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Zaman SB, Singh R, Evans RG, Singh A, Singh R, Singh P, Prakash H, Kumar M, Thrift AG. Development and evaluation of a training program on non-communicable diseases to empower community health workers in rural India. PEC INNOVATION 2024; 4:100305. [PMID: 38974935 PMCID: PMC11225916 DOI: 10.1016/j.pecinn.2024.100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 07/09/2024]
Abstract
Objective We developed and evaluated a training program for Accredited Social Health Activists (ASHAs), female community health workers (CHWs) in India, on non-communicable diseases (NCDs). Methods A 5-day training program, developed using government-approved manuals, was tested in a randomised controlled trial in the Tehri-Garhwal district. Quantitative comparisons were undertaken using Student's t-test and two-way ANOVA. ASHAs in the intervention group were asked questions about new skills learnt. Results Thirty-six ASHAs (20 intervention, 16 controls) participated (response rate 75.0%). Mean pre-test knowledge score was 43.3/100 points (95% CI 36.7-49.9) for the intervention group and 44.4 (38.9-49.9) for controls. The mean post-test knowledge score increased more in the intervention group (48.5-point increase; P < 0.0001), than in controls (9.8-point increase, P = 0.016; ANOVA interaction term (time*allocation) P < 0.0001). ASHAs in the intervention group reported learning new skills for detecting NCDs. Conclusion The training program increased knowledge of ASHAs on NCDs and improved their skills to detect NCDs. Our development and testing process for this training program, coupled with open-source resources, fosters innovation and collaboration in managing NCDs in LMICs. Innovation Our novel and adaptable training program incorporates interactive elements, case studies, and real-world scenarios to augment routine communication between ASHAs and community members for preventing NCDs.
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Affiliation(s)
- Sojib Bin Zaman
- Department of Health Sciences, James Madison University, Harrisonburg, VA, USA
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rajkumari Singh
- Garhwal Community Development and Welfare Society, Tehri-Gharwal, Uttarakhand, India
| | - Roger G. Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
- Florey Institute of Neurosciences and Mental Health, University of Melbourne, Melbourne, Australia
| | - Akash Singh
- Garhwal Community Development and Welfare Society, Tehri-Gharwal, Uttarakhand, India
| | - Rajesh Singh
- Garhwal Community Development and Welfare Society, Tehri-Gharwal, Uttarakhand, India
| | - Parul Singh
- Garhwal Community Development and Welfare Society, Tehri-Gharwal, Uttarakhand, India
| | - Hem Prakash
- Garhwal Community Development and Welfare Society, Tehri-Gharwal, Uttarakhand, India
| | - Manoj Kumar
- Garhwal Community Development and Welfare Society, Tehri-Gharwal, Uttarakhand, India
| | - Amanda G. Thrift
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
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D R, R S, Manjunath U. Quality of life among community health workers in the districts of Koppal, Raichur and Mysore, Karnataka State, India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2024; 29:None. [PMID: 39345353 PMCID: PMC11427304 DOI: 10.1016/j.cegh.2024.101752] [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: 09/15/2023] [Revised: 07/24/2024] [Accepted: 08/02/2024] [Indexed: 10/01/2024] Open
Abstract
Aim To explore the Quality of life among the community health workers and its association with the socio-demographic variables. Subject and methods A cross-sectional study was conducted among 739 Community Health Workers (CHWs), where a multistage random sampling technique was used and three districts were selected based on the proportion of Accredited Social Health Activist (ASHA) in the districts of Karnataka. "WHOQOL-BREF" was used along with a Sociodemographic profile to determine the Quality of Life (QoL) among the CHWs. Multivariate regression models, T-test and ANOVA tests were used for the analysis. Results The overall Quality of life mean ± SD was 3.4 ± 0.95. Domain-wise social relationship was found to be highest with a mean ± SD of 66.5 ± 21.7 and Environmental domain was found to be the least with a mean ± SD of 48.6 ± 16.6. The Multivariate regression models reveal that education up to primary level, an individual income of INR 5000 and more, and family income of INR 15000 to 40000 contribute to the higher score, whereas total family members of 5-8, age 25 to 44, and education of secondary schooling, PUC/diploma contribute to the lower scores of QoL. Conclusion The results of the study showed that CHWs had neither good nor bad quality of life. And there is a need to improve physical and environmental factors such as job satisfaction, population coverage, better income, physical safety, good working environment, better transportation facilities which can improve the QoL among CHWs.
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Affiliation(s)
- Rajendra D
- Institute of Health Management Research Bangalore #319, Near Thimma Reddy Layout, Hulimangala Rd, Electronics City Phase 1, Bengaluru, Karnataka, 560105, India
| | - Sarala R
- Institute of Health Management Research Bangalore #319, Near Thimma Reddy Layout, Hulimangala Rd, Electronics City Phase 1, Bengaluru, Karnataka, 560105, India
| | - Usha Manjunath
- Institute of Health Management Research Bangalore #319, Near Thimma Reddy Layout, Hulimangala Rd, Electronics City Phase 1, Bengaluru, Karnataka, 560105, India
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Sripad P, Peterson S, Idrissou D, Kamanga M, Kezembe A, Ndwiga C, Okondo C, Ranjalahy AN, Stevanovic-Fenn N, Warren CE, Zieman B, Mathur S. Applying a Power and Gender Lens to Understanding Health Care Provider Experience and Behavior: A Multicountry Qualitative Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200420. [PMID: 38035723 PMCID: PMC10698231 DOI: 10.9745/ghsp-d-22-00420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/21/2023] [Indexed: 12/02/2023]
Abstract
A limited but growing body of literature shows that health care providers (HCPs) in reproductive, maternal, and newborn health face challenges that affect how they provide services. Our study investigates provider perspectives and behaviors using 4 interrelated power domains-beliefs and perceptions; practices and participation; access to assets; and structures-to explore how these constructs are differentially experienced based on one's gender, position, and function within the health system. We conducted a framework-based secondary analysis of qualitative in-depth interview data gathered with different cadres of HCPs across Kenya, Malawi, Madagascar, and Togo (n=123). We find across countries that power dynamics manifest in and are affected by all 4 domains, with some variation by HCP cadre and gender. At the service interface, HCPs' power derives from the nature and quality of their relationships with clients and the community. Providers' power within working relationships stems from unequal decision-making autonomy among HCP cadres. Limited and sometimes gendered access to remuneration, development opportunities, material resources, supervision quality, and emotional support affect HCPs' power to care for clients effectively. Power manifests variably among community and facility-based providers because of differences in prevailing hierarchical norms in routine and acute settings, community linkages, and type of collaboration required in their work. Our findings suggest that applying power-and secondarily, gender lenses-can elucidate consistencies in how providers perceive, internalize, and react to a range of relational and environmental stressors. The findings also have implications on how to improve the design of social behavior change interventions aimed at better supporting HCPs.
