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Adhikari B, Bayo M, Peto TJ, Callery JJ, Tripura R, Dysoley L, Mshamu S, Gesase S, von Seidlein L, Dondorp AM. Comparing the roles of community health workers for malaria control and elimination in Cambodia and Tanzania. BMJ Glob Health 2023; 8:e013593. [PMID: 38070880 PMCID: PMC10729139 DOI: 10.1136/bmjgh-2023-013593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/12/2023] [Indexed: 12/18/2023] Open
Abstract
The reduction of deaths from malaria in sub-Saharan Africa (SSA) is stalling, whereas many countries in Southeast Asia are approaching malaria elimination. We reviewed the role of community health worker (CHW) programmes in malaria control and elimination between regions, with a more detailed description of the programmes in Tanzania and Cambodia. Compared with Tanzania, Cambodia has a much more developed CHW network, which has been pivotal in the near elimination of malaria. In Tanzania, the malaria burden has remained similar over the last decade and treatment continues to rely on healthcare facilities, which provide more limited access to early diagnosis and treatment. Overall, the proportion of malaria cases treated by CHWs is substantially lower in SSA than in Southeast Asia. Even though networks of CHWs are resource intensive and malaria epidemiology differs substantially between countries, there is a strong case for expanding CHW networks in rural SSA to improve early access to effective malaria treatment and reduce the malaria burden.
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Affiliation(s)
- Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - Makhily Bayo
- Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas J Peto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - James J Callery
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - Rupam Tripura
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - Lek Dysoley
- C.N.M National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Salum Mshamu
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
- CSK Research Solutions, Mtwara, Tanzania
| | - Samwel Gesase
- Korogwe Research Laboratory, National Institute for Medical Research, Tanga, Tanzania
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
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von Salmuth V, Buijs L, Chirangi B, Vreugdenhil AC, van Schayck OC. Health needs assessment for the double burden of malnutrition: a community-based study on nutrition facilitators and barriers in rural Tanzania. Public Health Nutr 2023; 26:2450-2459. [PMID: 37581236 DOI: 10.1017/s1368980023001568] [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] [Indexed: 08/16/2023]
Abstract
OBJECTIVE The aim of this study is to explore nutrition-related health needs, the perceptions and beliefs regarding the double burden of malnutrition, as well as barriers and facilitators in accessing nutritious food among the local population in rural Tanzania. DESIGN A qualitative study design using semi-structured individual interviews and focus-group discussions (FGD) was used. Basic socio-demographic information was obtained from all participants. SETTING The study was conducted in four villages within the catchment area of the Shirati KMT Hospital in Rorya district, in north-western Tanzania. PARTICIPANTS Men and women in the reproductive age as well as Community Health Workers (CHW) were included. RESULTS In total, we performed fourteen interviews (N 41), consisting of four FGD, one dual and nine individual interviews. The three most significant topics that were identified are the large knowledge gap concerning overweight and obesity as a health problem, changing weather patterns and its implications on food supply and the socio-cultural drivers including gender roles and household dynamics. CONCLUSION Environmental and socio-cultural factors play a crucial role in the determinants for DBM, which underlines the importance of understanding the local context and the nutrition practices and beliefs of the communities. Future nutritional interventions should aim towards more inclusion of men in project implementation as well as support of women empowerment. CHW could play a key role in facilitating some of the suggested interventions, including nutritional counselling and increasing awareness on the drivers of the double burden of malnutrition.
