1
|
Panday S, van Teijlingen E, Barnes A. Exploring the motivations of female community health volunteers in primary healthcare provision in rural Nepal: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003428. [PMID: 39088488 PMCID: PMC11293747 DOI: 10.1371/journal.pgph.0003428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/07/2024] [Indexed: 08/03/2024]
Abstract
Motivating Community Health Workers (CHWs)-many of whom are volunteers-is crucial for achieving Universal Healthcare Coverage (UHC) for Primary Healthcare (PHC) in resource-poor areas. In rural Nepal, PHC is mostly delivered by female CHWs, locally known as Female Community Health Volunteers (FCHVs), but little is known about them. This paper explores experiential factors influencing FCHVs' motivations, including how motivation intersects with women's livelihoods and consider what this means for achieving PHC in Nepal and globally. We conducted qualitative research in the hill and the Terai (flatland bordering India) areas of Nepal. Data were purposively collected through 31 semi-structured interviews (20 volunteers, 11 paid local health workers) and three focus group discussions with additional 15 volunteers. All interviews were audio-recorded, transcribed verbatim in Nepali and translated into English. Data were coded using NVivo10, analysed thematically at individual, organisational and community levels. FCHVs' motivations to volunteer was affected in several ways. At the individual level, participants wanted and were committed to voluntary work, yet the opportunity costs of volunteering, out-of-pocket expenditure and inadequate family support strained many of the women who were already overburdened. At the community level, perceived lack of appreciation of volunteer efforts by community members, who saw volunteers as paid health workers, undermined FCHVs motivation to volunteer. Finally, at the organizational level, a bureaucratic emphasis on recording and reporting, and lack of respect from local health workers undermined their motivation at work. Our paper illustrates how FCHVs from some of the poorest backgrounds can be highly motivated to volunteer, yet inadequate social and economic support across individual, organisational and community levels undermined this motivation, the security of their livelihoods, and thus wider efforts to achieve PHC. Financial investments are needed to compensate FCHVs, so that they remain motivated to deliver global health goals for PHC.
Collapse
Affiliation(s)
- Sarita Panday
- School of Health and Social Care, University of Essex, Colchester, United Kingdom
| | - Edwin van Teijlingen
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Amy Barnes
- Department of Health Sciences, University of York, York, United Kingdom
| |
Collapse
|
2
|
Tesfa H, Getahun FA, Alemu YM. Motivation and associated factors of health development army in the implementation of health extension packages in Northwest Ethiopia: a cross-sectional study. BMJ Open 2024; 14:e077060. [PMID: 38521525 PMCID: PMC10961543 DOI: 10.1136/bmjopen-2023-077060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION Health development army is a network of women volunteers organised to promote health and prevent disease through community empowerment and participation. OBJECTIVE To assess the level of motivation and associated factors of the health development army in the implementation of health extension packages in Northwest Ethiopia. DESIGN Data were from a community-based cross-sectional study. SETTING This study was conducted in Mecha district, Northwest Ethiopia. The district is located around 30 km from Bahir Dar, the capital city of Amhara National Regional State, Ethiopia. PARTICIPANTS A total of 624 health development army members were interviewed using a structured questionnaire from 20 April 2020 to 20 May 2020. OUTCOME MEASURES Motivation was assessed using a five-item Likert scale statement ranging from 1 to 5. Data were collected using a structured questionnaire and analysed using a binary logistic regression model. RESULTS The proportion of health development army members, who had motivation in the implementation of the health extension package, was 47.8% (95% CI (43.90 to 51.80)). The odds of having motivation were higher among health development army members who lived in urban areas ((adjusted OR, AOR 2.47; 95% CI (1.21 to 5.03)), were less than 30 years ((AOR 2.42; 95% CI (1.22 to 4.78)), had more than 4 years work experience ((AOR 4.72; 95% CI (2.54 to 8.76)), had high intrinsic job satisfaction ((AOR 2.31; 95% CI (1.51 to 3.55)), had good community support ((AOR 2.46; 95% CI (1.34 to 4.51)), received supportive supervision ((AOR 1.85; 95% CI (1.24 to 2.77)) and were recognised for their efforts ((AOR 1.52; 95% CI (1.01 to 2.30)). CONCLUSION The proportion of motivation among health development army members was low. To increase the motivation of health development army members in the implementation of the health extension package, measures or strategies may consider targeting members who live in rural areas, are older than 30 years, have less than 4 years of work experience, report low job satisfaction, have low community support, do not have supportive supervision and are not recognised.
Collapse
Affiliation(s)
- Hiwot Tesfa
- College of Medicine and Health Sciences, Department of Public Health, Injibara University, Injibara, Ethiopia
| | - Fentie Ambaw Getahun
- College of Medicine and Health Sciences, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yihun Mulugeta Alemu
- College of Medicine and Health Sciences, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| |
Collapse
|
3
|
Vieira EMDA, da Silva JMN, Leite WKDS, Oliveira RSG, da Silva LB. Analysis of the influence of occupational, sociodemographic and health factors on the demotivation of the intensivist. Rev Bras Med Trab 2024; 22:e2022976. [PMID: 39165528 PMCID: PMC11333065 DOI: 10.47626/1679-4435-2022-976] [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: 02/05/2022] [Accepted: 05/26/2022] [Indexed: 08/22/2024] Open
Abstract
Introduction Understanding motivation, identifying motivational factors of health professionals, and recognizing how managers and leaders can successfully motivate healthcare professionals is a growing concern. Objectives To assess the occupational, sociodemographic, and health factors that influence the occurrence of demotivation in the intensive care unit professionals. Methods We performed a cross-sectional study with health professionals from nine intensive care units in João Pessoa, Paraíba state, Brazil. Data were collected using an adapted version of the Health Care Establishment Questionnaire. We built a Logistic Regression model to analyze the influence of variables on the motivational state, and variables were selected by the Backward method. We used 80% of the sample for parameter estimation and the remaining 20% for testing and validation. We used the R software for the analyses, with a significance level of α ≤ 0.05. Results We identify that the variable with the greatest power over the intensivist's demotivation was shift work (odds ratio [OR] = 4.215, p = 0.006). The number of symptoms (OR = 1.206, p = 0.000) and working time (OR = 1.080, p = 0.031) were also significant risk variables. When the three variables were combined, the professional's chance of feeling unmotivated increased by 38 times (OR = 38.99, p = 0.000). Conclusions Based on these results, it is possible to identify aspects that will require organizational adjustments so that intensivists remain satisfied and motivated.
Collapse
|
4
|
Chauhan V, Dumka N, Hannah E, Ahmed T, Kotwal A. Mid-level health providers (MLHPs) in delivering and improving access to primary health care services - a narrative review. DIALOGUES IN HEALTH 2023; 3:100146. [PMID: 38515797 PMCID: PMC10953921 DOI: 10.1016/j.dialog.2023.100146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 03/23/2024]
Abstract
Background For primary healthcare systems to bring care closer to the communities, the availability of appropriate human resources is crucial. The primary care workforce in the world is expanding to include non-physician health workers (NPHWs) to increase its capacity. Also, NPHWs as mid-level health providers (MLHPs) are currently being employed in high- and low-income countries to assist doctors and specialists to make up for the scarcity of health professionals. Given the wide prevalence in the deployment of NPHWs as mid-level health providers, this article collates recent evidence on the role of MLHPs in improving access to primary healthcare services, and their enablers and barriers in integrating them in primary care teams. The article also presents gaps in evidence and recommendations for the way forward. Methods A systematic search of contemporary literature published from January 2012 to September 2022 was undertaken using two bibliographic databases (PubMed and Cochrane) and hand searching the reference list of retrieved papers. Duplicates, papers older than ten years, and whose focus was not on primary healthcare were excluded. The papers finalised for appraisal were scrutinised for key themes and their summaries were collated for analysis. The papers comprised of twenty-four quantitative, twenty-three qualitative, and nine mixed approach study designs (n = 56) due to which a narrative approach was conducted as per guidelines. Results The review identified and presents the following themes - task shifting and its effectiveness in service delivery, quality of care, enablers and barriers of NPHWs in primary health care in both HIC and LMIC settings. Conclusion Task-shifting interventions need effective engagement and constant coordination with relevant stakeholders. For this, policymakers, public health researchers, healthcare professionals of all cadres and community members need to be involved across all stages of introduction and absorption of the cadre into the primary healthcare delivery system.