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Affiliation(s)
| | | | - Daoudou Idrissou
- Country Liaison Associate, Ouagadougou Partnership Coordination Unit, Lome, Togo
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Dahal U, Tamang RL, Dræbel TA, Neupane D, Koirala Adhikari S, Soti PB, Gyawali B. Female community health volunteers' experience in navigating social context while providing basic diabetes services in western Nepal: Social capital and beyond from systems thinking. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002632. [PMID: 37992049 PMCID: PMC10664953 DOI: 10.1371/journal.pgph.0002632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Abstract
The global burden of non-communicable diseases (NCDs) has led to an increased mobilization of community health workers (CHWs) in the prevention and management of NCDs, particularly in resource-poor settings. However, little is known about the experiences of CHWs as they navigate the complex social context while proving home-based NCD management. This study aims to explore the experiences of female community health volunteers (FCHVs) in a community-based pilot project in western Nepal, specially regarding the social challenges they face while delivering basic type 2 diabetes (T2D) services. Using a qualitative phenomenological approach, the study conducted two focus group discussions and nine in-depth interviews with a total of 14 and 9 FCHVs, respectively. Social Capital theory was employed to understand the sociological aspects. The findings shed light on the challenges encountered by FCHVs in expanding their social networks, building trust, and fostering reciprocity among T2D intervention recepients. Notably, social trust was a significant challenge, compounded by power dynamics related to gender and socioeconomic status. FCHVs managed to overcome these challenges through their perseverance, self-motivation, and leaveraging their strong bonding and linking social capital. The recognition they received from the community played a crucial role in sustaining their motivation. The study highlights the importance of FCHVs' strong social capital, supported by available resources and personal motivation, in overcoming social obstacles. It is imperative for community health interventions to anticipate challenges across various elements of social capital to ensure the long-term retention and motivation of CHWs. Establishing appropriate support systems that address personal motivating factors and the strengthen social capital is essential.
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Affiliation(s)
- Usha Dahal
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rekha Lama Tamang
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tania Aase Dræbel
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dinesh Neupane
- Nepal Development Society, Kaski, Nepal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | | | | | - Bishal Gyawali
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Shrivastava R, Sharma L, Jolly M, Ahuja R, Sharma R, Naslund JA, Agrawal J, Shidhaye R, Mehrotra S, Hollon SD, Patel V, Tugnawat D, Kumar A, Bhan A, Bondre AP. "We are everyone's ASHAs but who's there for us?" a qualitative exploration of perceptions of work stress and coping among rural frontline workers in Madhya Pradesh, India. Soc Sci Med 2023; 336:116234. [PMID: 37778144 DOI: 10.1016/j.socscimed.2023.116234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 08/23/2023] [Accepted: 09/09/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE More than a million female village-level lay providers called 'Accredited Social Health Activists (ASHAs)', who deliver primary care, face high levels of stress due to work demands and low compensation, within the context of poverty and gender inequality. Evidence on ASHAs has focused on workplace challenges from a system perspective, without sufficient probing into individual-level stress. This study aims to gain perspectives into the experiences of work stress, the related health symptoms, and the responses to stress among ASHAs in India. METHODS Focus group discussions (FGDs) conducted with ASHAs in Sehore district, Madhya Pradesh, were audio-recorded and transcribed. Grounded theory was used to generate themes under the various domains of ASHAs' work and domestic life. We identified pathways between the conditions that trigger stressful events, experiences of these events, resulting perceptions, effects on health and wellbeing, and approaches used by ASHAs to respond to stress. RESULTS Six FGDs with 59 ASHAs generated the following themes: (a) Facility: Workload, undue pressures, unstructured work; ASHAs' relationships with seniors (e.g., feelings of being disrespected, blamed, or targeted), and low access to physical and administrative resources; (b) Home: Feelings of guilt for putting less time for family/child care; disrespect by the elderly for a poorly incentivised job; (c) Community: Low acceptance by the villagers; caste- and gender-bias; difficult community-level relationships (emotional labour, fear/stigma towards her services); (d) Somatic and psychological symptoms: headache, exhaustion, depressive symptoms (to cite a few); and (e) Responses to stress: Motivation (support from peers, family, a sense of identity/pride, incentives), Individual strengths (e.g., social responsibility), and spiritual recourse mechanisms. CONCLUSIONS This study will inform the development of a strengths-based coaching intervention to address work stress among ASHAs. The findings are relevant to building the evidence on alleviation of work stress among female frontline cadres in low-resource settings globally.
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Affiliation(s)
- Ritu Shrivastava
- Sangath, 106, Good Shepherd Colony, Kolar Road, Bhopal, Madhya Pradesh, 462042, India.
| | - Lochan Sharma
- Sangath, 106, Good Shepherd Colony, Kolar Road, Bhopal, Madhya Pradesh, 462042, India
| | - Mehak Jolly
- Sangath, 106, Good Shepherd Colony, Kolar Road, Bhopal, Madhya Pradesh, 462042, India
| | - Romi Ahuja
- Sangath, 106, Good Shepherd Colony, Kolar Road, Bhopal, Madhya Pradesh, 462042, India
| | - Radhika Sharma
- Sangath, 106, Good Shepherd Colony, Kolar Road, Bhopal, Madhya Pradesh, 462042, India
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
| | - Jyotsna Agrawal
- National Institute of Mental Health and Neurosciences, Hosur Road, Lakkasandra, Wilson Garden, Bengaluru, Karnataka, 560029, India
| | - Rahul Shidhaye
- Pravara Institute of Medical Sciences, Tal: Rahata, Dist: Ahmednagar, Maharashtra, 413736, India
| | - Seema Mehrotra
- National Institute of Mental Health and Neurosciences, Hosur Road, Lakkasandra, Wilson Garden, Bengaluru, Karnataka, 560029, India
| | - Steve D Hollon
- Vanderbilt University, Brentwood, TN, 37027, United States
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
| | - Deepak Tugnawat
- Sangath, 106, Good Shepherd Colony, Kolar Road, Bhopal, Madhya Pradesh, 462042, India
| | - Ananth Kumar
- National Health Systems Resource Centre, National Institute of Health & Family Welfare Campus, Baba Gang Nath Marg, Block F, Munirka, New Delhi, Delhi, 110067, India
| | - Anant Bhan
- Sangath, 106, Good Shepherd Colony, Kolar Road, Bhopal, Madhya Pradesh, 462042, India
| | - Ameya P Bondre
- Sangath, 106, Good Shepherd Colony, Kolar Road, Bhopal, Madhya Pradesh, 462042, India
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Nyassi S, Abdi YA, Minto J, Osman F. "Helping Mentally Ill, a Reward Both in this Life and After": A Qualitative Study Among Community Health Professionals in Somaliland. Community Ment Health J 2023; 59:1051-1063. [PMID: 36602699 PMCID: PMC10289922 DOI: 10.1007/s10597-022-01085-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023]
Abstract
This study aimed to describe the experiences of community mental health workers, predominantly female, nurses and doctors providing community-based mental health services in Borama, Somaliland. A qualitative explorative study using focus group discussions was conducted. Data were collected from three focus group discussions with 22 female community health workers, two medical doctors, and two registered nurses and analyzed using content analysis with an inductive approach. Three main categories were identified from the analysis: (1) bridging the mental health gap in the community; (2) working in a constrained situation; and (3) being altruistic. Overall, the community mental health workers felt that their role was to bridge the mental health gap in the community. They described their work as a rewarding and motivated them to continue despite challenges and improving community healthcare workers' work conditions and providing resources in mental health services will contribute to strengthening mental health services in Somaliland.