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Affiliation(s)
- Victoria von Salmuth
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Lieke Buijs
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Bwire Chirangi
- Shirati KMT District Hospital, Rorya, Mara, Shirati, Tanzania
| | - Anita Ce Vreugdenhil
- Department of Paediatrics, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Onno Cp van Schayck
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands
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Shakerian S, Gharanjik GS. Recruitment and selection of community health workers in Iran; a thematic analysis. BMC Public Health 2023; 23:839. [PMID: 37161389 PMCID: PMC10169114 DOI: 10.1186/s12889-023-15797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/03/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND In Iran, community health workers (CHWs) are selected and employed according to the instructions of the Ministry of Health (MOH). The present study aimed to investigate the views of different stakeholders regarding the selection criteria, as well as the competency of CHWs. METHODS This study was conducted using a qualitative thematic analysis in Golestan Province, Iran. Data were collected using semi-structured interviews with managers, supervisors, CHWs, and common people in 2021. The interviews were recorded and then transcribed. To extract key themes, the six-step Brown model was used, which involved becoming acquainted with the data, meaningful organization of transcripts, extracting primary open codes, searching for themes in an iterative approach, theme extraction, defining themes, and preparing a report. The relationships between codes and sub-themes and themes were represented using ATLAS.ti version 8. RESULTS Data saturation was achieved after interviewing 22 people. The extracted data included 340 open codes, two main sub-themes of "CHW effectiveness" and "CHW sustainability", and three main themes of "criteria for employing competent people", "barriers to employing competent people", and "identifying the barriers to employing competent people", according to the MOH instructions. CONCLUSION In the present study, local hiring was one of the major challenges in the competency-based selection of CHWs. One of the most repeated codes was expanding the local hiring concept and its requirements. Since different regions of Iran have different climatic, economic, cultural, and social conditions, the selection and hiring criteria for CHWs should be tailored to the needs of the community.
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Affiliation(s)
- Sareh Shakerian
- Departments of Community Based Education of Health Sciences, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Gozal Shafeei Gharanjik
- Departments of Community Based Education of Health Sciences, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Karim A, de Savigny D, Awor P, Cobos Muñoz D, Mäusezahl D, Kitoto Tshefu A, Ngaima JS, Enebeli U, Isiguzo C, Nsona H, Ogbonnaya I, Ngoy P, Alegbeleye A. The building blocks of community health systems: a systems framework for the design, implementation and evaluation of iCCM programs and community-based interventions. BMJ Glob Health 2022; 7:bmjgh-2022-008493. [PMID: 35772810 PMCID: PMC9247653 DOI: 10.1136/bmjgh-2022-008493] [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: 01/11/2022] [Accepted: 05/30/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction Almost all sub-Saharan African countries have adopted some form of integrated community case management (iCCM) to reduce child mortality, a strategy targeting common childhood diseases in hard-to-reach communities. These programs are complex, maintain diverse implementation typologies and involve many components that can influence the potential success of a program or its ability to effectively perform at scale. While tools and methods exist to support the design and implementation of iCCM and measure its progress, these may not holistically consider some of its key components, which can include program structure, setting context and the interplay between community, human resources, program inputs and health system processes. Methods We propose a Global South-driven, systems-based framework that aims to capture these different elements and expand on the fundamental domains of iCCM program implementation. We conducted a content analysis developing a code frame based on iCCM literature, a review of policy documents and discussions with key informants. The framework development was guided by a combination of health systems conceptual frameworks and iCCM indices. Results The resulting framework yielded 10 thematic domains comprising 106 categories. These are complemented by a catalogue of critical questions that program designers, implementers and evaluators can ask at various stages of program development to stimulate meaningful discussion and explore the potential implications of implementation in decentralised settings. Conclusion The iCCM Systems Framework proposed here aims to complement existing intervention benchmarks and indicators by expanding the scope and depth of the thematic components that comprise it. Its elements can also be adapted for other complex community interventions. While not exhaustive, the framework is intended to highlight the many forces involved in iCCM to help managers better harmonise the organisation and evaluation of their programs and examine their interactions within the larger health system.