Collapse
Affiliation(s)
- Vishal Chauhan
- National Health Mission, Ministry of Health and Family Welfare, India
| | - Neha Dumka
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, India
| | - Erin Hannah
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, India
| | - Tarannum Ahmed
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, India
| | - Atul Kotwal
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, India
| |
Collapse
|
5
|
Babatunde GB, Akintola O. Beyond Access: Can a School Health Initiative Facilitate Healthcare Services Utilisation for School-Going Children? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6448. [PMID: 37568989 PMCID: PMC10418310 DOI: 10.3390/ijerph20156448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 08/13/2023]
Abstract
Accessing quality healthcare services is critical to addressing the different health challenges confronting school-going children, especially those in low-resource communities. However, the evidence of access to services is utilisation and not the mere availability of such services. This study explored caregivers' descriptions of the factors influencing the access and utilisation of quality healthcare services for school-going children and their perceptions of the services provided through the integrated school health programme in South Africa. Qualitative interviews were conducted with 17 caregivers of school-going children in three low-resource communities of KwaZulu-Natal province. The data was analysed using thematic analysis, and the themes were clustered using components of the Aday and Andersen framework for access. Despite the efforts to expand the coverage and range of services provided through the Integrated School Health Programme (ISHP), we identified various factors that undermine the overall aim of the ISHP. Financial constraints, distance to health facilities, poor communication and information dissemination systems, low literacy levels, healthcare workers' negative attitudes, and long waiting periods at the referral sites constitute barriers to service utilisation. Specific attention should be paid to improving the communication system between the school-health team and the caregivers, providing support for transportation, improving the attitude of the clinic staff, and providing follow-up services for children referred for further screening and treatment.
Collapse
Affiliation(s)
- Gbotemi Bukola Babatunde
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa;
- Graduate School of Professional Psychology, University of Denver, Denver, CO 80208, USA
| | - Olagoke Akintola
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa;
| |
Collapse
|
6
|
Makholwa N, Tlou B, Dlungwane TP. Job satisfaction among rehabilitation professionals employed in public health facilities in KwaZulu-Natal. Afr Health Sci 2023; 23:764-772. [PMID: 38223643 PMCID: PMC10782330 DOI: 10.4314/ahs.v23i2.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background Job satisfaction is essential in stimulating productivity and efficiency in the health sector. Dissatisfied employees are likely to leave, which places an added burden considering the shortage of health workers. Rehabilitation professionals form a critical component of the public health workforce. Objective The aim of the study was to document the level of job satisfaction and factors associated with job satisfaction among rehabilitation professionals employed in public health facilities in KwaZulu-Natal. Methods A cross-sectional survey was conducted. A self-administered questionnaire was utilized. A Chi-square test and logistic regression were used to assess associations and to identify factors associated with job satisfaction. A p-value less than 0.05 was deemed statistically significant. Results Most participants (59%) reported a low level of overall job satisfaction. The participants were dissatisfied about not getting recognition for work related to their specific professions (61.3 %) and not being considered for career advancement (74.3 %). In addition, inadequate financial rewards (87.2%) and benefits (71.3%) were also linked to low job satisfaction. Conclusion Participants displayed a low level of job satisfaction. Rehabilitation services should be prioritized, and appropriate recognition should be granted to rehabilitation professionals in order to enhance job satisfaction.
Collapse
Affiliation(s)
- N Makholwa
- College of Health Sciences, School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, South Africa
| | - B Tlou
- College of Health Sciences, School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, South Africa
| | - T P Dlungwane
- College of Health Sciences, School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, South Africa
| |
Collapse
|
7
|
Ejigu Y, Abera N, Haileselassie W, Berhanu N, Haile BT, Nigatu F, Tewfik N, Kiflie Y, Medhin G, Walelign F, Demissie M, Tigabu S, Taddesse D, Dadi TL, Teklu A. Motivation and job satisfaction of community health workers in Ethiopia: a mixed-methods approach. HUMAN RESOURCES FOR HEALTH 2023; 21:35. [PMID: 37127695 PMCID: PMC10152586 DOI: 10.1186/s12960-023-00818-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Ethiopia has been providing health care to its rural population since 2004 using female Community Health Workers called Health Extension Workers (HEWs). The HEWs are credited with several achievements in improving the country's health indicators. However, information about the HEWs' motivation and job satisfaction is limited. The aim of this study was to assess the HEWs' motivation and job satisfaction, as well as the factors that influence them. METHODS A mixed-methods study was nested within a national health extension program assessment conducted from March 01 to May 31, 2019. A structured questionnaire which looked at motivation and satisfaction with Likert type single-question and multiple-item measures was used to collect quantitative data from 584 HEWs. Focus group discussion and in-depth interviews were used to gather qualitative data. Means and percentages were used to descriptively summarize important variables. Linear regression was used to identify factors associated with job satisfaction. The qualitative data was analysed thematically. RESULTS Overall, 48.6% of HEWs were satisfied with their job, with a mean score of 2.5 out of 4.0. The result showed a high level of satisfaction with autonomy (72%), relationships with co-workers (67%), and recognition (56%). Low level of satisfaction was linked to pay and benefits (13%), opportunities for promotion (29%), and education (34%). Regression analysis showed that HEWs in the age category of 30 years and older had lower satisfaction scores as compared to HEWs in the age category of 18-24 years (adjusted β = - 7.71, 95% CI: - 14.42, - 0.99). The qualitative result revealed that desire to help their community, recognition or respect gained from the community, and achievement were the major motivating factors. In contrast, inadequate pay and benefit, limited education and career advancement opportunities, workload, work environment, limited supportive supervision, and absence of opportunity to change workplace were the demotivating factors. CONCLUSIONS The overall job satisfaction of HEWs was low; extrinsic factors, such as inadequate pay, limited education and career advancement opportunities were the major sources of demotivation. Policy makers and human resource managers should revise their human resource policies and guidelines to address the main sources of low level of job satisfaction and demotivation.
Collapse
Affiliation(s)
- Yohannes Ejigu
- Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.
- Monitoring, Evaluation, Research, and Quality Improvement (MERQ) PLC, Ethiopia Office, Addis Ababa, Ethiopia.
| | - Netsanet Abera
- School of Public Health, Hawassa University, Hawassa, Ethiopia
| | | | - Negalign Berhanu
- Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
| | - Biniyam Tadesse Haile
- Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care, Addis Ababa, Ethiopia
| | - Nurhan Tewfik
- International Institute for Primary Health Care, Addis Ababa, Ethiopia
| | - Yibeltal Kiflie
- Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- Monitoring, Evaluation, Research, and Quality Improvement (MERQ) PLC, Ethiopia Office, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Monitoring, Evaluation, Research, and Quality Improvement (MERQ) PLC, Ethiopia Office, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fasil Walelign
- Monitoring, Evaluation, Research, and Quality Improvement (MERQ) PLC, Ethiopia Office, Addis Ababa, Ethiopia
- School of Public Health, Wollo University, Dessie, Ethiopia
| | - Mekdes Demissie
- Monitoring, Evaluation, Research, and Quality Improvement (MERQ) PLC, Ethiopia Office, Addis Ababa, Ethiopia
| | - Setegn Tigabu
- Monitoring, Evaluation, Research, and Quality Improvement (MERQ) PLC, Ethiopia Office, Addis Ababa, Ethiopia
| | - Daniel Taddesse
- Monitoring, Evaluation, Research, and Quality Improvement (MERQ) PLC, Ethiopia Office, Addis Ababa, Ethiopia
| | - Tegene Legese Dadi
- Monitoring, Evaluation, Research, and Quality Improvement (MERQ) PLC, Ethiopia Office, Addis Ababa, Ethiopia
- School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Alula Teklu
- Monitoring, Evaluation, Research, and Quality Improvement (MERQ) PLC, Ethiopia Office, Addis Ababa, Ethiopia
| |
Collapse
|
8
|
Sharma A, Prinja S, Rao KD, Aggarwal AK. Human Resources for Health in Haryana, India: What can be Done Better? WHO South East Asia J Public Health 2023; 12:4-14. [PMID: 37843177 DOI: 10.4103/who-seajph.who-seajph_11_22] [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: 10/17/2023]
Abstract
Introduction Health systems in developing countries suffers from both input and productivity issues. We examined the status of three domains of human resources for health, i.e., availability and distribution, capacity and productivity, and motivation and job-satisfaction, of the health-care workforce employed in the public health system of Haryana, a North Indian state. Methodology The primary data were collected from 377 public health facilities and 1749 healthcare providers across 21 districts. The secondary data were obtained from government reports in the public domain. Bivariate and multivariate statistical techniques were used for evaluating district performances, making inter-district comparisons and identifying determinants of motivation and job-satisfaction of the clinical cadres. Results We found 3.6 core health-care workers (doctors, staff nurses, and auxiliary nurses-midwives) employed in the public health-care system per 10,000 population, ranging from 1.35 in Faridabad district to 6.57 in Panchkula district. Around 78% of the sanctioned positions were occupied. A number of inpatient hospitalizations per doctor/nurses per month were 17 at the community health center level and 29 at the district hospital level; however, significant differences were observed among districts. Motivation levels of community health workers (85%) were higher than clinical workforce (78%), while health system administrators had lowest motivation and job satisfaction levels. Posting at primary healthcare facility, contractual employment, and co-habitation with family at the place of posting were found to be the significant motivating factors. Conclusions A revamp of governance strategies is required to improve health-care worker availability and equitable distribution in the public health system to address the observed geographic variations. Efforts are also needed to improve the motivation levels of health system administrators, especially in poorly performing districts and reduce the wide gap with better-off districts.