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Affiliation(s)
- Sungkutu Nyassi
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
| | - Yakoub Aden Abdi
- College of Health Science, Amoud University, Amoud Valley, Borama, Somaliland Somalia
| | - John Minto
- University of the West of Scotland, Paisley, Scotland
| | - Fatumo Osman
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
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de Laat J, Radner J, Holding P, van der Haar L, Slemming W, Krapels J, van der Harst M, Raikes A, Sanou AS, Dusabe C. Measurement for Change: Reflections from innovators' experiences with monitoring, evaluation, and learning systems for Early Childhood Development. Front Public Health 2023; 11:1021790. [PMID: 37006525 PMCID: PMC10060850 DOI: 10.3389/fpubh.2023.1021790] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/23/2023] [Indexed: 03/18/2023] Open
Abstract
In this review paper, we explore how on-the-ground Early Childhood Development (ECD) innovators are using monitoring, evaluation, and learning (MEL) systems to guide the design and implementation of ECD programs, as well as how MEL systems can influence policy and support the achievement of impact at scale. We reflect on articles in the Frontiers series “Effective delivery of integrated interventions in early childhood: innovations in evidence use, monitoring, evaluation, and learning.” The 31 contributions to the series reflect the breadth and depth of complexity that characterizes ECD, including global geographic spread, with studies from Asia, Europe, Africa, and Latin America and the Caribbean. Our synthesis finds that integrating MEL processes and systems into the fabric of a program or policy initiative can broaden the underlying value proposition. Specifically, ECD organizations sought to design their MEL systems to ensure programs fit the values, goals, experiences and conceptual frameworks of diverse stakeholders, so that participating makes sense to all. For example, formative, exploratory research identified the priorities and needs of the target population and frontline service providers, and informed the content and delivery of an intervention. ECD organizations also designed their MEL systems to support a shift of accountability toward broader ownership: They included delivery agents and program participants alike as subjects rather than objects, through active participation in data collection, and by providing opportunities for equitable discussion of results and decision-making. Programs collected data to respond to specialized characteristics, priorities and needs, embedding program activities into existing day-to-day routines. Further, papers pointed to the importance of intentionally involving a variety of stakeholders in national and international dialogues to ensure that diverse ECD data collection efforts are aligned and multiple perspectives are considered in the development of national ECD policies. And, several papers illustrate the value of creative methods and measurement tools to integrate MEL into a program or policy initiative. Finally, our synthesis concludes that these findings align with the five aspirations that were formulated as part of the Measurement for Change dialogue, which motivated the launch of the series.
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Affiliation(s)
- Joost de Laat
- Utrecht University Centre for Global Challenges, Utrecht University, Utrecht, Netherlands
- *Correspondence: Joost de Laat
| | - James Radner
- Munk School of Global Affairs & Public Policy, University of Toronto, Toronto, ON, Canada
| | - Penny Holding
- Identitéa/Affiliate of Utrecht University Centre for Global Challenges, London, United Kingdom
| | - Lotte van der Haar
- Utrecht University Centre for Global Challenges, Utrecht University, Utrecht, Netherlands
| | - Wiedaad Slemming
- Department of Paediatrics and Child Health, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa
| | | | - Maria van der Harst
- Utrecht University Centre for Global Challenges, Utrecht University, Utrecht, Netherlands
| | - Abbie Raikes
- College of Public Health, University of Nebraska Medical Centre, Omaha, NE, United States
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Abbas F, Monroe A, Kiware S, Khamis M, Serbantez N, Al- Mafazy AW, Mohamed F, Kigadye E. Stakeholder perspectives on a door-to-door intervention to increase community engagement for malaria elimination in Zanzibar. Malar J 2023; 22:51. [PMID: 36774478 PMCID: PMC9921074 DOI: 10.1186/s12936-023-04474-w] [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: 06/18/2022] [Accepted: 01/29/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Malaria remains a major public health problem in sub-Saharan Africa. The 2021 World Health Organization (WHO) World Malaria Report indicates a slowing in the decline of malaria incidence since 2015. Malaria prevalence in Zanzibar has been maintained at less than 1% since 2010, however from 2018 to 2021, the annual number of reported malaria cases has gradually increased from 4106 to 9290. Community engagement has been emphasized by the WHO for reducing malaria transmission. To better understand the potential for a door-to-door approach for malaria, a three-month pilot programme was carried out. This qualitative study aimed at understanding stakeholder experiences with the pilot programme and considerations for its implementation. METHODS Through multistage sampling, four shehias (wards-the lowest administrative structure) with comparatively high (> 1.9 per 1000) and four with low (< 1 per 1000) incidence of local malaria cases were selected and involved in a door-to-door pilot intervention. The qualitative study was conducted after the pilot intervention and employed focus group discussions and in-depth interviews. All field notes were written on paper and audiotaped using digital audio-recorders. Summaries were developed by integrating field notes with reviews of recordings; themes were developed based on the topics identified a priori. Responses for each theme were summarized using an iterative process. RESULTS Most community members reported high levels of acceptance of door-to-door interventions. Some factors that might affect implementation of door-to-door include, low risk perception of the disease, local beliefs and practice, lack of initiative from the programme level to involve communities, and political instability during the election period. All Community Health Volunteers (CHVs) recommended this approach for community engagement, however, ensuring adequate resources was identified as a key factor for ensuring its sustainability. CONCLUSION The door-to-door intervention was perceived as helpful for promoting community engagement. There are several factors to consider including ensuring that CHVs are provided with adequate education, regular supervision, and have access to essential resources. Community leaders should be fully involved in choosing CHVs that are acceptable to the community. To ensure sustainability, the government should allocate sufficient resources and improve coordination systems.