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Affiliation(s)
- Aliya Karim
- University of Basel, Basel, Switzerland .,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Don de Savigny
- University of Basel, Basel, Switzerland.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Phyllis Awor
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daniel Cobos Muñoz
- University of Basel, Basel, Switzerland.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Daniel Mäusezahl
- University of Basel, Basel, Switzerland.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Jean Serge Ngaima
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ugo Enebeli
- Department of Community Medicine, University of Port Harcourt, Choba, Rivers State, Nigeria
| | - Chinwoke Isiguzo
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Society for Family Health Nigeria, Abuja, Nigeria
| | - Humphreys Nsona
- IMCI, Malawi Ministry of Health, Lilongwe, Central Region, Malawi
| | - Ikechi Ogbonnaya
- Department of Health, Planning, Research & Statistics, Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Pascal Ngoy
- PROSANI, USAID, Washington, District of Columbia, USA
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Ahmed S, Chase LE, Wagnild J, Akhter N, Sturridge S, Clarke A, Chowdhary P, Mukami D, Kasim A, Hampshire K. Community health workers and health equity in low- and middle-income countries: systematic review and recommendations for policy and practice. Int J Equity Health 2022; 21:49. [PMID: 35410258 PMCID: PMC8996551 DOI: 10.1186/s12939-021-01615-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/27/2021] [Indexed: 01/06/2023] Open
Abstract
Background The deployment of Community Health Workers (CHWs) is widely promoted as a strategy for reducing health inequities in low- and middle-income countries (LMIC). Yet there is limited evidence on whether and how CHW programmes achieve this. This systematic review aimed to synthesise research findings on the following questions: (1) How effective are CHW interventions at reaching the most disadvantaged groups in LMIC contexts? and (2) What evidence exists on whether and how these programmes reduce health inequities in the populations they serve? Methods We searched six academic databases for recent (2014–2020) studies reporting on CHW programme access, utilisation, quality, and effects on health outcomes/behaviours in relation to potential stratifiers of health opportunities and outcomes (e.g., gender, socioeconomic status, place of residence). Quantitative data were extracted, tabulated, and subjected to meta-analysis where appropriate. Qualitative findings were synthesised using thematic analysis. Results One hundred sixty-seven studies met the search criteria, reporting on CHW interventions in 33 LMIC. Quantitative synthesis showed that CHW programmes successfully reach many (although not all) marginalized groups, but that health inequalities often persist in the populations they serve. Qualitative findings suggest that disadvantaged groups experienced barriers to taking up CHW health advice and referrals and point to a range of strategies for improving the reach and impact of CHW programmes in these groups. Ensuring fair working conditions for CHWs and expanding opportunities for advocacy were also revealed as being important for bridging health equity gaps. Conclusion In order to optimise the equity impacts of CHW programmes, we need to move beyond seeing CHWs as a temporary sticking plaster, and instead build meaningful partnerships between CHWs, communities and policy-makers to confront and address the underlying structures of inequity. Trial registration PROSPERO registration number CRD42020177333. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01615-y.
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Doshi RH, Casey RM, Adrien N, Ndiaye A, Brennan T, Roka JL, Bathily A, Ndiaye C, Li A, Garon J, Badiane O, Diallo A, Loharikar A. Feasibility and acceptability of nationwide HPV vaccine introduction in Senegal: Findings from community-level cross-sectional surveys, 2020. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000130. [PMID: 36962130 PMCID: PMC10021483 DOI: 10.1371/journal.pgph.0000130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/02/2022] [Indexed: 12/24/2022]
Abstract
In Senegal, cervical cancer is the most common cancer among women and the leading cause of morbidity and mortality from all cancers. In 2018, Senegal launched a national human papillomavirus (HPV) vaccination program with Gavi, the Vaccine Alliance (Gavi), support. HPV vaccination was incorporated into the national immunization program as a two-dose schedule, with a 6-12-month interval, to nine-year-old girls via routine immunization (RI) services at health facilities, schools and community outreach services throughout the year. During February to March 2020, we conducted interviews to assess the awareness, feasibility, and acceptability of the HPV vaccination program with a cross-sectional convenience sample of healthcare workers (HCWs), school personnel, community healthcare workers (cHCWs), parents, and community leaders from 77 rural and urban health facility catchment areas. Participants were asked questions on HPV vaccine knowledge, delivery, training, and community acceptability of the program. We conducted a descriptive analysis stratified by respondent type. Data were collected from 465 individuals: 77 HCW, 78 school personnel, 78 cHCWs, 152 parents, and community leaders. The majority of HCWs (83.1%) and cHCWs (74.4%) and school personnel (57.7%) attended a training on HPV vaccine before program launch. Of all respondents, most (52.5-87.2%) were able to correctly identify the target population. The majority of respondents (60.2-77.5%) felt that the vaccine was very accepted or accepted in the community. Senegal's HPV vaccine introduction program, among the first national programs in the African region, was accepted by community stakeholders. Training rates were high, and most respondents identified the target population correctly. However, continued technical support is needed for the integration of HPV vaccination as a RI activity for this non-traditional age group. The Senegal experience can be a useful resource for countries planning to introduce the HPV vaccine.