Collapse
Affiliation(s)
- Atul Sharma
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishna Dipankar Rao
- Centre for Global Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Arun Kumar Aggarwal
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
9
|
Lar L, Stewart M, Isiyaku S, Dean L, Ozano K, Mpyet C, Theobald S. Does inter-border conflict influence the views of task sharing among community health volunteers in Nigeria? A qualitative study. Confl Health 2022; 16:43. [PMID: 35871004 PMCID: PMC9308912 DOI: 10.1186/s13031-022-00472-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/27/2022] [Indexed: 01/17/2023] Open
Abstract
Background Volunteer community health workers are increasingly being engaged in Nigeria, through the World Health Organization’s task sharing strategy. This strategy aims to address gaps in human resources for health, including inequitable distribution of health workers. Recent conflicts in rural and fragile border communities in northcentral Nigeria create challenges for volunteer community health workers to meet their community's increasing health needs. This study aimed to explore the perception of volunteers involved in task sharing to understand factors affecting performance and delivery in such contexts. Methods This was a qualitative study conducted in fragile border communities in north central Nigeria. Eighteen audio recorded, semi-structured interviews with volunteers and supervisors were performed. Their perceptions on how task sharing and allocation of tasks affect performance and delivery were elucidated. The transactional social framework was applied during the thematic analysis process to generate an explanatory account of the research data, which was analysed using NVivo software. Results Promotive and preventive tasks were shared among the predominantly agrarian respondents. There was a structured task allocation process that linked the community with the health system and mainly cordial relationships were in place. However, there were barriers related to ethnoreligious crises and current conflict, timing of task allocations, gender inequities in volunteerism, shortage of commodities, inadequate incentives, dwindling community support and negative attitudes of some volunteers. Conclusion The perception of task sharing was mainly positive, despite the challenges, especially the current conflict. In this fragile context, reconsideration of non-seasonal task allocations within improved community-driven selection and security systems should be encouraged. Supportive supervision and providing adequate and timely renumeration will also be beneficial in this fragile setting.
Collapse
|
10
|
Using the RE-AIM framework to evaluate the implementation of scaling-up the Friendship Bench in Zimbabwe - a quantitative observational study. BMC Health Serv Res 2022; 22:1392. [PMID: 36419089 PMCID: PMC9682765 DOI: 10.1186/s12913-022-08767-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/30/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the real-world implementation of the Friendship Bench (FB) - an evidence-based brief psychological intervention delivered by community health workers (CHWs) - three years after its implementation in three city health departments in Zimbabwe. Implementation sites were evaluated according to their current performance using the RE-AIM framework making this one of the first evaluations of a scaled-up evidence-based psychological intervention in sub-Saharan Africa (SSA). METHODS Using the RE-AIM guide ( www.re-aim.org ), the authors designed quantitative indicators based on existing FB implementation data. Thirty-six primary health care clinics (PHC) in Harare (n=28), Chitungwiza (n=4) and Gweru (n=4) were included. Among these clinics 20 were large comprehensive health care centers, 7 medium (mostly maternal and child healthcare) and 9 small clinics (basic medical care and acting as referral clinic). Existing data from these clinics, added to additionally collected data through interviews and field observations were used to investigate and compare the performance of the FB across clinics. The focus was on the RE-AIM domains of Reach, Adoption, and Implementation. RESULTS Small clinics achieved 34% reach, compared to large (15%) and medium clinics (9%). Adoption was high in all clinic types, ranging from 59% to 71%. Small clinics led the implementation domain with 53%, followed by medium sized clinics 43% and large clinics 40%. Small clinics performed better in all indicators and differences in performance between small and large clinics were significant. Program activity and data quality depends on ongoing support for delivering agents and buy-in from health authorities. CONCLUSION The Friendship Bench program was implemented over three years transitioning from a research-based implementation program to one led locally. The Reach domain showed the largest gap across clinics where larger clinics performed poorly relative to smaller clinics and should be a target for future implementation improvements. Program data needs to be integrated into existing health information systems. Future studies should seek to optimize scale-up and sustainment strategies to maintain effective task-shared psychological interventions in SSA.
Collapse
|
11
|
Acceptability and feasibility of community-based provision of urine pregnancy tests to support linkages to reproductive health services in Western Kenya: a qualitative analysis. BMC Pregnancy Childbirth 2022; 22:674. [PMID: 36050632 PMCID: PMC9434878 DOI: 10.1186/s12884-022-04869-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The majority of women living in rural Kenya access antenatal care (ANC) late in pregnancy, and approximately 20% have an unmet need for family planning (FP). This study aimed to determine whether training community health volunteers (CHVs) to deliver urine pregnancy testing (UPT), post-test counselling, and referral to care was an acceptable and feasible intervention to support timely initiation of ANC and uptake of FP. METHODS We applied community-based participatory methods to design and implement the pilot intervention between July 2018 and May 2019. We conducted qualitative content analysis of 12 pre-intervention focus group discussions (FGDs) with women, men, and CHVs, and of 4 post-intervention FGDs with CHVs, each with 7-9 participants per FGD group. Using a pragmatic approach, we conducted inductive line-by-line coding to generate themes and subthemes describing factors that positively or negatively contributed to the intervention's acceptability and feasibility, in terms of participants' views and the intervention aims. RESULTS We found that CHV-delivered point of care UPT, post-test counselling, and referral to care was an acceptable and feasible intervention to increase uptake of ANC, FP, and other reproductive healthcare services. Factors that contributed to acceptability were: (1) CHV-delivery made UPT more accessible; (2) UPT and counselling supported women and men to build knowledge and make informed choices, although not necessarily for women with unwanted pregnancies interested in abortion; (3) CHVs were generally trusted to provide counselling, and alternative counselling providers were available according to participant preference. A factor that enhanced the feasibility of CHV delivering UPT and counselling was CHV's access to appropriate supplies (e.g. carrying bags). However, factors that detracted from the feasibility of women actually accessing referral services after UPT and counselling included (1) downstream barriers like cost of travel, and (2) some male community members' negative attitudes toward FP. Finally, improved financial, educational, and professional supports for CHVs would be needed to make the intervention acceptable and feasible in the long-term. CONCLUSION Training CHVs in rural western Kenya to deliver UPT, post-test counselling, and referral to care was acceptable and feasible to men, women, and CHVs in this context, and may promote early initiation of ANC and uptake of FP. Additional qualitative work is needed to explore implementation challenges, including issues related to unwanted pregnancies and abortion, the financial burden of volunteerism on CHVs, and educational and professional supports for CHVs.
Collapse
|
12
|
Serapelwane MG, Manyedi EM. Unfair labour practice on staff in primary health care facilities, North West province, South Africa: A qualitative study. Curationis 2022; 45:e1-e10. [PMID: 35261254 PMCID: PMC8905370 DOI: 10.4102/curationis.v45i1.2171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/07/2021] [Accepted: 11/12/2021] [Indexed: 11/08/2022] Open
Abstract
Background Unfair labour practices on staff is a worldwide concern which creates conflicts and disharmony among health workers in the workplace. It is found that, nursing staff members are unfairly treated without valid reasons in primary health care (PHC) facilities and predominantly in the developing countries and South Africa is not an exception. Objectives The purpose of the study was to explore and describe the experiences of operational managers regarding unfair labour practices on staff by their local health area managers, and describe the perceptions of operational managers towards such treatment. Method A qualitative, descriptive, exploratory and contextual research approach was considered appropriate for the study. The population of the study comprised operational managers working in PHC facilities in the North West province, South Africa. Purposive sampling was used to select participants for the study and focus group interviews used to interview 23 operational managers. Ethical measures were applied throughout the study. Results The six phases of thematic analysis were used to analyse the data collected for the study. Two themes that emerged are experiences of factors related to unfair labour practices in the PHC facilities and the perceptions regarding how to improve their working conditions. The categories that were found in the first themes were favouritism and discrimination. In the second theme, in-service training and transparency regarding staff training and development emerged. Recommendations comprised, among others, training on the concepts of equality in the workplace, and reinforcement of transparency regarding granting of study leave and attending workshops. Conclusion Operational managers in the PHC facilities experienced unfair labour practices as evidenced by favouritism and discrimination.