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Affiliation(s)
- Faiza Abbas
- Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania. .,Open University of Tanzania, Dar es Salaam, Tanzania.
| | - April Monroe
- grid.449467.c0000000122274844Johns Hopkins Center for Communication Programs, Baltimore, MD USA
| | - Samson Kiware
- grid.414543.30000 0000 9144 642XIfakara Health Institute, Dar es Salaam, United Republic of Tanzania ,Pan African Mosquito Control Association (PAMCA), Nairobi, Kenya
| | - Mwinyi Khamis
- Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania
| | - Naomi Serbantez
- U.S. President’s Malaria Initiative, U.S. Agency for International Development, Dar es Salaam, Tanzania
| | | | - Fauzia Mohamed
- grid.442447.50000 0001 0819 3175Open University of Tanzania, Dar es Salaam, Tanzania
| | - Emmanuel Kigadye
- grid.442447.50000 0001 0819 3175Open University of Tanzania, Dar es Salaam, Tanzania
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Haregu TN, Alemayehu YK, Alemu YA, Medhin G, Woldegiorgis MA, Fentaye FW, Gerbaba MJ, Teklu AM. Disparities in the implementation of the Health Extension Program in Ethiopia: Doing more and better towards universal health coverage. DIALOGUES IN HEALTH 2022; 1:100047. [PMID: 38515918 PMCID: PMC10953949 DOI: 10.1016/j.dialog.2022.100047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 03/23/2024]
Abstract
Introduction Large-scale implementation of the Health Extension Program (HEP) has enabled Ethiopia to make significant progress in health services coverage and health outcomes. However, evidence on equity and disparities in the implementation of the HEP is limited. The aim of this study was to examine disparities in the implementation of the HEP in Ethiopia. Methods We used data from the 2019 National HEP assessment which was conducted between Oct 2018 and Sept 2019 in nine regions in the country. Data were collected from 62 districts, 343 Health posts, 179 Health centres, 584 Health Extension Workers (HEWs), and 7043 women from 7122 Households. This study focused on selected input, service delivery, and coverage indicators. We used rate differences, rate ratios and index of disparity to assess disparities in HEP implementation across regions. Results We found wide inter-regional disparities in HEP implementation. Developing regional states (DRS) had significantly lower availability of qualified HEWs (Rate Ratio (RR) = 0.54), proportion of households visited by Health Extension workers (RR = 0.40), and proportion of mothers who received education on child nutrition (RR = 0.45) as compared national average. There were also significant disparities in HEP implementation among DRS in the proportion of households visited by HEWs in the past 12 months (Index of disparity = 1.58) and proportion of adolescents who interacted with HEWs (Index of disparity = 1.43). Despite low overall coverage of health services in DRS, the contribution of the HEP for maternal health services was relatively high. Conclusion There were significant inter-regional disparities in the implementation HEP in Ethiopia. The level of disparity among DRS was also remarkable. To achieve Universal Health Coverage, it is important that these disparities are addressed systematically and strategically. We recommend a tailored approach in HEP implementation in DRS.
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Affiliation(s)
- Tilahun Nigatu Haregu
- The MERQ Institute, Addis Ababa, Ethiopia
- Nossal Institute for Global Health, University of Melbourne, Australia
| | | | | | - Girmay Medhin
- The MERQ Institute, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
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Hennein R, Nanziri LM, Musinguzi J, Ggita JM, Turimumahoro P, Ochom E, Gupta AJ, Halder A, Katamba A, White MA, Pietrzak RH, Armstrong-Hough M, Davis JL. Cultural Adaptation and Validation of the General Self-Efficacy Scale in Ugandan Community Health Workers. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2022; 2:371-383. [PMID: 37736283 PMCID: PMC10512428 DOI: 10.1007/s43477-022-00064-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/18/2022] [Indexed: 09/23/2023]
Abstract
Self-efficacy is central to community health workers' capacity and motivation to deliver evidence-based care; thus, validated measures of self-efficacy are needed to assess the effectiveness of community health worker programs. In this study, we culturally adapted and evaluated the General Self-Efficacy Scale among community health workers in Uganda using multiple methods. We adapted the ten-item General Self-Efficacy Scale through cross-cultural discussions within our multidisciplinary research team, translation from English into Luganda and back-translation into English, and six cognitive interviews with community health workers. We administered the adapted scale in a staged, two-part cross-sectional study, including a total of 147 community health workers. Exploratory factor analysis yielded three factors, which we labeled problem-solving, persistence, and resourcefulness. This three-factor solution had good model fit (standardized root mean square residual = 0.07) and explained 53.4% of the variance. We found evidence of convergent validity, as scores for the total scale were positively correlated with years of experience (r = 0.48; p < .001) and perceived social support (r = 0.39, p < .001). Scores were also higher among those with higher educational attainment in one-way analysis of variance and Bonferroni-corrected post hoc tests [F (2,72) = 9.16, p < .001]. We also found evidence of discriminant validity, as scores for the total scale were not correlated with age (r = - 0.07, p = .55), in agreement with literature showing that general self-efficacy is an age-independent construct. The internal consistency of the adapted scale was within the acceptable range for a pilot study (Cronbach's α = 0.61). This evaluation of a Uganda-adapted General Self-Efficacy Scale demonstrated promising psychometric properties; however, larger studies with repeated measures are warranted to further assess the adapted scale's factor structure, validity, reliability, and stability over time.
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Affiliation(s)
- Rachel Hennein
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Leah M. Nanziri
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Johnson Musinguzi
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Joseph M. Ggita
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | | | - Emmanuel Ochom
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Amanda J. Gupta
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anushka Halder
- Department of Social and Behavioral Sciences, New York University, New York, NY, USA
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Clinical Epidemiology and Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Marney A. White
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Robert H. Pietrzak
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Mari Armstrong-Hough
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Department of Social and Behavioral Sciences, New York University, New York, NY, USA
- Department of Epidemiology, New York University, New York, NY, USA
| | - J. Lucian Davis
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, CT, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
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Deshmukh V, John S, Pakhare A, Dasgupta R, Joshi A, Chaturvedi S, Goswami K, Das MK, Mukhopadhyay R, Singh R, Shrivastava P, Dhingra B, Bingler S, Hill BP, Arora NK. Barriers in reaching new-borns and infants through home visits: A qualitative study using nexus planning framework. Front Public Health 2022; 10:956422. [PMID: 36249255 PMCID: PMC9558122 DOI: 10.3389/fpubh.2022.956422] [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: 05/30/2022] [Accepted: 08/19/2022] [Indexed: 01/24/2023] Open
Abstract
Background Home visitation has emerged as an effective model to provide high-quality care during pregnancy, childbirth, and post-natal period and improve the health outcomes of mother- new born dyad. This 3600 assessment documented the constraints faced by the community health workers (known as the Accredited Social Health Activists, ASHAs) to accomplish home visitation and deliver quality services in a poor-performing district and co-created the strategies to overcome these using a nexus planning approach. Methods The study was conducted in the Raisen district of Madhya Pradesh, India. The grounded theory approach was applied for data collection and analysis using in-depth interviews, and focus group discussions with stakeholders representing from health system (including the ASHAs) and the community (rural population). A key group of diverse stakeholders were convened to utilize the nexus planning five domain framework (social-cultural, educational, organizational, economic, and physical) to prioritize the challenges and co-create solutions for improving the home visitation program performance and quality. The nexus framework provides a systemic lens for evaluating the success of the ASHAs home visitation program. Results The societal (caste and economic discrimination), and personal (domestic responsibilities and cultural constraints of working in the village milieu) issues emerged as the key constraints for completing home visits. The programmatic gaps in imparting technical knowledge and skills, mentoring system, communication abilities, and unsatisfactory remuneration system were the other barriers to the credibility of the services. The nexus planning framework emphasized that each of the above factors/domains is intertwined and affects or depends on each other for home-based maternal and newborn care services delivered with quality through the ASHAs. Conclusion The home visitation program services, quality and impact can be enhanced by addressing the social-cultural, organizational, educational, economic, and physical nexus domains with concurrent efforts for skill and confidence enhancement of the ASHAs and their credibility.