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Affiliation(s)
- Reena H Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States Of America
| | - Rebecca M Casey
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States Of America
- CDC Foundation, Atlanta, Georgia, United States Of America
| | - Nedghie Adrien
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States Of America
- CDC Foundation, Atlanta, Georgia, United States Of America
| | - Alassane Ndiaye
- Expanded Programme on Immunization, Ministry of Health and Social Action, Dakar, Senegal
| | - Timothy Brennan
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States Of America
- CDC Foundation, Atlanta, Georgia, United States Of America
| | - Jerlie Loko Roka
- Division of Global Health Protection, Centers for Disease control and Prevention, Dakar, Senegal
| | | | | | - Anyie Li
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States Of America
- CDC Foundation, Atlanta, Georgia, United States Of America
| | - Julie Garon
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States Of America
- CDC Foundation, Atlanta, Georgia, United States Of America
| | - Ousseynou Badiane
- Expanded Programme on Immunization, Ministry of Health and Social Action, Dakar, Senegal
| | | | - Anagha Loharikar
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States Of America
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Pinto RM, Rahman R, Zanchetta MS, Galhego-Garcia W. Brazil's Community Health Workers Practicing Narrative Medicine: Patients' Perspectives. J Gen Intern Med 2021; 36:3743-3751. [PMID: 33826059 PMCID: PMC8642505 DOI: 10.1007/s11606-021-06730-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/16/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Narrative medicine (NM) encourages health care providers to draw on their personal experiences to establish therapeutic alliances with patients of prevention and care services. NM medicine practiced by nurses and physicians has been well documented, yet there is little understanding of how community health workers (CHWs) apply NM concepts in their day-to-day practices from patient perspectives. OBJECTIVE To document how CHWs apply specific NM concepts in Brazil's Family Health Strategy (FHS), the key component of Brazil's Unified Health System. DESIGN We used a semi-structured interview, grounded in Charon's (2001) framework, including four types of NM relationships: provider-patient, provider-colleague, provider-society, and provider-self. A hybrid approach of thematic analysis was used to analyze data from 27 patients. KEY RESULTS Sample: 18 females; 13 White, 12 "Pardo" (mixed races), 12 Black. We found: (1) provider-patient relationship-CHWs offered health education through compassion, empathy, trustworthiness, patience, attentiveness, jargon-free communication, and altruism; (2) provider-colleague relationship-CHWs lacked credibility as perceived by physicians, impacting their effectiveness negatively; (3) provider-society relationship-CHWs mobilized patients civically and politically to advocate for and address emerging health care and prevention needs; (4) provider-self relationship-patients identified possible low self-esteem among CHWs and a need to engage in self-care practices to abate exhaustion from intense labor and lack of resources. CONCLUSION This study adds to patient perspectives on how CHWs apply NM concepts to build and sustain four types of relationships. Findings suggest the need to improve provider-colleague relationships by ongoing training to foster cooperation among FHS team members. More generous organizational supports (wellness initiatives and supervision) may facilitate the provider-self relationship. Public education on CHWs' roles is needed to enhance the professional and societal credibility of their roles and responsibilities. Future research should investigate how CHWs' personality traits may influence their ability to apply NM.
