: 35499097 PMCID: PMC9112673 DOI: 10.1017/s1463423622000081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 08/14/2021] [Accepted: 01/14/2022] [Indexed: 11/25/2022] Open
Abstract
AIM This study aimed to (i) identify community health workers' (CHWs) perceived satisfaction for maternal and neonatal health services, with respect to (1) socio-demographic characteristics; (2) coronavirus preparedness; (3) coronavirus responsiveness; and (4) employee satisfaction and (ii) investigate the interplay among study variables to identify the role of direct effects and mediation. BACKGROUND Women CHWs are salient providers for maternal and neonatal services at the primary level, especially in conservative regions. Service delivery is a valuable indicator for mother and newborn wellbeing. There is need for empirical evidence to understand how CHWs may be supported in delivering maternal and neonatal health services during pandemics. METHODS Bivariate regression was used to identify the lower odds for CHWs' perceived satisfaction for maternal and neonatal health services. In addition, structural equation modeling was used to investigate if coronavirus responsiveness and employee satisfaction as mediating variables influence the relationship between coronavirus preparedness and maternal and neonatal health services. Data were collected telephonically from 350 CHWs. The sample was representative of 35 districts of Punjab, which is the most populated province in the country. FINDINGS We found thirty predictors with respect to coronavirus preparedness, coronavirus responsiveness and employee satisfaction which contribute to lower odds of satisfaction for maternal and neonatal health services. We also found that coronavirus preparedness has a direct effect on maternal and neonatal health service satisfaction (β = .242, P < .001) and an indirect effect on maternal health satisfaction (β = .242, P < .001) via the mediation of employee satisfaction. We conclude with four critical recommendations to support CHWs in delivering optimal services, comprising of education and training, operational support, public acceptance, and employee support and benefits. The findings are important for the planning of primary health services and governance support for CHWs and poor women clients in Pakistan and other developing countries.
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Affiliation(s)
- Sara Rizvi Jafree
- Department of Sociology, Forman Christian College University, Lahore, Pakistan
| | - Amna Khawar
- Department of Psychology, Lahore College of Women University, Lahore, Pakistan
| | - Ain ul Momina
- Institute of Public Health, King Edward Medical University
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Perveen S, Lassi ZS, Mahmood MA, Perry HB, Laurence C. Application of primary healthcare principles in national community health worker programmes in low-income and middle-income countries: a scoping review. BMJ Open 2022; 12:e051940. [PMID: 35110314 PMCID: PMC8811559 DOI: 10.1136/bmjopen-2021-051940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 01/05/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify which primary healthcare (PHC) principles are reflected in the implementation of national community health worker (CHW) programmes and how they may contribute to the outcomes of these programmes in the context of low-income and middle-income countries (LMICs). DESIGN Scoping review. DATA SOURCES A systematic search was conducted through PubMed, CINAHL, EMBASE and Scopus databases. ELIGIBILITY CRITERIA The review considered published primary studies on national programmes, projects or initiatives using the services of CHWs in LMICs focused on maternal and child health. We included only English language studies. Excluded were programmes operated by non-government organisations, study protocols, reviews, commentaries, opinion papers, editorials and conference proceedings. DATA EXTRACTION AND SYNTHESIS We reviewed the application of four PHC principles (universal health coverage, community participation, intersectoral coordination and appropriateness) in the CHW programme's objectives, implementation and stated outcomes. Data extraction was undertaken systematically in an excel spreadsheet while the findings were synthesised in a narrative manner. The quality appraisal of the selected studies was not performed in this scoping review. RESULTS From 1280 papers published between 1983 and 2019, 26 met the inclusion criteria. These 26 papers included 14 CHW programmes from 13 LMICs. Universal health coverage and community participation were the two commonly reported PHC principles, while intersectoral coordination was generally missing. Similarly, the cultural acceptability aspect of the principle of appropriateness was present in all programmes as these programmes select CHWs from within the communities. Other aspects, particularly effectiveness, were not evident. CONCLUSION The implementation of PHC principles across national CHW programmes in LMICs is patchy. For comprehensiveness and improved health outcomes, programmes need to incorporate all attributes of PHC principles. Future research may focus on how to incorporate more attributes of PHC principles while implementing national CHW programmes in LMICs. Better documentation and publications of CHW programme implementation are also needed.