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Affiliation(s)
| | - Shibu John
- School of Management and Business Studies, Jamia Hamdard, New Delhi, India
| | - Abhijit Pakhare
- Department of Community Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rajib Dasgupta
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
| | - Ankur Joshi
- Department of Community Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Sanjay Chaturvedi
- Department of Community Medicine, University College of Medical Sciences, New Delhi, India
| | - Kiran Goswami
- Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Rakesh Singh
- The INCLEN Trust International, New Delhi, India
| | | | - Bhavna Dhingra
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Steven Bingler
- Concordia–Architecture, Planning, Community Engagement, New Orleans, LA, United States
| | - Bobbie Provosty Hill
- Concordia–Architecture, Planning, Community Engagement, New Orleans, LA, United States
| | - Narendra K. Arora
- The INCLEN Trust International, New Delhi, India,*Correspondence: Narendra K. Arora
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12
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Kalne PS, Kalne PS, Mehendale AM. Acknowledging the Role of Community Health Workers in Providing Essential Healthcare Services in Rural India-A Review. Cureus 2022; 14:e29372. [PMID: 36304347 PMCID: PMC9584634 DOI: 10.7759/cureus.29372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
Abstract
In underserved communities, the community health worker (CHW) concept has been employed to improve health and lessen unfavourable health consequences. In India's rural healthcare delivery system, auxiliary nurse midwives (ANMs), accredited social health activists (ASHA workers), and Anganwadi workers (AWWs) are the primary field-level frontline officials who come into direct contact with the population. They bear a large portion of the burden of carrying out health services. This review investigated the various contributions made by these CHWs, ANMs, ASHA workers, and AWWs to the advancement of basic healthcare in Indian rural areas. The goal of reviewing this paper was to learn more about what CHWs do to provide the target demographic with high-quality healthcare. A thorough literature search was conducted using crucial databases including PubMed, Google, and Google Scholar. Recent studies were examined to determine how well CHWs perform essential healthcare services in low and middle-income nations. Numerous studies demonstrate how their work has a good effect on society. The length of time CHWs spend at work each day and how well they perform as a whole depends on several variables. This review study showed that, globally, there is a growing interest in CHWs' performance. In terms of incentives, pay, and training expenses, CHWs are thought to be a more affordable option than other types of health workers. They are recognised as the main factors in providing promotive, preventive, curative and rehabilitative healthcare services, achieving enhanced neonatal and maternal health and the development of children and adolescents. The current review also examined previous studies on the work done by CHWs and their potential benefits for enhancing primary healthcare in rural India. It focused on the routine work done by these health workers to increase service accessibility and access to high-quality healthcare, particularly for individuals living in rural areas. Hence, it is necessary to evaluate the functions and general status of community health workers (CHWs), as well as recognise their role, to improve their efficiency in providing basic healthcare services to society and make necessary changes in the future.
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13
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Mukherjee A, Daniel M, Kaur A, Devarapalli S, Kallakuri S, Essue B, Raman U, Thornicroft G, Saxena S, Peiris D, Maulik PK. Operational challenges in the pre-intervention phase of a mental health trial in rural India: reflections from SMART Mental Health. Int J Ment Health Syst 2022; 16:42. [PMID: 35974341 PMCID: PMC9379869 DOI: 10.1186/s13033-022-00549-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Availability of mental health services in low- and middle-income countries is largely concentrated in tertiary care with limited resources and scarcity of trained professionals at the primary care level. SMART Mental Health is a strategy that combines a community anti-stigma campaign with a primary health care workforce strengthening initiative, using electronic decision support with the goal of better identifying and supporting people with common mental disorders in India. METHODS We describe the challenges faced and lessons learnt during the pre-intervention phase of SMART Mental Health cluster Randomised Controlled Trial. Pre-intervention phase includes preliminary activities for setting-up the trial and research activities prior to delivery of the intervention. Field notes from project site visit, project team meetings and detailed follow-up discussions with members of the project team were used to document operational challenges and strategies adopted to overcome them. The socio-ecological model was used as the analytical framework to organise the findings. RESULTS Key challenges included delays in government approvals, addressing community health worker needs, and building trust in the community. These were addressed through continuous communication, leveraging support of relevant stakeholders, and addressing concerns of community health workers and community. Issues related to use of digital platform for data collection were addressed by a dedicated technical support team. The COVID-19 pandemic and political unrest led to significant and unexpected challenges requiring important adaptations to successfully implement the project. CONCLUSION Setting up of this trial has posed challenges at a combination of community, health system and broader socio-political levels. Successful mitigating strategies to overcome these challenges must be innovative, timely and flexibly delivered according to local context. Systematic ongoing documentation of field-level challenges and subsequent adaptations can help optimise implementation processes and support high quality trials. TRIAL REGISTRATION The trial is registered with Clinical Trials Registry India (CTRI/2018/08/015355). Registered on 16th August 2018. http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=23254&EncHid=&userName=CTRI/2018/08/015355.