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Affiliation(s)
| | - Rahbel Rahman
- Graduate School of Social Service, Fordham University, New York, NY, USA
| | | | - W Galhego-Garcia
- Department of Basic Sciences, Faculty of Dentistry of Araçatuba, Estadual Paulista University, São Paulo, Brazil
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Schleiff MJ, Aitken I, Alam MA, Damtew ZA, Perry HB. Community health workers at the dawn of a new era: 6. Recruitment, training, and continuing education. Health Res Policy Syst 2021; 19:113. [PMID: 34641898 PMCID: PMC8506097 DOI: 10.1186/s12961-021-00757-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This is the sixth of our 11-paper supplement entitled "Community Health Workers at the Dawn of New Era". Expectations of community health workers (CHWs) have expanded in recent years to encompass a wider array of services to numerous subpopulations, engage communities to collaborate with and to assist health systems in responding to complex and sometimes intensive threats. In this paper, we explore a set of key considerations for training of CHWs in response to their enhanced and changing roles and provide actionable recommendations based on current evidence and case examples for health systems leaders and other stakeholders to utilize. METHODS We carried out a focused review of relevant literature. This review included particular attention to a 2014 book chapter on training of CHWs for large-scale programmes, a systematic review of reviews about CHWs, the 2018 WHO guideline for CHWs, and a 2020 compendium of 29 national CHW programmes. We summarized the findings of this latter work as they pertain to training. We incorporated the approach to training used by two exemplary national CHW programmes: for health extension workers in Ethiopia and shasthya shebikas in Bangladesh. Finally, we incorporated the extensive personal experiences of all the authors regarding issues in the training of CHWs. RESULTS The paper explores three key themes: (1) professionalism, (2) quality and performance, and (3) scaling up. Professionalism: CHW tasks are expanding. As more CHWs become professionalized and highly skilled, there will still be a need for neighbourhood-level voluntary CHWs with a limited scope of work. Quality and performance: Training approaches covering relevant content and engaging CHWs with other related cadres are key to setting CHWs up to be well prepared. Strategies that have been recently integrated into training include technological tools and provision of additional knowledge; other strategies emphasize the ongoing value of long-standing approaches such as regular home visitation. Scale-up: Scaling up entails reaching more people and/or adding more complexity and quality to a programme serving a defined population. When CHW programmes expand, many aspects of health systems and the roles of other cadres of workers will need to adapt, due to task shifting and task sharing by CHWs. CONCLUSION Going forward, if CHW programmes are to reach their full potential, ongoing, up-to-date, professionalized training for CHWs that is integrated with training of other cadres and that is responsive to continued changes and emerging needs will be essential. Professionalized training will require ongoing monitoring and evaluation of the quality of training, continual updating of pre-service training, and ongoing in-service training-not only for the CHWs themselves but also for those with whom CHWs work, including communities, CHW supervisors, and other cadres of health professionals. Strong leadership, adequate funding, and attention to the needs of each cadre of CHWs can make this possible.
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Affiliation(s)
- Meike J. Schleiff
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Iain Aitken
- Management Sciences for Health, Ministry of Public Health, Kabul, Afghanistan
| | | | | | - Henry B. Perry
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Li AJ, Manzi F, Kyesi F, Makame Y, Mwengee W, Fleming M, Mkopi A, Mmbaga S, Lyimo D, Loharikar A. Tanzania's human papillomavirus (HPV) vaccination program: Community awareness, feasibility, and acceptability of a national HPV vaccination program, 2019. Vaccine 2021; 40 Suppl 1:A38-A48. [PMID: 34229889 PMCID: PMC9601816 DOI: 10.1016/j.vaccine.2021.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/31/2021] [Accepted: 06/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND In April 2018, Tanzania introduced the human papillomavirus (HPV) vaccine nationally to 14-year-old girls, utilizing routine delivery strategies (i.e. vaccinating girls at health facilities and community outreach, including schools). We sought to assess awareness, feasibility, and acceptability of the HPV vaccination program among health workers and community-level stakeholders. METHODS We conducted cross-sectional in-person surveys among health workers, school personnel, community leaders, and council leaders in 18 council areas across six regions of Tanzania in October-November 2019. Regions were purposively selected to provide demographic, geographic, and vaccination coverage variability; sub-regional levels used random or stratified random sampling. Surveys included questions on HPV vaccine training and knowledge, delivery strategy, target population, and vaccine and program acceptability. Descriptive analysis was completed for all variables stratified by respondent