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Affiliation(s)
- Shagufta Perveen
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Zohra S Lassi
- Robinson Research Institute, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mohammad Afzal Mahmood
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Henry B Perry
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caroline Laurence
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Dieberger AM, van Poppel MNM, Watson ED. Baby Steps: Using Intervention Mapping to Develop a Sustainable Perinatal Physical Activity Healthcare Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5869. [PMID: 34070723 PMCID: PMC8198094 DOI: 10.3390/ijerph18115869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/16/2022]
Abstract
While the benefits of physical activity (PA) during and after pregnancy have been established, many women do not reach the recommended PA levels during this time. A major barrier found in the literature is a lack of counselling by healthcare providers (HCPs), which is partly caused by the limited knowledge on the topic. The aim of this study was to develop an intervention to improve the promotion of PA by HCPs. We used Intervention Mapping (IM), a theory-based framework to develop an intervention, called "Baby steps", in a high-income (Austria) and a low-to-middle-income country (South Africa). We applied the following IM steps: (1) A needs assessment to determine the barriers and enablers of PA promotion by HCPs, including a scoping literature review and community needs assessments (qualitative interviews, questionnaires, and focus groups with midwives, obstetricians, and community health workers) to determine the desired outcomes of the intervention. (2) Performance and change objectives were formulated, describing the behaviors that need to change for the intervention to succeed. (3) Based on these objectives, theory-based behavior change techniques were selected, and practical applications were developed. (4) The applications were combined into two evidence-based interventions tailored to each country's needs. Step (5) and (6) consist of an implementation and evaluation plan, respectively. The intervention is aimed at HCPs, such as midwives and community health workers, consisting of a two-day training course, including practical resources. Combining didactic and interactive education, it addresses both PA knowledge and the skills needed to transfer knowledge and facilitate behavior change. In the future, the intervention's effect on women's activity levels during and after pregnancy needs to be studied.
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Affiliation(s)
- Anna M. Dieberger
- Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - Mireille N. M. van Poppel
- Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, 8010 Graz, Austria;
| | - Estelle D. Watson
- Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrews Road, Parktown, Johannesburg 2193, South Africa;
- Department of Exercise Sciences, Faculty of Science, The University of Auckland, Building 907, Suiter Street, Newmarket, Auckland 1142, New Zealand
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Buthelezi SF, Modeste RRM, Phetlhu DR. Barriers to the management of children under five exposed to HIV in the rural areas of South Africa. Curationis 2021; 44:e1-e12. [PMID: 33764130 PMCID: PMC8008009 DOI: 10.4102/curationis.v44i1.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 11/17/2019] [Accepted: 12/07/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND South Africa has made enormous progress in reducing mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV), however, MTCT and AIDS related death persist among children particularly in the rural areas. Lack of adherence to health policies and guidelines implementation remain one of the contributory factors to poor management of HIV-exposed children. Hence, the need to deeply explore the complexity of the problems and understand the barriers to the management of HIV exposed children in the rural areas. OBJECTIVES To explore and synthesise the barriers to the management of children under 5 years old exposed to HIV in rural areas in South Africa. METHOD An integrative literature review was conducted. An electronic search was conducted on several databases. The researchers applied the Boolean ' AND'/'OR' in combination with phrases such as 'HIV infection*', 'HIV transmission', 'HIV-exposed infant*, child*, and neonate*' and 'South Africa*'. Included studies were limited to South Africa, and articles were written in English and published in peer-reviewed journals from 2005 to 2018. Both qualitative and quantitative studies between 2005 and 2018 were utilised. RESULTS The findings highlighted that healthcare institution-related barriers, healthcare provider-related barriers, patient-related barriers and Socio-economic-related barriers were the significant barriers to the management of HIV-exposed children in the rural areas. CONCLUSION Continuous engagement with all relevant stakeholders should remain a priority in protecting HIV-exposed children. It is evident that there exist gaps in the current implementation of prevention of mother-to-child transmission (PMTCT), especially in rural areas. Therefore, intervention strategies that could improve implementation of PMTCT policy guidelines for HIV-exposed children in rural areas are needed.