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Affiliation(s)
| | - Mercian Daniel
- The George Institute for Global Health, New Delhi, India
| | - Amanpreet Kaur
- The George Institute for Global Health, New Delhi, India
| | | | | | - Beverley Essue
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Usha Raman
- Department of Communication, University of Hyderabad, Hyderabad, India
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - David Peiris
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Pallab K. Maulik
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, Australia
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Jain M, Caplan Y, Ramesh BM, Kemp H, Hammer B, Isac S, Blanchard J, Namasivayam V, Sgaier SK. Improving Community Health Worker Compensation: A Case Study From India Using Quantitative Projection Modeling and Incentive Design Principles. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100413. [PMID: 36332076 PMCID: PMC9242609 DOI: 10.9745/ghsp-d-21-00413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/26/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Although community health workers (CHWs) are effective at mobilizing important health behaviors, there is limited evidence on how financial incentive systems can best be designed to drive their effectiveness. This study intends to bridge this evidence gap by analyzing the compensation model of India's accredited social health activist (ASHA) program and identifying areas of improvement in the system's design and implementation. METHODS We analyze the ASHA program in Uttar Pradesh, India. ASHAs receive compensation through a mix of program-linked, performance-based, and routine activity-based incentive structures. Using multiple data sources, including a novel linked household and ASHA survey, we estimate ASHA performance-linked incentive earnings under different scenarios of ASHA actions and household behaviors. Juxtaposing statistical projection models and actual government payments, we identified which incentives promised the highest payments, which were claimed or not, which could be claimed more by increasing ASHA actions, and which were paid despite not meeting payment criteria. We also report findings on ASHA awareness of and experiences with claiming incentives. RESULTS We find crucial gaps and implementation challenges in the ASHA incentive structure. ASHAs could double their earnings by completing certain tasks within their control. ASHAs may also be paid for partial completion of activities, as incentives are paid in lump sums for a series of activities rather than for each activity. Family planning incentives have the largest gap between potential and actual earnings. Incentivizing ASHAs for achieving certain health outcomes is inefficient, as no clear linkage was found between the achievability of such health outcomes and the claim amounts. CONCLUSION There are several opportunities for improving CHW compensation, from improving the incentive claims process to shifting focus to achievable outcomes. Optimizing incentive system designs can further enhance CHW effectiveness globally to affect key health behaviors.
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Affiliation(s)
| | | | | | | | | | - Shajy Isac
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- India Health Action Trust, Lucknow, India
| | - James Blanchard
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Vasanthakumar Namasivayam
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- India Health Action Trust, Lucknow, India
| | - Sema K Sgaier
- Surgo Ventures, Washington, DC, USA.
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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Scott K, Ummer O, Chamberlain S, Sharma M, Gharai D, Mishra B, Choudhury N, LeFevre AE. '[We] learned how to speak with love': a qualitative exploration of accredited social health activist (ASHA) community health worker experiences of the Mobile Academy refresher training in Rajasthan, India. BMJ Open 2022; 12:e050363. [PMID: 35701061 PMCID: PMC9198783 DOI: 10.1136/bmjopen-2021-050363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Mobile Academy is a mobile-based training course for India's accredited social health activist (ASHA) community health workers (CHW). The course, which ASHAs access by dialling a number from their phones, totals 4 hours of audio content. It consists of 11 chapters, each with their own quiz, and provides a cumulative pass or fail score at the end. This qualitative study of Mobile Academy explores how the programme was accessed and experienced by CHWs, and how they perceive it to have influenced their work. METHODS We conducted in-depth interviews (n=25) and focus group discussions (n=5) with ASHAs and other health system actors. Open-ended questions explored ASHA perspectives on Mobile Academy, the course's perceived influence on ASHAs and preferences for future training programmes. After applying a priori codes to the transcripts, we identified emergent themes and grouped them according to our CHW mLearning framework. RESULTS ASHAs reported enjoying Mobile Academy, specifically praising its friendly tone and the ability to repeat content. They, and higher level health systems actors, conceived it to primarily be a test not a training. ASHAs reported that they found the quizzes easy but generally did not consider the course overly simplistic. ASHAs considered Mobile Academy's content to be a useful knowledge refresher but said its primary benefit was in modelling a positive communications approach, which inspired them to adopt a kinder, more 'loving' communication style when speaking to beneficiaries. ASHAs and health system actors wanted follow-on mLearning courses that would continue to compliment but not replace face-to-face training. CONCLUSION This mLearning programme for CHWs in India was well received by ASHAs across a wide range of education levels and experience. Dial-in audio training has the potential to reinforce topical knowledge and showcase positive ways to communicate.
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Affiliation(s)
- Kerry Scott
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Osama Ummer
- Oxford Policy Management, New Delhi, India
- BBC Media Action, New Delhi, India
| | | | | | | | | | - Namrata Choudhury
- Centre for the Study of Law and Governance, Jawaharlal Nehru University, New Delhi, India
| | - Amnesty Elizabeth LeFevre
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
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Hämmerli P, Moukam AD, Wisniak A, Sormani J, Vassilakos P, Kenfack B, Petignat P, Schmidt NC. "My motivation was to save": a qualitative study exploring factors influencing motivation of community healthcare workers in a cervical cancer screening program in Dschang, Cameroon. Reprod Health 2022; 19:133. [PMID: 35668427 PMCID: PMC9167909 DOI: 10.1186/s12978-022-01420-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cervical cancer is a major public health issue among women in Cameroon and uptake of screening programs remains a challenge in many low- and middle-income countries. Community healthcare workers can play an important role in promoting cervical cancer services. This study aimed to explore factors affecting the motivation of community healthcare workers in a cervical cancer screening program in Dschang, Cameroon. Methods A qualitative approach including 11 in-depth individual interviews with community healthcare workers was used. The interviews were audio-recorded, transcribed and coded using thematic analysis assisted by ATLAS.ti software. Results Four women and seven men aged between 21 and 77 years old were interviewed. Community healthcare workers had high motivation. Factors affecting motivation were divided into individual and environmental level, based on a theoretical framework. Factors with a positive influence on motivation were mainly on the individual side while impeding factors were mainly associated with the environmental level. Conclusions Key interventions to improve motivation among community healthcare workers include: (i) more training and supportive supervision; (ii) evaluation of remuneration systems by workload; and (iii) provision of job-enabling resources such as uniforms, cellphone cards and transport. Trial registration: Geneva Cantonal Ethics Committee on Human Research (No. 2017-01110) and the Cameroonian National Ethics Committee for Human Health Research (No. 2018/07/1083/CE/CNERSH/SP). Cervical cancer is the second leading cause of cancer-related death among women in Cameroon. This is mainly due to the absence of routine cervical cancer screening programs and the lack of treatment. However, even in case of availability of cervical cancer screening programs, barriers exist. Therefore, community healthcare workers have been involved successfully to increase the screening coverage. As retention of these actors remains a challenge, the main objective of this study was to identify key factors affecting their motivation aiming to suggest interventions to address motivational factors. 11 qualitative interviews with individual community healthcare workers were conducted at a cervical cancer screening program in Dschang, Cameroon. Motivation was generally high and affecting factors were divided into the individual and the environmental level. Factors with a positive influence on motivation were mainly on the individual side while impeding factors were mainly associated with the environmental level. Ongoing collaboration with community healthcare workers is beneficial for cervical cancer screening programs, and key interventions should therefore include: (i) more training and supportive supervision; (ii) evaluation of remuneration systems by workload; and (iii) provision of job-enabling resources such as uniforms, cellphone cards and transport.