Collapse
|
13
|
Ndambo MK, Munyaneza F, Aron MB, Nhlema B, Connolly E. Qualitative assessment of community health workers' perspective on their motivation in community-based primary health care in rural Malawi. BMC Health Serv Res 2022; 22:179. [PMID: 35148772 PMCID: PMC8840069 DOI: 10.1186/s12913-022-07558-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community Health Workers (CHWs) have a positive impact on the provision of community-based primary health care through screening, treatment, referral, psychosocial support, and accompaniment. With a broad scope of work, CHW programs must balance the breadth and depth of tasks to maintain CHW motivation for high-quality care delivery. Few studies have described the CHW perspective on intrinsic and extrinsic motivation to enhance their programmatic activities. METHODS We utilized an exploratory qualitative study design with CHWs employed in the household model in Neno District, Malawi, to explore their perspectives on intrinsic and extrinsic motivators and dissatisfiers in their work. Data was collected in 8 focus group discussions with 90 CHWs in October 2018 and March-April 2019 in seven purposively selected catchment areas. All interviews were audiotaped, transcribed verbatim, coded, and analyzed using Dedoose. RESULTS Themes of complex intrinsic and extrinsic factors were generated from the perspectives of the CHWs in the focus group discussions. Study results indicate that enabling factors are primarily intrinsic factors such as positive patient outcomes, community respect, and recognition by the formal health care system but can lead to the challenge of increased scope and workload. Extrinsic factors can provide challenges, including an increased scope and workload from original expectations, lack of resources to utilize in their work, and rugged geography. However, a positive work environment through supportive relationships between CHWs and supervisors enables the CHWs. CONCLUSION This study demonstrated enabling factors and challenges for CHW performance from their perspective within the dual-factor theory. We can mitigate challenges through focused efforts to limit geographical distance, manage workload, and strengthen CHW support to reinforce their recognition and trust. Such programmatic emphasis can focus on enhancing motivational factors found in this study to improve the CHWs' experience in their role. The engagement of CHWs, the communities, and the formal health care system is critical to improving the care provided to the patients and communities, along with building supportive systems to recognize the work done by CHWs for the primary health care systems.
Collapse
Affiliation(s)
| | - Fabien Munyaneza
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Blantyre, Malawi
| | - Moses Banda Aron
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Blantyre, Malawi
| | - Basimenye Nhlema
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Blantyre, Malawi
| | - Emilia Connolly
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Blantyre, Malawi.,Division of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, USA.,Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45529, USA
| |
Collapse
|
14
|
Mhlongo EM, Lutge E. Facility Managers' Perceptions of Support and Supervision of Ward Based Primary Health Care Outreach Teams in National Health Insurance Pilot Districts in KwaZulu-Natal, South Africa. A Qualitative Study. Healthcare (Basel) 2021; 9:healthcare9121718. [PMID: 34946444 PMCID: PMC8701860 DOI: 10.3390/healthcare9121718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction: Evidence from many countries suggests that provision of home and community-based health services, linked to care at fixed primary health care facilities, is critical to good health outcomes. In South Africa, the Ward-Based Primary Health Care Outreach Teams are well placed to provide these services. The teams report to a primary health care facility through their outreach team leader. The facility manager/operational manager provides guidance and support to the outreach team leader. Aim: The aim of the study was to explore and describe the perceptions of facility managers regarding support and supervision of ward-based outreach teams in the National Health Insurance pilot sites in Kwa Zulu-Natal. Setting: The study was carried out in three National Health Insurance pilot districts in KwaZulu- Natal. Methods: An exploratory qualitative design was used to interview 12 primary health care facility managers at a sub-district (municipal) level. The researchers conducted thematic analysis of data. Findings: Some gaps in the supervisory and managerial relationships between ward based primary health care outreach teams and primary health care facility managers were identified. High workload at clinics may undermine the capacity of PHC facility managers to support and supervise the teams. Field supervision seems to take place only rarely and for those teams living far away from the clinic, communication with the clinic manager may be difficult. The study further highlights issues around the training and preparation of the teams. Conclusions: Ward based primary health care outreach teams have a positive impact in preventive and promotive health in rural communities. Furthermore, these teams have also made impact in improving facility indicators. However, their work does not happen without challenges.
Collapse
Affiliation(s)
- Euphemia Mbali Mhlongo
- Department of Nursing, School of Nursing and Public Health, Howard College, University of KwaZulu Natal, Durban 4000, South Africa;
- Correspondence: ; Tel.: +27-31260-1210
| | - Elizabeth Lutge
- Department of Nursing, School of Nursing and Public Health, Howard College, University of KwaZulu Natal, Durban 4000, South Africa;
- KwaZulu-Natal Department of Health, Pietermaritzburg 3200, South Africa
| |
Collapse
|
15
|
Okyere E, Ward P, Marfoh K, Mwanri L. What do Health Workers say About Rural Practice? Glob Qual Nurs Res 2021; 8:23333936211054812. [PMID: 34869792 PMCID: PMC8637704 DOI: 10.1177/23333936211054812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022] Open
Abstract
Adequately staffed rural health services improve healthcare delivery and health outcomes,
yet this is lacking in rural Ghana. We used a descriptive qualitative design to understand
the contextual issues that affect rural practice, in the Upper East Region, Ghana.
Sixty-eight in-depth interviews were conducted with healthcare workers and analysed
thematically. Four themes were identified: types of postings to rural settings, healthcare
workers’ perceptions of their rural postings, perceived enablers and motivators for rural
practice, and perceived challenges and barriers to rural practice. While adequate
supervision and family proximity are needed to improve the feelings of loneliness,
isolation and neglect in rural areas, challenges and barriers such as inadequate security,
unstable electricity supply, language barrier, lack of equipment and transport/ambulance
have been identified to have negative influence on healthcare workers. The findings
highlight the need for healthcare managers to improve fairness and transparency in the
posting and reshuffling processes of healthcare workers.
Collapse
Affiliation(s)
- Eunice Okyere
- College of Medicine, Nursing and Health
Sciences, Fiji National University, Suva, Fiji Islands
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
- Eunice Okyere, Department of Public Health, College
of Medicine, Nursing and Health Sciences, Fiji National University, Princess Road,
Tamavua, Suva, Fiji Islands.
| | - Paul Ward
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | - Kissinger Marfoh
- Department of Public Health, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| |
Collapse
|
16
|
Irani L, Schooley J, Supriya, Chaudhuri I. Layering of a health, nutrition and sanitation programme onto microfinance-oriented self-help groups in rural India: results from a process evaluation. BMC Public Health 2021; 21:2131. [PMID: 34801003 PMCID: PMC8605516 DOI: 10.1186/s12889-021-12049-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The state of Bihar has been lagging behind Indian national averages on indicators related to maternal and child health, primarily due to lack of knowledge among mothers of young children on lifesaving practices and on where to seek services when healthcare is needed. Hence, the JEEViKA Technical Support Programme was established in 101 blocks to support the state rural livelihood entity, JEEViKA, in order to increase demand for and link rural families to existing health, nutrition and sanitation services. Programme activities were geared to those engaged in JEEViKA's microfinance-oriented self-help groups. These groups were facilitated by a village-based community mobilizer who was trained on health, nutrition and sanitation-related topics which she later shared in self-help group meetings monthly and during ad hoc home visits. Further, a block-level health, nutrition and sanitation integrator was introduced within JEEViKA to support community mobilizers. Also, indicators were added into the existing monitoring system to routinely capture the layering of health, nutrition and sanitation activities. METHODS A process evaluation was conducted from August-November 2017 which comprised of conducting 594 quantitative surveys with community mobilizers, from program and non-programme intervention blocks. Linear and logistic regressions were done to capture the association of at least one training that the community mobilizers received on knowledge of the topics learned and related activities they carried out. RESULTS Community mobilizers who had received at least one training were more likely to have higher levels of knowledge on the topics they learned and were also more likely to carry out related activities, such as interacting with block-level integrators for guidance and support, routinely collect data on health, nutrition and sanitation indicators and spend time weekly on related activities. CONCLUSIONS Successful integration of health, nutrition and sanitation programming within a non-health programme such as JEEViKA is possible through trainings provided to dedicated staff in decentralized positions, such as community mobilizers. The findings of this evaluation hold great promise for engaging existing non-health, nutrition and sanitation systems that are serving vulnerable communities to become partners in working towards ensuring stronger health, nutrition and sanitation outcomes for all.