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Houle B, Kabudula CW, Stein A, Gareta D, Herbst K, Clark SJ. Linking the timing of a mother's and child's death: Comparative evidence from two rural South African population-based surveillance studies, 2000-2015. PLoS One 2021; 16:e0246671. [PMID: 33556118 PMCID: PMC7869981 DOI: 10.1371/journal.pone.0246671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/24/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The effect of the period before a mother's death on child survival has been assessed in only a few studies. We conducted a comparative investigation of the effect of the timing of a mother's death on child survival up to age five years in rural South Africa. METHODS We used discrete time survival analysis on data from two HIV-endemic population surveillance sites (2000-2015) to estimate a child's risk of dying before and after their mother's death. We tested if this relationship varied between sites and by availability of antiretroviral therapy (ART). We assessed if related adults in the household altered the effect of a mother's death on child survival. FINDINGS 3,618 children died from 2000-2015. The probability of a child dying began to increase in the 7-11 months prior to the mother's death and increased markedly in the 3 months before (2000-2003 relative risk = 22.2, 95% CI = 14.2-34.6) and 3 months following her death (2000-2003 RR = 20.1; CI = 10.3-39.4). This increased risk pattern was evident at both sites. The pattern attenuated with ART availability but remained even with availability at both sites. The father and maternal grandmother in the household lowered children's mortality risk independent of the association between timing of mother and child mortality. CONCLUSIONS The persistence of elevated mortality risk both before and after the mother's death for children of different ages suggests that absence of maternal care and abrupt breastfeeding cessation might be crucial risk factors. Formative research is needed to understand the circumstances for children when a mother is very ill or dies, and behavioral and other risk factors that increase both the mother and child's risk of dying. Identifying families when a mother is very ill and implementing training and support strategies for other members of the household are urgently needed to reduce preventable child mortality.
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Affiliation(s)
- Brian Houle
- School of Demography, The Australian National University, Canberra, Australia
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States of America
| | - Chodziwadziwa W. Kabudula
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Alan Stein
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Samuel J. Clark
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States of America
- Department of Sociology, The Ohio State University, Columbus, Ohio, United States of America
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Mhlongo EM, Lutge E, Adepeju L. The roles, responsibilities and perceptions of community health workers and ward-based primary health care outreach teams: a scoping review. Glob Health Action 2020; 13:1806526. [PMID: 32892739 PMCID: PMC7782342 DOI: 10.1080/16549716.2020.1806526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 08/04/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Community health workers play important roles in rural primary health care settings. They work within ward-based primary health care outreach teams yet their roles are not always clearly defined and operationalized. There is thus a need to explore perceptions about the roles and responsibilities of community health workers. OBJECTIVE To investigate the roles, responsibilities and effectiveness of community health workers working within ward-based primary health care outreach teams. METHOD A scoping review of the published peer reviewed literature on community health workers working in ward-based primary health care outreach teams within low and middle-income countries was conducted. The following five electronic databases were searched: EBSCOhost, Google Scholar, Science Direct, EMBASE, PubMed, and Clinical key. Out of 69,969 identified articles, 31 met the inclusion criteria. The majority of the studies were from South Africa. RESULTS Both positive and negative perceptions were reported. Suggestions for improvements were also put forward. Positive factors included: ongoing training and up skilling; collaboration and trust building with other health care workers; mentoring and supervision; motivation and recognition, and incentives and remuneration. Negative factors covered: inadequate mentorship and poor supervision; role conflict; lack of support; poor remuneration; inadequate manpower; poor knowledge, and insufficient training. The review identified the following as the roles and responsibilities of community health workers: conducting home visits; identifying vulnerable community groups; promoting health and wellness; increasing access to health care; contact tracing; delivering health education; giving counselling and psychosocial support, and providing preventive health services. CONCLUSION The information available for community health workers in terms of their roles, responsibilities and effectiveness is inadequate, considering their roles and responsibilities in ward-based primary health care outreach teams. This lack of information constitutes barriers to effective service delivery, a common situation among this group of community health workers.