groups. RESULTS Across the 18 councils, there were 461 respondents, including health workers (165), school personnel (135), community leaders (143), and council leaders (18). Over half of each respondent group (50-78%) attended a training or orientation on HPV vaccine. Almost 75% of the health workers and school personnel respondent groups, and less than half (45%) of community leaders correctly identified the target age group for HPV vaccine. Most (80%) of the health workers indicated HPV vaccination was available at health facilities and schools; most (79%) indicated that the majority of girls receive HPV vaccine in school. Approximately half (52%) of all respondents reported hearing misinformation about HPV vaccine, but 97% of all respondents indicated that HPV vaccine was either "very accepted" or "somewhat accepted" in their community. CONCLUSION The HPV vaccination program in Tanzania was well accepted by community stakeholders in 18 councils; adequate knowledge of HPV vaccine and the HPV vaccination program was demonstrated by health workers and school personnel. However, continued technical support for integration of HPV vaccination as a routine immunization activity and reinforcement of basic knowledge about HPV vaccine in specific community groups is needed. The Tanzania experience provides an example of how this vaccine can be integrated into routine immunization delivery strategies and can be a useful resource for countries planning to introduce HPV vaccine as well as informing global partners on how to best support to countries in operationalizing their HPV vaccine introduction plans.
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Affiliation(s)
- Anyie J Li
- CDC Foundation, Atlanta, GA, USA; Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Furaha Kyesi
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | | | - William Mwengee
- World Health Organization, Tanzania Country Office, Dar es Salaam, Tanzania
| | - Monica Fleming
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Dafrossa Lyimo
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | - Anagha Loharikar
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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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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11
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Rahman M, Jahir T, Yeasmin F, Begum F, Mobashara M, Hossain K, Khan R, Hossain R, Nizame FA, Jain A, Leontsini E, Unicomb L, Luby SP, Winch PJ. The Lived Experiences of Community Health Workers Serving in a Large-Scale Water, Sanitation, and Hygiene Intervention Trial in Rural Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073389. [PMID: 33805884 PMCID: PMC8037636 DOI: 10.3390/ijerph18073389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Abstract
Community health workers (CHWs) are key to implementing community-based health interventions and quality can be enhanced by better understanding their lived experiences. The WASH Benefits, Bangladesh trial engaged 540 female CHWs to promote varying health intervention packages. We report on factors influencing their lived experiences during the trial, to aid future recruitment, training and retention of CHWs. Nine focus groups and 18 in-depth interviews were conducted with CHWs. Focus groups and interviews were transcribed and thematic content analysis performed to summarize the results. All CHWs described experiencing positive working conditions and many benefits both socially and financially; these contributed to their retention and job satisfaction. Their honorarium was commonly applied towards their children's education and invested for income generation. CHWs gained self-confidence as women, to move unaccompanied in the community and speak in public. They earned respect from the community and their family members who helped them manage their family obligations during work and were viewed as a resource for advice on health and social issues. Many participated in family decision-making from which they were previously excluded. Health programs should foster a positive experience among their CHWs to aid the recruitment, retention and development of this important human resource.
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Affiliation(s)
- Mahbubur Rahman
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
- Correspondence: ; Tel.: +88-017-1200-1294
| | - Tania Jahir
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Farzana Yeasmin
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Farzana Begum
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Mosammot Mobashara
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Khobair Hossain
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Rizwana Khan
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Rezwana Hossain
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Fosiul Alam Nizame
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Anika Jain
- Department of International Health, John Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (A.J.); (E.L.); (P.J.W.)
| | - Elli Leontsini
- Department of International Health, John Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (A.J.); (E.L.); (P.J.W.)
| | - Leanne Unicomb
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA 94305, USA;
| | - Peter J. Winch
- Department of International Health, John Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (A.J.); (E.L.); (P.J.W.)