Collapse
Affiliation(s)
- Laili Irani
- Population Council, Zone 5A, Ground Floor, India Habitat Centre, Lodi Road, New Delhi, 110003, India.
| | - Janine Schooley
- Project Concern International, 5151 Murphy Canyon Rd, Suite 320, San Diego, CA, 92123, USA
| | - Supriya
- Population Council, Zone 5A, Ground Floor, India Habitat Centre, Lodi Road, New Delhi, 110003, India
| | - Indrajit Chaudhuri
- Project Concern International, 38, Okhla Phase 3 Rd, Okhla Phase III, Okhla Industrial Area, New Delhi, 110020, India
| |
Collapse
|
17
|
Mahilall R, Swartz L. Spiritual Care: Motivations and Experiences through the Lenses and Voices of a Cohort of Spiritual Care Workers at an Established Hospice in Cape Town, South Africa. JOURNAL OF RELIGION AND HEALTH 2021; 60:2906-2924. [PMID: 33755819 PMCID: PMC7985573 DOI: 10.1007/s10943-021-01232-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
While palliative care is beginning to gain prominence in South Africa, spiritual care remains less understood. Spiritual care is less prioritised and, consequently, this service, if offered, is mostly entrusted to volunteers. It therefore becomes prudent to understand who these volunteers are, what motivates them to volunteer, and how they see spiritual care being sustainable in the future. A cohort of spiritual care workers from a prominent hospice in Cape Town, South Africa, participated in this qualitative study. The participants made suggestions about formalising spiritual care as well as making a call for a basic entry requirement into spiritual care work.
Collapse
Affiliation(s)
- Ronita Mahilall
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7700, South Africa.
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7700, South Africa
| |
Collapse
|
18
|
Adams S, Mulubwa M, van Huyssteen M, Bheekie A. Access to chronic medicines: patients' preferences for a last kilometre medicine delivery service in Cape Town, South Africa. BMC FAMILY PRACTICE 2021; 22:43. [PMID: 33618657 PMCID: PMC7899209 DOI: 10.1186/s12875-021-01392-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 02/09/2021] [Indexed: 01/31/2023]
Abstract
Background Chronic patients are required to access their chronic medicines on a regular basis, often only to refill their repeat prescriptions. Adherence to chronic medicines is challenging and has stimulated health care providers to devise differentiated service delivery models of care to decentralise chronic medicine distribution to decrease the frequency of medicine collection at health care facilities. One such option includes a last kilometre medicine delivery service. This study investigated chronic patients’ preferences for a last kilometre medicine delivery service model. Methods An exploratory non-randomised quantitative study was conducted over 4 weeks at four public sector primary health care facilities in Cape Town, South Africa. Data was collected on a structured questionnaire from chronic patients queuing to receive medication at each facility’s pharmacy waiting area. Patient demographics were noted to align with preferences for chronic medicine service delivery characteristics including; mobile ordering, fee for service and location for delivery. Chi-square test and frequencies were employed to analyse data using SPSS version 23. Results A total of 116 patients participated in this study. Most were interested in a medicine delivery service (80.2%) and were willing to use a mobile application to order their medicines (84.5%). Almost all patients (96.8%) preferred that their medicines be delivered to their home. More than three quarters of participants were willing to pay for the service (77.6%). Chi-square test showed that gender, age group, employment status, distance to the health facility and /or average waiting time at the clinic significantly influenced the preference for certain characteristics of the medicine delivery service (p < 0.05). Conclusion Most participants were interested in a last kilometre medicine delivery service, especially those older than 45 years, waiting for more than 6 h at the facility, and staying within one kilometre radius of the clinic. More studies are needed to establish the influence of patients’ employment status and the distance to health facility on interest in the medicine delivery service. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01392-1.
Collapse
Affiliation(s)
- Siraaj Adams
- Iyeza Health, 4 Phatha Close, Harare Business Square, Khayelitsha, Cape Town, South Africa
| | - Mwila Mulubwa
- School of Pharmacy, University of the Western Cape, Private bag X17, Bellville, Cape Town, South Africa
| | - Mea van Huyssteen
- School of Pharmacy, University of the Western Cape, Private bag X17, Bellville, Cape Town, South Africa.
| | - Angeni Bheekie
- School of Pharmacy, University of the Western Cape, Private bag X17, Bellville, Cape Town, South Africa
| |
Collapse
|
19
|
Jobson G, Naidoo N, Matlakala N, Marincowitz G, Railton J, McIntyre JA, Struthers HE, Peters RPH. Contextual factors affecting the integration of community health workers into the health system in Limpopo Province, South Africa. Int Health 2021; 12:281-286. [PMID: 31693110 PMCID: PMC7322200 DOI: 10.1093/inthealth/ihz082] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/30/2019] [Accepted: 08/08/2019] [Indexed: 12/03/2022] Open
Abstract
Background Community health workers (CHWs) are an essential cadre in the health systems of many low- and middle-income countries. These workers provide a wide variety of services and are key to ongoing processes of task shifting within human immunodeficiency virus programmes in particular. Ward-based outreach teams (WBOTs) are South Africa’s latest iteration of the CHW programme and have been introduced as part of the National Department of Health’s Primary Health Care Re-engineering programme. Methods In order to assess the perceived effectiveness of the WBOTs in supporting the ongoing rollout of antiretroviral therapy, tuberculosis care and patient support, we conducted a qualitative investigation focusing on the perceived successes and challenges of the programme among CHWs, community leaders, healthcare workers and community members in the Mopani district, Limpopo province, South Africa. Results The CHW programme operates across these contexts, each associated with its own set of challenges and opportunities. Conclusions While these challenges may be interrelated, a contextual analysis provides a useful means of understanding the programme’s implementation as part of ongoing decision-making processes.
Collapse
Affiliation(s)
- Geoffrey Jobson
- Anova Health Institute, 12 Sherborne Rd., Park Town, Johannesburg, South Africa
| | - Nireshni Naidoo
- Anova Health Institute, 12 Sherborne Rd., Park Town, Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Gert Marincowitz
- Provincial Department of Health, Mafeking, Limpopo, South Africa
| | - Jean Railton
- Anova Health Institute, 12 Sherborne Rd., Park Town, Johannesburg, South Africa
| | - James A McIntyre
- Anova Health Institute, 12 Sherborne Rd., Park Town, Johannesburg, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, 7925, Cape Town, South Africa
| | - Helen E Struthers
- Anova Health Institute, 12 Sherborne Rd., Park Town, Johannesburg, South Africa.,Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Remco P H Peters
- Anova Health Institute, 12 Sherborne Rd., Park Town, Johannesburg, South Africa.,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
20
|
Moderating Effects of Organizational Climate on the Relationship between Emotional Labor and Burnout among Korean Firefighters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030914. [PMID: 33494423 PMCID: PMC7908541 DOI: 10.3390/ijerph18030914] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022]
Abstract
This study examined the association of emotional labor and organizational climate with burnout and elucidated the moderating effect of organizational climate on the relationship between emotional labor and burnout among 18,936 Korean firefighters (male: 17,790, 93.9%, female: 1146, 6.1%). To examine the effects of organizational climate on the relationships between five sub-scales of emotional labor and burnout, four groups were created using various combinations of emotional labor (“normal” vs. “risk”) and organizational climate (“good” vs. “bad”): (1) “normal” and “good” (Group I), (2) “normal” and “bad” (Group II), (3) “risk” and “good” (Group III), and (4) “risk” and “bad” (Group IV). A hierarchical multiple linear regression analysis indicated that firefighters’ burnout was significantly higher in the group with “bad” than “good” organizational climate and was significantly higher among people with “risk” than “normal” emotional labor. Combined effects of organizational climate with emotional labor on burnout were observed in all five sub-scales. Groups II, III, and IV were more likely to experience burnout than Group I (trend p < 0.001). Additionally, the moderating effects of organizational climate on the relationship between the five sub-scales of emotional labor and burnout were observed, except for factor 5. These results emphasize the importance of stress management to alleviate burnout caused by emotional labor at the organizational level and coping strategies to reinforce the personal potentiality suitable to organizational norms at the individual level.
Collapse
|
21
|
Liu CC, Liu LF, Chuang SS. The Effect of Ageist Behaviors on Home Care Workers' Job Satisfaction and Retention in Long-Term Care. J Appl Gerontol 2020; 41:322-331. [PMID: 33292035 DOI: 10.1177/0733464820975598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study aimed to examine how intrinsic and extrinsic factors of job satisfaction affect home care workers' intention to stay and determine whether ageist behaviors moderate the relation between job satisfaction and intention to stay. METHOD We recruited 380 participants to complete measures of job satisfaction, ageist behaviors, and intention to stay. RESULTS Monthly wages, extrinsic and intrinsic factors, and positive and negative ageist behaviors were significantly related to home care workers' retention. Both positive and negative ageist behaviors negatively moderated the relation between job satisfaction and retention. CONCLUSION Home care workers' retention may be increased by providing reasonable extrinsic rewards and enhancing the intrinsic nature of the job itself. Reducing negative ageist behaviors and increasing positive ones for those with low job satisfaction could be related to higher retention. The harmful effects of positive behaviors should be addressed. These findings could contribute to workforce retention in long-term care.