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Affiliation(s)
| | - Elizabeth Lutge
- School of Nursing & Public Health, University of KwaZulu- Natal, Durban, South Africa
- KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
| | - Lateef Adepeju
- School of Nursing & Public Health, University of KwaZulu- Natal, Durban, South Africa
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Al-Mujtaba M, Shobo O, Oyebola BC, Ohemu BO, Omale I, Shuaibu A, Anyanti J. Assessing the acceptability of village health workers' roles in improving maternal health care in Gombe State, Nigeria a qualitative exploration from women beneficiaries. PLoS One 2020; 15:e0240798. [PMID: 33091072 PMCID: PMC7580965 DOI: 10.1371/journal.pone.0240798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/03/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Maternal, and under-five mortality rates in Gombe State are disproportionately high. The Society for Family Health (a Non-Governmental Organization) in collaboration with Gombe State Primary Health Care Development Agency implemented the Village Health Worker (VHW) Program in Gombe to address the low uptakes of maternal neonatal and child health (MNCH) services and reduced the impact of healthcare worker insufficiency. VHWs are lay indigenous women trained to educate and encourage women to use MNCH services, provide simple community-based maternal and new-born care through home visits, and facilitate facility linkage. We assessed the acceptability of VHW services among women beneficiaries of the Program. Methods Qualitative data were obtained through six focus group discussions with 58 women beneficiaries of the VHW program who delivered within the last 12 months preceding study period (October–November 2018). Themes explored were roles and acceptability of VHWs, and the influence of VHWs on the uptake of MNCH services. We analyzed data with NVivo 12, using Grounded Theory. Results Participants’ mean age was 25.1 (± 5.3) years old. Most participants 39 (67%), had been in contact with a VHW for at least 10 months. VHWs visited pregnant women at home and registered them for antenatal care, provided them basic maternal healthcare, health education, and facilitated facility linkage. Participants generally accepted the VHW Program because it was community-based, VHWs were indigenous community members, delivered clear messages, and influenced husbands and mothers-in-law to support women’s’ use of MNCH services. VHWs’ interventions were perceived to have improved health literacy and the uptake of MNCH services. Participants generally admired the VHW occupation and recommended VHW program scale-up, and for VHWs to be offered basic obstetric training and employment by health facilities or the government. Conclusion The general acceptance and positive views of VHWs from beneficiaries of the program demonstrates the feasibility of the program to improve the uptake of MNCH services.
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Affiliation(s)
- Maryam Al-Mujtaba
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
- * E-mail: ,
| | - Olukolade Shobo
- Monitoring and Evaluation Department, Society for Family Health, Abuja, Federal Capital Territory Nigeria
| | - Bolanle C. Oyebola
- Programmes Department, Society for Family Health, Abuja, Federal Capital Territory, Nigeria
| | - Benson O. Ohemu
- Communications Department, Society for Family Health, Abuja, Federal Capital Territory, Nigeria
| | - Isaac Omale
- Monitoring and Evaluation Department, Society for Family Health, Abuja, Federal Capital Territory Nigeria
| | - Abdulrahman Shuaibu
- Office of the Executive Secretary, Gombe State Primary Healthcare Development Agency, Gombe, Gombe State, Nigeria
| | - Jennifer Anyanti
- Office of the Deputy Managing Director, Society for Family Health, Abuja, Nigeria
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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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Goudge J, de Kadt J, Babalola O, Muteba M, Tseng YH, Malatji H, Rwafa T, Nxumalo N, Levin J, Thorogood M, Daviaud E, Watkins J, Griffiths F. Household coverage, quality and costs of care provided by community health worker teams and the determining factors: findings from a mixed methods study in South Africa. BMJ Open 2020; 10:e035578. [PMID: 32819939 PMCID: PMC7440700 DOI: 10.1136/bmjopen-2019-035578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Community health workers (CHWs) are undertaking more complex tasks as part of the move towards universal health coverage in South Africa. CHW programmes can improve access to care for vulnerable communities, but many such programmes struggle with insufficient supervision. In this paper, we assess coverage (proportion of households visited by a CHW in the past year and month), quality of care and costs of the service provided by CHW teams with differing configurations of supervisors, some based in formal clinics and some in community health posts. PARTICIPANTS CHW, their supervisors, clinic staff, CHW clients. METHODS We used mixed methods (a random household survey, focus group discussions, interviews and observations of the CHW at work) to examine the performance of six CHW teams in vulnerable communities in Sedibeng, South Africa. RESULTS A CHW had visited 17% of households in the last year, and we estimated they were conducting one to two visits per day. At household registration visits, the CHW asked half of the questions required. Respondents remembered 20%-25% of the health messages that CHW delivered from a visit in the last month, and half of the respondents took the action recommended by the CHW. Training, supervision and motivation of the CHW, and collaboration with other clinic staff, were better with a senior nurse supervisor. We estimated that if CHW carried out four visits a day, coverage would increase to 30%-90% of households, suggesting that some teams need more CHW, as well as better supervision. CONCLUSION Household coverage was low, and the service was limited. Support from the local facility was key to providing a quality service, and a senior supervisor facilitated this collaboration. Greater investment in numbers of CHW, supervisors, training and equipment is required for the potential benefits of the programme to be delivered.