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Affiliation(s)
| | - Alida Datchoua Moukam
- Department of Gynaecology and Obstetrics, District Hospital of Dschang, Dschang, Cameroon
| | - Ania Wisniak
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Jessica Sormani
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.,Geneva School of Health Sciences, HESSO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Bruno Kenfack
- Department of Gynaecology and Obstetrics, District Hospital of Dschang, Dschang, Cameroon
| | - Patrick Petignat
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Nicole Christine Schmidt
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland. .,Faculty of Social Science, Catholic University of Applied Science, Preysingstr. 95, 81667, Munich, Germany.
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Ajayi IO, Oyewole OE, Ogah OS, Akinyemi JO, Salawu MM, Bamgboye EA, Obembe T, Olawuwo M, Sani MU. Development and evaluation of a package to improve hypertension control in Nigeria [DEPIHCON]: a cluster-randomized controlled trial. Trials 2022; 23:366. [PMID: 35501887 PMCID: PMC9058739 DOI: 10.1186/s13063-022-06209-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/26/2022] [Indexed: 11/19/2022] Open
Abstract
Background Nigeria’s healthcare system capacity to stem the increasing trend in hypertension is limited in coverage, scope and manpower. Use of trained community-based care providers demonstrated to be an effective complement in improving access to, and supporting healthcare delivery has not been adequately examined for hypertension care in Nigeria. This study is proposed to evaluate the effectiveness of using trained community-oriented resource persons (CORPs) to improve hypertension control in Nigeria. Methods An intervention study will be conducted in three states using a mixed method design. First is a baseline survey using a semi-structured pre-tested questionnaire to collect information on demographics, clinical data, knowledge, occurrence and risk factors of hypertension among 1704 adults ≥18 years. Focus group discussions (FGD) and key informant interviews (KII) will be conducted to explore a community’s experience of hypertension, challenges with hypertension management and support required to improve control in 10 selected communities in each state. The second is a cluster-randomized controlled trial to evaluate effect of a package on reduction of blood pressure (BP) and prevention of cardiovascular (CVD) risk factors among 200 hypertensive patients to be followed up in intervention and control arms over a 6-month period in each state. The package will include trained CORPs conducting community-based screening of BP and referral, diagnosis confirmation and initial treatment in the health facility, followed by monthly home-based follow-up care and provision of health education on hypertension control and healthy lifestyle enhanced by phone voice message reminders. In the control arm, the usual care (diagnosis, treatment and follow-up care in hospital of a patient’s choice) will continue. Third, an endline survey will be conducted in both intervention and control communities to evaluate changes in mean BP, control, knowledge and proportion of other CVD risk factors. In addition, FGD and KII will be used to assess participants’ perceived quality and acceptability of the interventions as delivered by CORPs. Discussion This research is expected to create awareness, improve knowledge, perception, behaviours, attitude and practices that will reduce hypertension in Nigeria. Advocacy for buy-in and scale up of using CORPs in hypertension care by the government is key if found to be effective. Trial registration PACTR Registry PACTR202107530985857. Registered on 26 July 2021.
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Ahmed S, Chase LE, Wagnild J, Akhter N, Sturridge S, Clarke A, Chowdhary P, Mukami D, Kasim A, Hampshire K. Community health workers and health equity in low- and middle-income countries: systematic review and recommendations for policy and practice. Int J Equity Health 2022; 21:49. [PMID: 35410258 PMCID: PMC8996551 DOI: 10.1186/s12939-021-01615-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/27/2021] [Indexed: 01/06/2023] Open
Abstract
Background The deployment of Community Health Workers (CHWs) is widely promoted as a strategy for reducing health inequities in low- and middle-income countries (LMIC). Yet there is limited evidence on whether and how CHW programmes achieve this. This systematic review aimed to synthesise research findings on the following questions: (1) How effective are CHW interventions at reaching the most disadvantaged groups in LMIC contexts? and (2) What evidence exists on whether and how these programmes reduce health inequities in the populations they serve? Methods We searched six academic databases for recent (2014–2020) studies reporting on CHW programme access, utilisation, quality, and effects on health outcomes/behaviours in relation to potential stratifiers of health opportunities and outcomes (e.g., gender, socioeconomic status, place of residence). Quantitative data were extracted, tabulated, and subjected to meta-analysis where appropriate. Qualitative findings were synthesised using thematic analysis. Results One hundred sixty-seven studies met the search criteria, reporting on CHW interventions in 33 LMIC. Quantitative synthesis showed that CHW programmes successfully reach many (although not all) marginalized groups, but that health inequalities often persist in the populations they serve. Qualitative findings suggest that disadvantaged groups experienced barriers to taking up CHW health advice and referrals and point to a range of strategies for improving the reach and impact of CHW programmes in these groups. Ensuring fair working conditions for CHWs and expanding opportunities for advocacy were also revealed as being important for bridging health equity gaps. Conclusion In order to optimise the equity impacts of CHW programmes, we need to move beyond seeing CHWs as a temporary sticking plaster, and instead build meaningful partnerships between CHWs, communities and policy-makers to confront and address the underlying structures of inequity. Trial registration PROSPERO registration number CRD42020177333. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01615-y.
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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.
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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
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Charani E, Mendelson M, Ashiru-Oredope D, Hutchinson E, Kaur M, McKee M, Mpundu M, Price JR, Shafiq N, Holmes A. Navigating sociocultural disparities in relation to infection and antibiotic resistance-the need for an intersectional approach. JAC Antimicrob Resist 2021; 3:dlab123. [PMID: 34604747 PMCID: PMC8485076 DOI: 10.1093/jacamr/dlab123] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
One of the key drivers of antibiotic resistance (ABR) and drug-resistant bacterial infections is the misuse and overuse of antibiotics in human populations. Infection management and antibiotic decision-making are multifactorial, complex processes influenced by context and involving many actors. Social constructs including race, ethnicity, gender identity and cultural and religious practices as well as migration status and geography influence health. Infection and ABR are also affected by these external drivers in individuals and populations leading to stratified health outcomes. These drivers compromise the capacity and resources of healthcare services already over-burdened with drug-resistant infections. In this review we consider the current evidence and call for a need to broaden the study of culture and power dynamics in healthcare through investigation of relative power, hierarchies and sociocultural constructs including structures, race, caste, social class and gender identity as predictors of health-providing and health-seeking behaviours. This approach will facilitate a more sustainable means of addressing the threat of ABR and identify vulnerable groups ensuring greater inclusivity in decision-making. At an individual level, investigating how social constructs and gender hierarchies impact clinical team interactions, communication and decision-making in infection management and the role of the patient and carers will support better engagement to optimize behaviours. How people of different race, class and gender identity seek, experience and provide healthcare for bacterial infections and use antibiotics needs to be better understood in order to facilitate inclusivity of marginalized groups in decision-making and policy.