Collapse
Affiliation(s)
- Chien-Chih Liu
- Department of Business Administration, National Cheng Kung University, Tainan
| | - Li-Fan Liu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan
| | - Shuang-Shii Chuang
- Department of Business Administration, National Cheng Kung University, Tainan
| |
Collapse
|
22
|
Ebenso B, Mbachu C, Etiaba E, Huss R, Manzano A, Onwujekwe O, Uzochukwu B, Ezumah N, Ensor T, Hicks JP, Mirzoev T. Which mechanisms explain motivation the of primary health workers? Insights from the realist evaluation of a maternal and child health programme in Nigeria. BMJ Glob Health 2020; 5:e002408. [PMID: 32843524 PMCID: PMC7449364 DOI: 10.1136/bmjgh-2020-002408] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Well-trained, adequately skilled and motivated primary healthcare (PHC) workers are essential for attaining universal health coverage (UHC). While there is abundant literature on the drivers of workforce motivation, published knowledge on the mechanisms of motivation within different contexts is limited, particularly in resource-limited countries. This paper contributes to health workforce literature by reporting on how motivation works among PHC workers in a maternal and child health (MCH) programme in Nigeria. METHODS We adopted a realist evaluation design combining document review with 56 in-depth interviews of PHC workers, facility managers and policy-makers to assess the impact of the MCH programme in Anambra State, Nigeria. A realist process of theory development, testing and consolidation was used to understand how and under what circumstances the MCH programme impacted on workers' motivation and which mechanisms explain how motivation works. We drew on Herzberg's two-factor and Adam's equity theories to unpack how context shapes worker motivation. RESULTS A complex and dynamic interaction between the MCH programme and organisational and wider contexts triggered five mechanisms which explain PHC worker motivation: (1) feeling supported, (2) feeling comfortable with work environment, (3) feeling valued, (4) morale and confidence to perform tasks and (5) companionship. Some mechanisms were mutually reinforcing while others operated in parallel. Other conditions that enabled worker motivation were organisational values of fairness, recognition of workers' contributions and culture of task-sharing and teamwork. CONCLUSIONS Policy designs and management strategies for improving workforce performance, particularly in resource-constrained settings should create working environments that foster feelings of being valued and supported while enabling workers to apply their knowledge and skills to improve healthcare delivery and promote UHC. Future research can test the explanatory framework generated by this study and explore differences in motivational mechanisms among different cadres of PHC workers to inform cadre-related motivational interventions.
Collapse
Affiliation(s)
- Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds School of Medicine, Leeds, UK
| | - Chinyere Mbachu
- Health Policy Research Group, University of Nigeria Faculty of Medical Sciences, Nsukka, Enugu, Nigeria
| | - Enyi Etiaba
- Health Policy Research Group, University of Nigeria Faculty of Medical Sciences, Nsukka, Enugu, Nigeria
| | - Reinhard Huss
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ana Manzano
- Sociology & Social Policy, University of Leeds School of Sociology and Social Policy, Leeds, UK
| | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria Faculty of Medical Sciences, Nsukka, Enugu, Nigeria
| | - Benjamin Uzochukwu
- Health Policy Research Group, University of Nigeria Faculty of Medical Sciences, Nsukka, Enugu, Nigeria
| | - Nkoli Ezumah
- Faculty of Social Sciences, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Timothy Ensor
- Nuffield Centre for International Health and Development, University of Leeds School of Medicine, Leeds, UK
| | - Joseph Paul Hicks
- Nuffield Centre for International Health and Development, University of Leeds School of Medicine, Leeds, UK
| | - Tolib Mirzoev
- Nuffield Centre for International Health and Development, University of Leeds School of Medicine, Leeds, UK
| |
Collapse
|
23
|
Lorenzetti L, Tharaldson J, Pradhan S, Rastagar SH, Hemat S, Ahmadzai SAH, Dulli LS, Weissman A, Todd CS. Adapting a health video library for use in Afghanistan: provider-level acceptability and lessons for strengthening operational feasibility. HUMAN RESOURCES FOR HEALTH 2020; 18:35. [PMID: 32429956 PMCID: PMC7236098 DOI: 10.1186/s12960-020-00477-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 05/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Community health workers (CHWs) in Afghanistan are a critical care extender for primary health services, including reproductive, maternal, neonatal, and child health (RMNCH) care. However, volunteer CHWs face challenges including an ever-expanding number of tasks and insufficient time to conduct them. We piloted a health video library (HVL) intervention, a tablet-based tool to improve health promotion and counseling by CHWs. We qualitatively assessed provider-level acceptability and operational feasibility. METHODS CHWs implemented the HVL pilot in three rural districts of Balkh, Herat, and Kandahar provinces. We employed qualitative methods, conducting 47 in-depth interviews (IDIs) with male and female CHWs and six IDIs with community health supervisors. We used semi-structured interview guides to explore provider perceptions of program implementation processes and solicit feedback on how to improve the HVL intervention to inform scale-up. We conducted a thematic analysis. RESULTS CHWs reported that the HVL increased time efficiencies, reduced work burden, and enhanced professional credibility within their communities. CHWs felt video content and format were accessible for low literacy clients, but also identified challenges to operational feasibility. Although tablets were considered easy-to-use, certain technical issues required continued support from supervisors and family. Charging tablets was difficult due to inconsistent electricity access. Although some CHWs reported reaching most households in their catchment area for visits with the HVL, others were unable to visit all households due to sizeable populations and gender-related barriers, including women's limited mobility. CONCLUSIONS The HVL was acceptable and feasible for integration into existing CHW duties, indicating it may improve RMNCH counseling, contributing to increased care-seeking behaviors in Afghanistan. Short-term challenges with technology and hardware can be addressed through continued training and provision of solar chargers. Longer-term challenges, including tablet costs, community coverage, and gender issues, require further consideration with an emphasis on equitable distribution.
Collapse
Affiliation(s)
- Lara Lorenzetti
- Global Health, Population and Nutrition, FHI 360, Durham, NC, USA.
| | - Jenae Tharaldson
- Global Health, Population and Nutrition, FHI 360, Durham, NC, USA
| | - Subarna Pradhan
- Global Health, Population and Nutrition, FHI 360, Durham, NC, USA
| | | | - Shafiqullah Hemat
- Health Promotions Department, Ministry of Public Health, Islamic Republic of Afghanistan, Kabul, Afghanistan
| | | | - Lisa S Dulli
- Global Health, Population and Nutrition, FHI 360, Durham, NC, USA
| | - Amy Weissman
- Asia Pacific Regional Office, FHI 360, Bangkok, Thailand
| | - Catherine S Todd
- Global Health, Population and Nutrition, FHI 360, Durham, NC, USA
| |
Collapse
|
24
|
Breed M, Downing C, Ally H. Factors influencing motivation of nurse leaders in a private hospital group in Gauteng, South Africa: A quantitative study. Curationis 2020; 43:e1-e9. [PMID: 32129642 PMCID: PMC7059169 DOI: 10.4102/curationis.v43i1.2011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/01/2019] [Accepted: 12/07/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Nurse leadership is about aligning employees to a vision. This happens with buy-in, motivation and communication. When conducive environments are created by organisations, the motivation of nurse leaders will be enhanced, which will have a positive outcome on the organisation. Highly motivated nurse leaders accomplish more and are more productive. Nurse leadership is an essential source of support, mentorship and role modelling. These attributes tend to be more evident when nurse leaders are motivated. OBJECTIVES The objective of this study was to determine the factors that influence the motivation of nurse leaders. METHOD A quantitative, descriptive design and stratified sampling was used. Participants comprised unit managers (n = 49) from five hospitals in a private hospital group in South Africa. A self-administered questionnaire, namely, the Multidimensional Work Motivation Scale, was used to collect the data. Data were analysed using the IBM SPSS 22.0 program. RESULTS The results indicated that the nurse leaders in this study were intrinsically motivated. Their motivation was influenced by support, relatedness, autonomy and competence. No relationships were found between motivation and age, years in a management position, gender, qualifications and staff-reporting structure. CONCLUSION By implication, to understand what motivates nurse leaders and to keep them motivated, recommendations were proposed to nursing and human resources management. It is expected that the implementation of the recommendations will have a positive influence on patient outcomes, organisational success and the motivation and satisfaction of nurse leaders.