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Affiliation(s)
- Jane Goudge
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Julia de Kadt
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Olukemi Babalola
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michel Muteba
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yu-Hwei Tseng
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hlologelo Malatji
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Teurai Rwafa
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nonhlanhla Nxumalo
- Centre for Health Policy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan Levin
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Emmanuelle Daviaud
- Health Systems, South African Medical Research Council, Tygerberg, South Africa
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Oguma T, Watanabe E, Mori T, Fujino Y. Autonomous Continuation of Community Health Workers' Activities in Thegon Township, Bago Region, Myanmar. Front Public Health 2020; 8:201. [PMID: 32582608 PMCID: PMC7280436 DOI: 10.3389/fpubh.2020.00201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/04/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Few studies have reported on the autonomous continuation of Community Health Worker (CHW) activities after external supervision and support have ended. Objective: The study reports CHW activity continuation in Thegon Township, Bago Region, Myanmar, observed after the supervision by the external organization is completed. Method: Following the completion of a child nutrition program in Thegon Township, CHWs were left unsupervised and uninformed of a follow-up at 10, 23, and 40 months from the end of the program survey due to unforeseen circumstances. In a follow-up survey in 2014, data on the activity implementation status from CHWs and activity attendance from caregivers of the target children were collected. Focus group discussions were held with caregivers concerning their information sources on child nutrition and health. Results: On average, CHWs were found to have continued with 2.6 of the four core activities, often with modifications, irrespective of the time since completion of the non-profit-organization-led program. Meanwhile, caregiver attendance decreased over time. Caregivers recognized CHWs as information sources. Discussion: Although unsupervised, CHWs ambitiously continued with their activities, but sorted through and modified them, which may have been unrelated to the local acceptance of the program, as caregiver attendance decreased even as CHWs continued the activities. The observation may highlight the importance of proactive engagement and thus, the autonomy of CHWs in their activity continuation.
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Affiliation(s)
- Taeko Oguma
- Takemi Program in International Health, Harvard T. H. Chan School of Public Health, Boston, MA, United States.,Department of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Etsuko Watanabe
- Division of Nursing, Faculty of Healthcare, Tokyo Healthcare University, Tokyo, Japan
| | - Tomoari Mori
- Office of the Dean of Research, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
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Buthelezi SF, Modeste RR, Phetlhu DR. Barriers to the management of children under five exposed to human immunodeficiency virus in the rural areas in South Africa. Curationis 2020. [DOI: 10.4102/curationis.v43i1.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Assegaai T, Schneider H. The supervisory relationships of community health workers in primary health care: social network analysis of ward-based outreach teams in Ngaka Modiri Molema District, South Africa. BMJ Glob Health 2019; 4:e001839. [PMID: 31908861 PMCID: PMC6936529 DOI: 10.1136/bmjgh-2019-001839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction Supportive supervision remains a key challenge to the sustainability of community health worker (CHW) programmes globally. The aim of the study was to identify critical actors and patterns of relationships in the supervision of ward-based outreach teams (WBOT) in a rural South African district. Methods A cross-sectional study of social and professional relationships of WBOTs with other primary health care (PHC) system actors was conducted using a social network analysis (SNA) approach. A structured questionnaire was distributed to CHWs (37), WBOT team leaders (3), PHC facility managers (5) and PHC local area managers (2) (total n=47) assessing interaction patterns of supportive supervision, namely management, development and support. Results The supportive supervision system pivoted around team leaders, who were nurse cadres and who ensured internal cohesion and support among WBOT members. The network patterns also showed the extent of peer support between CHWs in WBOTs. PHC facility staff and middle managers in the subdistrict did not appear to play active roles in the supervision of CHWs and their team leaders. However, there were exceptions, with WBOTs drawing on sympathetic cadres identified among the PHC facility staff for support. Conclusion Supportive supervision of CHWs can be thought of as a system of horizontal and vertical relationships that go beyond just one supervisor–supervisee interaction. In this study, supervisory relationships within teams functioned better than those between teams and the rest of the PHC system. Understanding these relationships is key to designing effective supportive supervision in CHW programmes. SNA can be a valuable approach in identifying the relationships to be strengthened.