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12
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Sindato C, Mboera LEG, Beda E, Mwabukusi M, Karimuribo ED. Community Health Workers and Disease Surveillance in Tanzania: Promoting the Use of Mobile Technologies in Detecting and Reporting Health Events. Health Secur 2020; 19:116-129. [PMID: 33217238 DOI: 10.1089/hs.2019.0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This cross-sectional study was conducted in the Kilosa, Morogoro Urban, Ngorongoro, and Ulanga districts of Tanzania to investigate the practices of community health workers (CHWs) related to disease surveillance functions and to establish their needs and technology capacities. We also established the strength of mobile phone networks and internet connections in the study areas to inform the feasibility of using mobile-based applications in community-based disease surveillance. A total of 135 CHWs from 85 villages participated in the study. Health events captured at the community level were entirely paper-based. CHWs submitted reports to higher-level health authorities mainly on foot (100%), but they also used public transport (65%) and telephone calls (56%). The median number of days between the onset of a suspected disease outbreak at the community level and reporting to a primary healthcare facility was 10 days (interquartile range [IQR] 2-30). The median number of days between submitting a report and receiving a response was 7 days (IQR 2-30). Of the 53 CHWs who reported the most recent health events to a higher-level health authority, 39 (74%) never received feedback. All 85 villages had a reliable mobile phone network and 74 (87%) had a mobile phone internet connection that was strong enough to support data transmission using digital technology. Almost all (n = 132, 98%) of the CHWs owned mobile phones. The practices related to detection and reporting of health events could be improved to enhance early warning disease surveillance. Reliable mobile networks and internet connections and the ownership of mobile phones among CHWs in the study areas present opportunities to strengthen community event-based surveillance using mobile-based solutions.
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Affiliation(s)
- Calvin Sindato
- Calvin Sindato, PhD, is a Principal Research Scientist, National Institute for Medical Research, Tabora, Tanzania. At the time this work was conducted, he was a Postdoctoral Research Associate and One Health Epidemiologist with the SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Leonard E. G. Mboera, PhD, is Leader, Emerging and Vector-Borne Diseases Community of Practice; Eric Beda, MSc, is Regional ICT Specialist; and Mpoki Mwabukusi is an ICT Specialist/Computer System Analyst; all with SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Esron D. Karimuribo, PhD, is a One Health Epidemiologist, Professor, and Director of the Directorate of Postgraduate Studies, Research, Technology Transfer and Consultancy, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Leonard E G Mboera
- Calvin Sindato, PhD, is a Principal Research Scientist, National Institute for Medical Research, Tabora, Tanzania. At the time this work was conducted, he was a Postdoctoral Research Associate and One Health Epidemiologist with the SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Leonard E. G. Mboera, PhD, is Leader, Emerging and Vector-Borne Diseases Community of Practice; Eric Beda, MSc, is Regional ICT Specialist; and Mpoki Mwabukusi is an ICT Specialist/Computer System Analyst; all with SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Esron D. Karimuribo, PhD, is a One Health Epidemiologist, Professor, and Director of the Directorate of Postgraduate Studies, Research, Technology Transfer and Consultancy, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Eric Beda
- Calvin Sindato, PhD, is a Principal Research Scientist, National Institute for Medical Research, Tabora, Tanzania. At the time this work was conducted, he was a Postdoctoral Research Associate and One Health Epidemiologist with the SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Leonard E. G. Mboera, PhD, is Leader, Emerging and Vector-Borne Diseases Community of Practice; Eric Beda, MSc, is Regional ICT Specialist; and Mpoki Mwabukusi is an ICT Specialist/Computer System Analyst; all with SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Esron D. Karimuribo, PhD, is a One Health Epidemiologist, Professor, and Director of the Directorate of Postgraduate Studies, Research, Technology Transfer and Consultancy, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Mpoki Mwabukusi