Collapse
Affiliation(s)
- Maria Breed
- Department of Nursing, University of Johannesburg, Johannesburg.
| | | | | |
Collapse
|
25
|
Karuga RN, Kok M, Mbindyo P, Hilverda F, Otiso L, Kavoo D, Broerse J, Dieleman M. "It's like these CHCs don't exist, are they featured anywhere?": Social network analysis of community health committees in a rural and urban setting in Kenya. PLoS One 2019; 14:e0220836. [PMID: 31393923 PMCID: PMC6687128 DOI: 10.1371/journal.pone.0220836] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 07/25/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In Kenya, Community Health Committees (CHC) were established to enhance community participation in health services. Their role is to provide leadership, oversight in delivery of community health services, promote social accountability and mobilize resources for community health. CHCs form social networks with other actors, with whom they exchange health information for decision-making and accountability. This case study aimed to explore the structure of a rural and an urban CHC network and to analyze how health-related information flowed in these networks. Understanding the pathways of information in community settings may provide recommendations for strategies to improve the role and functioning of CHCs. METHODS In 2017, we conducted 4 focus group discussions with 27 community discussants and 10 semi-structured interviews with health professionals in a rural area and an urban slum. Using social network analysis, we determined the structure of their social networks and how health related information flowed in these networks. RESULTS Both CHCs were composed of respected persons nominated by their communities. Each social network had 12 actors that represented both community and government institutions. CHCs were not central actors in the exchange of health-related information. Health workers, community health volunteers and local Chiefs in the urban slum often passed information between the different groups of actors, while CHCs hardly did this. Therefore, CHCs had little control over the flow of health-related information. Although CHC members were respected persons who served in multiple roles within their communities, this did not enhance their centrality. It emerged that CHCs were often left out in the flow of health-related information and decision-making, which led to demotivation. Community health volunteers were more involved by other actors such as health managers and non-governmental organizations as a conduit for health-related information. CONCLUSION Social network analysis demonstrated how CHCs played a peripheral role in the flow of health-related information. Their perception of being left out of the information flow led to demotivation, which hampered their ability to facilitate community participation in community health services; hence challenging effective participation through CHCs.
Collapse
Affiliation(s)
- Robinson Njoroge Karuga
- LVCT Health, Nairobi, Kenya.,Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Maryse Kok
- Royal Tropical Institute (KIT), Amsterdam, The Netherlands
| | - Patrick Mbindyo
- Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | - Femke Hilverda
- School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | | | - Daniel Kavoo
- Community Health and Development Unit, Ministry of Health, Nairobi, Kenya
| | - Jaqueline Broerse
- Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marjolein Dieleman
- Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands.,Royal Tropical Institute (KIT), Amsterdam, The Netherlands
| |
Collapse
|
26
|
Nyalunga SLN, Ndimande JV, Ogunbanjo GA, Masango-Makgobela A, Bogongo T. Perceptions of community health workers on their training, teamwork and practice: a cross-sectional study in Tshwane district, Gauteng, South Africa. S Afr Fam Pract (2004) 2019. [DOI: 10.1080/20786190.2019.1613061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- SLN Nyalunga
- Discipline of Family Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - JV Ndimande
- Discipline of Family Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - GA Ogunbanjo
- Discipline of Family Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - A Masango-Makgobela
- Discipline of Family Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - T Bogongo
- Discipline of Family Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| |
Collapse
|
27
|
Assegaai T, Schneider H. National guidance and district-level practices in the supervision of community health workers in South Africa: a qualitative study. HUMAN RESOURCES FOR HEALTH 2019; 17:25. [PMID: 30943986 PMCID: PMC6446406 DOI: 10.1186/s12960-019-0360-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/11/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Supportive supervision is considered critical to community health worker programme performance, but there is relatively little understanding of how it can be sustainably done at scale. Supportive supervision is a holistic concept that encompasses three key functions: management (ensuring performance), education (promoting development) and support (responding to needs and problems). Drawing on the experiences of the ward-based outreach team (WBOT) strategy, South Africa's national community health worker (CHW) programme, this paper explores and describes approaches to supportive supervision in policy and programme guidelines and how these are implemented in supervision practices in the North West Province, an early adopter of the WBOT strategy. Outreach teams typically consist of six CHWs plus a nurse outreach team leader (OTL). METHODS A qualitative, descriptive study that combined a document review of national policy and guidelines with key informant interviews in two districts of the North West Province was conducted. An overall WBOT policy statement and four guidelines on aspects of the strategy, spanning the period 2011-2017, were reviewed for statements on the three core facets of supervision outlined above. Eight focus group discussions, involving facility managers, team leaders and community health workers (total 40 respondents), purposively selected from four sub-districts in two districts, assessed local-level supervision practices. Alignment across policy and guidance documents and between policy/guidance and practice was examined. FINDINGS While all the official policy documents and guidelines reviewed acknowledged the need for supervision and support, these elements were inadequately developed and poorly aligned, both in terms of scope and in providing firm guidance on the supervision of WBOTs. The practices of supervision entailed a variety of reporting lines, while development and support processes were informal and often lacking, and teams poorly resourced. There was internal cohesion and support within teams amongst CHWs and between CHWs and OTLs. However, primary health care clinic managers, who were supposed to supervise the WBOTs, struggled to fulfil this role amidst the high workloads in facilities, and relationships between WBOTs and facility staff often remained strained. CONCLUSION This study identified weaknesses in both the design and implementation of the supervision system of WBOTs. The lack of explicit, coherent and holistic guidance in policy and the failure to address constraints to supervision at local level undermine the performance and sustainability of the WBOT strategy in South Africa.
Collapse
Affiliation(s)
- Tumelo Assegaai
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Helen Schneider
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- University of the Western Cape/South African Medical Research Council Health Services to Systems Unit, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
28
|
Kok MC, Vallières F, Tulloch O, Kumar MB, Kea AZ, Karuga R, Ndima SD, Chikaphupha K, Theobald S, Taegtmeyer M. Does supportive supervision enhance community health worker motivation? A mixed-methods study in four African countries. Health Policy Plan 2018; 33:988-998. [PMID: 30247571 PMCID: PMC6263021 DOI: 10.1093/heapol/czy082] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2018] [Indexed: 01/27/2023] Open
Abstract
Supportive supervision is an important element of community health worker (CHW) programmes and is believed to improve CHW motivation and performance. A group supervision intervention, which included training and mentorship of supervisors, was implemented in Ethiopia, Kenya, Malawi and Mozambique. In three of the countries, this was combined with individual and/or peer supervision. A mixed-methods implementation study was conducted to assess the effect of the supervision intervention on CHWs' perceptions of supervision and CHW motivation-related outcomes. In total, 153 in-depth interviews were conducted with CHWs, their supervisors and managers. In addition, questionnaires assessing perceived supervision and motivation-related outcomes (organizational and community commitment, job satisfaction and conscientiousness) were administered to a total of 278 CHWs pre- and post-intervention, and again after 1 year. Interview transcripts were thematically analysed using a coding framework. Changes in perceived supervision and motivation-related outcomes were assessed using Friedman's ANOVA and post hoc Wilcoxon signed-rank tests. Interview participants reported that the supervision intervention improved CHW motivation. In contrast, the quantitative survey found no significant changes for measures of perceived supervision and inconsistent changes in motivation-related outcomes. With regard to the process of supervision, the problem-solving focus, the sense of joint responsibilities and team work, cross-learning and skill sharing, as well as the facilitating and coaching role of the supervisor, were valued. The empowerment and participation of supervisees in decision making also emerged in the analysis, albeit to a lesser extent. Although qualitative and quantitative findings differed, which could be related to the slightly different focus of methods used and a 'ceiling effect' limiting the detection of observable differences from the survey, the study suggests that there is potential for integrating supportive group supervision models in CHW programmes. A combination of group with individual or peer supervision, preferably accompanied with methods that assess CHW performance and corresponding feedback systems, could yield improved motivation and performance.
Collapse
Affiliation(s)
- Maryse C Kok
- KIT Health, Royal Tropical Institute, HA Amsterdam, The Netherlands
| | - Frédérique Vallières
- Centre for Global Health, School of Psychology, Trinity College, 709 Leinster Street South, Dublin 2, Ireland
| | - Olivia Tulloch
- Options Consultancy Services, 3 Lower Thames Street, London, UK
| | - Meghan B Kumar
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | | | - Robinson Karuga
- Research and Strategic Information Department, LVCT Health, Nairobi, Kenya
| | - Sozinho D Ndima
- Department of Community Health, University Eduardo Mondlane, Maputo, Mozambique
| | | | - Sally Theobald
- Options Consultancy Services, 3 Lower Thames Street, London, UK
| | | |
Collapse
|
29
|
Busza J, Dauya E, Makamba M, Ferrand RA. "I will not stop visiting!" a qualitative study of community health workers' reluctance to withdraw household support following the end of a community-based intervention in Zimbabwe. BMC Health Serv Res 2018; 18:718. [PMID: 30223831 PMCID: PMC6142685 DOI: 10.1186/s12913-018-3531-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community Health Worker (CHW) programmes are increasingly important in HIV service delivery. CHWs' familiarity with the local context can improve intervention acceptability and sustainability but concerns have been raised about potential exploitation and "burnout" of CHWs as they become emotionally involved in clients' lives. Little attention has been paid to what happens at the end of time-limited CHW interventions. This study aimed to examine the experience of CHWs' withdrawal from clients and their families. METHODS We conducted a qualitative study of CHWs' experiences of "exiting" from households during the ZENITH (Zimbabwe Study for Enhancing Testing and Improving Treatment of HIV in Children) intervention, which provided 12 structured home visits over 72 weeks to families with children recently diagnosed with HIV. We conducted semi-structured interviews at 12 and 18 months with all 19 CHWs delivering the intervention and 36 purposively selected caregivers who received home visits. Analysis focused on perceptions of the end of the trial, when CHWs completed the scheduled home-based visits and there was no guarantee of programme continuation beyond the study. RESULTS Termination of scheduled home visits caused significant distress to both CHWs and the households they visited. We identify 3 thematic "lessons learned" for CHW programmes. First, CHWs derived pride and self-worth from emotional labour as they became integral to families' improved ability to cope, motivating them to go beyond formal job requirements. Second, clients' growing dependence on CHWs led to "exit" being interpreted as abandonment by both CHWs and households, causing distress on both sides. Finally, in response to anxiety about "abandoning" families, CHWs maintained contact with families long after scheduled withdrawal of services. CONCLUSIONS CHWs can forge genuine bonds with households, creating expectations of long-term engagement. On the positive side, CHW derive pride from their work, attach social responsibility to their roles, and feel personal fulfilment in supporting families. If CHWs do not disengage from interventions as planned, or become demoralised by "exits", interventions will prove less sustainable. CHWs are often lauded for their ability to develop trust with peers, yet this willingness and ability to create enduring emotional bonds could threaten programme delivery.