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Affiliation(s)
- Tumelo Assegaai
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa
| | - Helen Schneider
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Trajman A, Wakoff-Pereira MF, Ramos-Silva J, Cordeiro-Santos M, Militão de Albuquerque MDF, Hill PC, Menzies D. Knowledge, attitudes and practices on tuberculosis transmission and prevention among auxiliary healthcare professionals in three Brazilian high-burden cities: a cross-sectional survey. BMC Health Serv Res 2019; 19:532. [PMID: 31362728 PMCID: PMC6668184 DOI: 10.1186/s12913-019-4231-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/07/2019] [Indexed: 01/27/2023] Open
Abstract
Background Tuberculosis elimination requires treatment of latently infected high-risk persons, such as contacts of index cases. Identification and referral of tuberculosis contacts for investigation are major barriers in the contact cascade-of-care. These tasks rely heavily on auxiliary primary healthcare workers in many low- and middle-income countries. We aimed to understand their knowledge, attitudes and practices (KAP) regarding contact investigation in Brazil. Methods We conducted a cross-sectional KAP survey on tuberculosis transmission and prevention among 135 auxiliary healthcare workers in three tuberculosis high-burden Brazilian cities. Trained interviewers applied a translated version of a previously applied questionnaire. Open answers were classified in pre-defined objective categories and analysed quantitatively. Answers were further classified as satisfactory or not according to criteria set by a panel of three specialists. Results Although 66% had received tuberculosis training in the past 10 years, only 19% were trained for tuberculosis prevention. 64% could not clearly distinguish latent tuberculosis infection (LTBI) from active tuberculosis; 63% did not know how to diagnose LTBI and 52% did not know how to prevent progression to active tuberculosis. Most believed that it is important to investigate adult (99%) and child (96%) contacts for LTBI. However, not all invite contacts - children (81%) or adults (71%) - to the clinic, despite only 24% perceiving difficulties for investigation. Conclusions Gaps in KAP among auxiliary health workers have been reported in other areas, such as obstetrics and other infectious diseases. To the best of our knowledge, this is the first KAP survey on tuberculosis transmission and prevention among auxiliary health care workers, and relevant gaps were also found. Knowledge gaps were notably related to LTBI management, including how to recognize it and prevent progression to active tuberculosis through treatment, despite most recognizing the importance of investigating contacts. Auxiliary healthcare workers in three Brazilian high-burden cities have important knowledge gaps despite their perception of the importance of tuberculosis prevention among contacts. They need to incorporate contact referral as one of their tasks to enable progress toward the target of tuberculosis elimination. Electronic supplementary material The online version of this article (10.1186/s12913-019-4231-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anete Trajman
- Programa de Pós-graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Universidade, Rio de Janeiro, Rua Macedo Sobrinho 74/203, Humaitá, Rio de Janeiro, 22271-080, Brazil. .,Respiratory Epidemiology & Clinical Research Unit (RECRU), McGill University, Montreal, Canada.