- Calvin Sindato, PhD, is a Principal Research Scientist, National Institute for Medical Research, Tabora, Tanzania. At the time this work was conducted, he was a Postdoctoral Research Associate and One Health Epidemiologist with the SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Leonard E. G. Mboera, PhD, is Leader, Emerging and Vector-Borne Diseases Community of Practice; Eric Beda, MSc, is Regional ICT Specialist; and Mpoki Mwabukusi is an ICT Specialist/Computer System Analyst; all with SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Esron D. Karimuribo, PhD, is a One Health Epidemiologist, Professor, and Director of the Directorate of Postgraduate Studies, Research, Technology Transfer and Consultancy, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Esron D Karimuribo
- Calvin Sindato, PhD, is a Principal Research Scientist, National Institute for Medical Research, Tabora, Tanzania. At the time this work was conducted, he was a Postdoctoral Research Associate and One Health Epidemiologist with the SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Leonard E. G. Mboera, PhD, is Leader, Emerging and Vector-Borne Diseases Community of Practice; Eric Beda, MSc, is Regional ICT Specialist; and Mpoki Mwabukusi is an ICT Specialist/Computer System Analyst; all with SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Esron D. Karimuribo, PhD, is a One Health Epidemiologist, Professor, and Director of the Directorate of Postgraduate Studies, Research, Technology Transfer and Consultancy, Sokoine University of Agriculture, Morogoro, Tanzania
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13
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Bajaria S, Abdul R, Exavery A, Minja E, Charles J, Mtenga S, Jere E, Geubbels E. Programmatic determinants of successful referral to health and social services for orphans and vulnerable children: A longitudinal study in Tanzania. PLoS One 2020; 15:e0239163. [PMID: 32946528 PMCID: PMC7500632 DOI: 10.1371/journal.pone.0239163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/31/2020] [Indexed: 11/18/2022] Open
Abstract
Background Trained community workers (CWs) successfully deliver health and social services, especially due to greater community acceptance. Orphans and vulnerable children (OVC) and their caregivers (CG) often need support from several sectors. We identified CW, program and referral characteristics that were associated with success of referrals provided to OVC and their CG in Tanzania in a cross-sectoral bi-directional referral system. Methods Data for this secondary analysis come from the first two years (2017–2018) of the USAID funded Kizazi Kipya project. Referral success was defined as feedback and service received within 90 days post-referral provision. We analyzed factors that are associated with the referral success of HIV related, education, nutrition, parenting, household economic strengthening, and child protection services among OVC and CG, using generalized estimating equations. Results During the study period, 19,502 CWs in 68 councils provided 146,996 referrals to 132,640 beneficiaries. OVC had much lower referral success for HIV related services (48.1%) than CG (81.2%). Adjusted for other covariates, CW age (26–49 versus 18–25 years, for OVC aOR = 0.83, 95%CI (0.78, 0.87) and CW gender (males versus females, for OVC aOR = 1.12, 95%CI (1.08, 1.16); CG aOR = 0.84, 95%CI (0.78, 0.90)) were associated with referral success. CWs who had worked > 1 year in the project (aOR = 1.52, 95%CI 1.46, 1.58) and those with previous work experience as CW (aOR = 1.57, 95%CI (1.42, 1.74) more successfully referred OVC. Referrals provided to OVC for all other services were more successful compared to HIV referrals, with aORs ranging from 2.99 to 7.22. Longer project duration in the district council was associated with increased referral success for OVC (aOR = 1.16 per month 95%CI 1.15,1.17), but decreased for CG (aOR = 0.96, 95%CI 0.94, 0.97). Referral success was higher for OVC and CGs with multiple (versus single) referrals provided within the past 30 days (aOR = 1.28 95%CI 1.21, 1.36) and (aOR = 1.17, 95%CI (1.06, 1.30)) respectively. Conclusion CW characteristics, referral type and project maturity had different and often contrasting associations with referral success for OVC versus for CG. These findings could help policymakers decide on the recruitment and allocation of CWs in community based multi-sectoral intervention programs to improve referral successes especially for OVC.
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Affiliation(s)
- Shraddha Bajaria
- Health Systems, Impact Evaluation and Policy Department, Ifakara Health Institute, Dar es Salaam, Tanzania
- * E-mail:
| | - Ramadhani Abdul
- Health Systems, Impact Evaluation and Policy Department, Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | | | | | - Sally Mtenga
- Health Systems, Impact Evaluation and Policy Department, Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Eveline Geubbels
- Health Systems, Impact Evaluation and Policy Department, Ifakara Health Institute, Dar es Salaam, Tanzania
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