Collapse
Affiliation(s)
- Joanna Busza
- Department of Public Health, Environment and Society and Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Ethel Dauya
- Biomedical Research & Training Institute, No. 10 Seagrave road, Avondale, Harare, Zimbabwe
| | - Memory Makamba
- Biomedical Research & Training Institute, No. 10 Seagrave road, Avondale, Harare, Zimbabwe
| | - Rashida A. Ferrand
- Biomedical Research & Training Institute, No. 10 Seagrave road, Avondale, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| |
Collapse
|
30
|
Busza J, Dauya E, Bandason T, Simms V, Chikwari CD, Makamba M, Mchugh G, Munyati S, Chonzi P, Ferrand RA. The role of community health workers in improving HIV treatment outcomes in children: lessons learned from the ZENITH trial in Zimbabwe. Health Policy Plan 2018; 33:328-334. [PMID: 29309578 PMCID: PMC5886269 DOI: 10.1093/heapol/czx187] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 11/22/2022] Open
Abstract
Reliance on community health workers (CHWs) for HIV care continues to increase, particularly in resource-limited settings. CHWs can improve HIV service use and adherence to treatment, but effectiveness of these programmes relies on providing an enabling work environment for CHWs, including reasonable workload, supportive supervision and adequate training and supplies. Although criteria for effective CHW programmes have been identified, these have rarely been prospectively applied to design and evaluation of new interventions. For the Zimbabwe study for Enhancing Testing and Improving Treatment of HIV in Children (ZENITH) randomized controlled trial, we based our intervention on an existing evidence-based framework for successful CHW programmes. To assess CHWs’ experiences delivering the intervention, we conducted longitudinal, qualitative semi-structured interviews with all 19 CHWs at three times during implementation. The study aimed to explore CHWs’ perceptions of how the intervention’s structure and management affected their performance, and consider implications for the programme’s future scale-up and adoption in other settings. CHWs expressed strong motivation, commitment and job satisfaction. They considered the intervention acceptable and feasible to deliver, and levels of satisfaction rose over interview rounds. Intensive supervision and mentoring emerged as critical to ensuring CHWs’ long-term satisfaction. Provision of job aids, standardized manuals and refresher training were also important, as were formalized links between clinics and CHWs. Concerns raised by CHWs included poor remuneration, their reluctance to stop providing support to individual families following the requisite number of home visits, and disappointment at the lack of programme sustainability following completion of the trial. Furthermore, intensive supervision and integration with clinical services may be difficult to replicate outside a trial setting. This study shows that existing criteria for designing successful CHW programmes are useful for maximizing effectiveness, but challenges remain for ensuring long-term sustainability of ‘task shifting’ strategies.
Collapse
Affiliation(s)
- Joanna Busza
- Department of Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Victoria Simms
- Department of Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Chido Dziva Chikwari
- Department of Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Grace Mchugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Rashida A Ferrand
- Department of Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
| |
Collapse
|
31
|
Paremoer L. Situating Expertise: Lessons from the HIV/AIDS Epidemic. GLOBAL CHALLENGES (HOBOKEN, NJ) 2018; 2:1700076. [PMID: 31565346 PMCID: PMC6607223 DOI: 10.1002/gch2.201700076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 03/20/2018] [Indexed: 06/08/2023]
Abstract
How do Scientific Advisory Committees (SACs) frame the relationship between political agency and expertise in their work? What are the political implications of the ways in which SACs legitimate or obscure specific forms of political agency? Using a South African case study, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) activists' participation in clinical trials designed to demonstrate the efficacy of highly active antiretroviral treatment (HAART) in resource-poor settings, and the process of translating scientific knowledge about HIV/AIDS into public policy under the leadership of a SAC, the South African National AIDS Council (SANAC), is analyzed. The case study suggests that 1) political agency plays a significant role in generating and disseminating scientific data that allow activists to fulfill their political goals; 2) SACs primarily value political agency as a resource for implementing their prescriptions and legitimating their work; 3) processes of political conscientization, movement building, democratic collective action, and deliberation can contribute to the reliability and validity of the technical knowledge SACs rely on, and under some circumstances, contribute to the political resonance their recommendations have with impacted constituencies; and 4) social theory can serve as a resource for negotiating conflicts between technical experts and activists that cannot be settled by appealing to clinical facts.
Collapse
Affiliation(s)
- Lauren Paremoer
- Department of Political StudiesRm 5.32 Robert Leslie BuildingUniversity of Cape Town
| |
Collapse
|
32
|
Morton D, Mayekiso T, Cunningham P. Structural barriers to South African volunteer home-based caregivers providing quality care: the need for a policy for caregivers not affiliated to primary healthcare clinics. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 17:47-53. [PMID: 29504501 DOI: 10.2989/16085906.2017.1397719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Community home-based care (CHBC) is a critical component of non-formal care in communities in Africa that have a high prevalence of HIV and tuberculosis (TB). Community carers consisting primarily of volunteers are critical role players in African healthcare systems and particularly in South Africa's strategy to fight HIV and AIDS. This paper explores the structural barriers volunteer caregivers need to overcome to provide quality CHBC. The researchers used two focus group discussions with key informants (each with four participants), and semi-structured interviews with six key informants to collect data relating to the meaning of quality CHBC. The data were coded using Tesch's data analysis technique. A major theme that emerged from the results was "Addressing structural challenges to improve the quality of CHBC". Subthemes underpinning this theme were: 1) lack of standardised training of volunteer caregivers; 2) the need for a scope of practice, parameters and legal boundaries; 3) lack of monitoring and evaluation (M&E) of CHBC; and 4) the importance of mentoring and supervision in CHBC. CHBC policy should address the need for standardised training programmes for caregivers, so that they are equipped with multiple skills. Furthermore CHBC policy must emphasise mentoring as well as M&E to encourage quality care. Finally, the policy should provide a clear scope of practice for caregivers to regulate their competencies and boundaries.
Collapse
Affiliation(s)
- David Morton
- a Department of Nursing Science , Nelson Mandela University , Port Elizabeth , South Africa
| | - Thoko Mayekiso
- b Vice Chancellor's Office , University of Mpumalanga , Mbombela , South Africa
| | - Peter Cunningham
- c Department of Sociology and Anthropology , Nelson Mandela University , Port Elizabeth , South Africa
| |
Collapse
|
33
|
Community health worker perspectives on a new primary health care initiative in the Eastern Cape of South Africa. PLoS One 2017; 12:e0173863. [PMID: 28301609 PMCID: PMC5354377 DOI: 10.1371/journal.pone.0173863] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/28/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In 2010, South Africa's National Department of Health launched a national primary health care (PHC) initiative to strengthen health promotion, disease prevention, and early disease detection. The strategy, called Re-engineering Primary Health Care (rPHC), aims to provide a preventive and health-promoting community-based PHC model. A key component of rPHC is the use of community-based outreach teams staffed by generalist community health workers (CHWs). METHODS We conducted focus group discussions and surveys on the knowledge and attitudes of 91 CHWs working on community-based rPHC teams in the King Sabata Dalindyebo (KSD) sub-district of Eastern Cape Province. RESULTS The CHWs we studied enjoyed their work and found it meaningful, as they saw themselves as agents of change. They also perceived weaknesses in the implementation of outreach team oversight, and desired field-based training and more supervision in the community. CONCLUSIONS There is a need to provide CHWs with basic resources like equipment, supplies and transport to improve their acceptability and credibility to the communities they serve.
Collapse
|