| | - Maria F Wakoff-Pereira
- Programa de Pós-graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Universidade, Rio de Janeiro, Rua Macedo Sobrinho 74/203, Humaitá, Rio de Janeiro, 22271-080, Brazil
| | - Jonas Ramos-Silva
- Programa de Pós-graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Universidade, Rio de Janeiro, Rua Macedo Sobrinho 74/203, Humaitá, Rio de Janeiro, 22271-080, Brazil
| | - Marcelo Cordeiro-Santos
- Fundação de Medicina Tropical Dr. Heitor Dourado Vieira, Universidade Estadual do Amazonas, Manaus, AM, Brazil
| | | | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Dick Menzies
- Respiratory Epidemiology & Clinical Research Unit (RECRU), McGill University, Montreal, Canada
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Yitbarek K, Abraham G, Morankar S. Contribution of women's development army to maternal and child health in Ethiopia: a systematic review of evidence. BMJ Open 2019; 9:e025937. [PMID: 31122974 PMCID: PMC6538000 DOI: 10.1136/bmjopen-2018-025937] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The aim of this review was to identify, appraise and synthesise studies that reported on the contribution of women's development army (WDA) to maternal and child health development. SETTING Studies conducted in Ethiopia 2010 onwards and published in English were considered. DATA SOURCES Evidence were searched in MEDLINE, CINAHL and EBSCOhost from 25 March to 10 April 2018. ELIGIBILITY CRITERIA Both quantitative and qualitative studies assessing the contribution of WDA to maternal and child health were considered. DATA EXTRACTION AND SYNTHESIS Two independent reviewers have extracted data using pre-planned data extraction tool separately for each study design. Findings were synthesised using tables and narrative summary. OUTCOME Maternal and child health services; maternal and child mortality. RESULTS Nine studies met the inclusion criteria and were used for synthesis. The results revealed that participation and membership in women's development teams (WDTs) have a positive effect on minimising maternal death and improving child immunisation service use. Skilled delivery and antenatal care service use were higher in WDTs located within a radius of 2 km from health facilities. Women's development teams were also the main sources of information for mothers to prepare themselves for birth and related complications. Moreover, well-established groups have strengthened the linkage of the health facility to the community so that delays in maternal health service use were minimised; health extension workers could effectively refer women to a health facility for birth and utilisation of skilled birth service was improved. CONCLUSION Voluntary health service intervention in Ethiopia has improved maternal and child health services' outcome. A decrease in maternal deaths, increase in antenatal and delivery service use and improved child immunisation service uptake are attributable to this intervention. The linkage between community members and the primary healthcare system served as an effective and efficient mechanism to share information.
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Affiliation(s)
- Kiddus Yitbarek
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
| | - Gelila Abraham
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
| | - Sudhakar Morankar
- Department of Health Behaviors and Society, Jimma University, Jimma, Ethiopia
- Jimma University Rapid Review Response Center: AHPSR/WHO Center of Excellence, Jimma University, Jimma, Ethiopia
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Horwood C, Jama NA, Haskins L, Coutsoudis A, Spies L. A qualitative study exploring infant feeding decision-making between birth and 6 months among HIV-positive mothers. MATERNAL AND CHILD NUTRITION 2018; 15:e12726. [PMID: 30338632 DOI: 10.1111/mcn.12726] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 01/10/2023]
Abstract
Despite efforts to support breastfeeding for HIV-positive mothers in South Africa, being HIV-positive remains a barrier to initiating and sustaining breastfeeding. The aim was to explore decision-making about infant feeding practices among HIV-positive mothers in a rural and urban settings in KwaZulu-Natal, South Africa. HIV-positive pregnant women were purposively sampled from one antenatal clinic in each setting. A qualitative longitudinal cohort design was employed, with monthly in-depth interviews conducted over 6 months postdelivery. Data were analysed using framework analysis. We report findings from 11 HIV-positive women within a larger cohort. Participants were aged between 15 and 41 years and were all on antiretroviral therapy. Before delivery, nine mothers intended to exclusively breastfeed (EBF) for 6 months, and two intended to exclusively formula feed (EFF). Three mothers successfully EBF for 6 months, whereas four had stopped breastfeeding, and two were mixed breastfeeding by 6 months. Mothers reported receiving strong advice from health workers (HWs) to EBF and made decisions based primarily on HWs advice, resisting contrary pressure from family or friends. The main motivation for EBF was to protect the child from HIV acquisition, but sometimes fear of mixed feeding led to mothers stopping breastfeeding entirely. Infant feeding messages from HWs advice were frequently inadequate and out of date, and failed to address mothers' challenges. Minimal support was provided for EFF. In conclusion, HWs play a pivotal role in providing infant feeding support to HIV infected mothers, but need regular updates to ensure if advice is correct and appropriate.
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Affiliation(s)
- Christiane Horwood
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Lyn Haskins
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Anna Coutsoudis
- Department of Paediatrics and Child Health School of Clinical Medicine Nelson R Mandela School of Medicine, University of KwaZulu-Natal Durban, Durban, South Africa
| | - Lenore Spies
- Department of Health, Nutrition Directorate, Pietermaritzburg, South Africa
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