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Affiliation(s)
- Esmita Charani
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Corresponding author. E-mail:
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | | | - Manmeet Kaur
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Mirfin Mpundu
- International Centre for Antimicrobial Resistance Solutions, Lusaka, Zambia
| | - James R Price
- Imperial College Healthcare NHS Trust, Department of Infectious Diseases, London, UK
| | - Nusrat Shafiq
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alison Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
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Kane S, Radkar A, Gadgil M, McPake B. Community Health Workers as Influential Health System Actors and not "Just Another Pair Of Hands". Int J Health Policy Manag 2021; 10:465-474. [PMID: 32610755 PMCID: PMC9056200 DOI: 10.34172/ijhpm.2020.58] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 04/13/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Over the last 20 years, community health workers (CHWs) have become a mainstay of human resources for health in many low- and middle-income countries (LMICs). A large body of research chronicles CHWs' experience of their work. In this study we focus on 2 narratives that stand out in the literature. The first is the idea that social, economic and health system contexts intersect to undermine CHWs' experience of their work, and that a key factor underpinning this experience is that LMIC health systems tend to view CHWs as just an 'extra pair of hands' to be called upon to provide 'technical fixes.' In this study we show the dynamic and evolving nature of CHW programmes and CHW identities and the need, therefore, for new understandings. METHODS A qualitative case study was carried out of the Indian CHW program (CHWs are called accredited social health activists: ASHAs). It aimed to answer the research question: How do ASHAs experience being CHWs, and what shapes their experience and performance? In depth interviews were conducted with 32 purposively selected ASHAs and key informants. Analysis was focused on interpreting and on developing analytical accounts of ASHAs' experiences of being CHWs; it was iterative and occurred throughout the research. Interviews were transcribed verbatim and transcripts were analysed using a framework approach (with Nvivo 11). RESULTS CHWs resent being treated as just another pair of hands at the beck and call of formal health workers. The experience of being a CHW is evolving, and many are accumulating substantial social capital over time - emerging as influential social actors in the communities they serve. CHWs are covertly and overtly acting to subvert the structural forces that undermine their performance and work experience. CONCLUSION CHWs have the potential to be influential actors in the communities they serve and in frontline health services. Health systems and health researchers need to be cognizant of and consciously engage with this emerging global social dynamic around CHWs. Such an approach can help guide the development of optimal strategies to support CHWs to fulfil their role in achieving health and social development goals.
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Affiliation(s)
- Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
- Gokhale Institute of Politics and Economics, Pune, Maharashtra, India
| | - Anjali Radkar
- Gokhale Institute of Politics and Economics, Pune, Maharashtra, India
| | - Mukta Gadgil
- State Health Systems Resource Centre, Pune, Maharashtra, India
| | - Barbara McPake
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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Successes, challenges, and support for men versus women implementers in water, sanitation, and hygiene programs: A qualitative study in rural Nepal. Int J Hyg Environ Health 2021; 236:113792. [PMID: 34144357 DOI: 10.1016/j.ijheh.2021.113792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/24/2021] [Accepted: 06/08/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Women's active participation is important for inclusive water, sanitation, and hygiene (WaSH) programs, yet gender roles that limit women's access to formal education and employment may reduce their skills, experience, and capacity for implementation. This paper explores differences between men and women implementers of rural WaSH programs in implementation approaches, challenges, and sources of support for implementation, and success in achieving program quality outcomes. METHODS We interviewed 18 men and 13 women in community-based implementation roles in four districts of Nepal. We identified challenges and sources of support for implementation in four domains-informational, tangible, emotional, or companionship-following social support theory. We assessed successes at achieving intermediate implementation outcomes (e.g., adoption, appropriateness, sustainability) and long-term intervention outcomes (e.g., community cleanliness, health improvements). RESULTS Women used relational approaches and leveraged social ties to encourage behavior change, while men used formative research to identify behavior drivers and sanctions to drive behavior change. Women experienced stigma for working outside the home, which was perceived as a traditionally male role. Companionship and emotional support from other women and male community leaders helped mitigate stigma and lack of informational support. Women were also more likely to receive no or low financial compensation for work and had fewer opportunities for feedback and training compared to men. Despite lack of support, women were motivated to work by a desire to build their social status, gain new knowledge, and break conventional gender roles. CONCLUSIONS Both men and women perceived that women were more effective than men at mobilizing widespread, sustained WaSH improvements, which was attributed to their successes using relational approaches and leveraging social ties to deliver acceptable and appropriate messages. Their skills for motivating collective action indicate that they can be highly effective WaSH implementers despite lack of technical experience and training, and that women's active participation is important for achieving transformative community change.
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Gatuguta A, Colombini M, Seeley J, Soremekun S, Devries K. Supporting children and adolescents who have experienced sexual abuse to access services: Community health workers' experiences in Kenya. CHILD ABUSE & NEGLECT 2021; 116:104244. [PMID: 31882066 DOI: 10.1016/j.chiabu.2019.104244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/10/2019] [Accepted: 10/18/2019] [Indexed: 06/10/2023]
Abstract
UNLABELLED Child sexual abuse (CSA) is a global health problem with significant health consequences. The World Health Organization recommends immediate and long-term treatment for all survivors. However, in low- and middle-income countries, less than 10 % of sexually abused children seek health services. Community health workers (CHWs) can potentially increase uptake of services, but, the risks and benefits of services provided by CHWs are poorly understood. METHODS Through in-depth interviews, we examined the experiences of CHWs providing services to children in Kenya. Sixteen CHWs were purposively selected from two locations. Data were audio-recorded, transcribed verbatim and analysed thematically. FINDINGS Nearly all the CHWs reported assisting children who had experienced sexual abuse. Children were brought to their attention by caregivers, neighbours, teachers, local authorities or the police. CHWs roles included providing information and advice, assisting the child to report to the police, access healthcare or find shelter. Multiple challenges were reported including lack of support from formal institutions; community norms; safety concerns; inadequate resources and interference from family, perpetrators and local authorities. Lack of protocols and training on how to handle children was evident. CONCLUSIONS CHWs are a crucial community-level resource for CSA survivors and their caregivers. However, community norms, lack of guidelines and training may compromise the quality of services provided. There is a significant gap in literature on service models for CHWs delivering CSA services. Data are lacking on what services CHWs can effectively offer, how they should be delivered and what factors may influence delivery, acceptance and uptake of services.
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Affiliation(s)
- Anne Gatuguta
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK; Department of Community Health, School of Public Health, Kenyatta University, Nairobi, Kenya.
| | - Manuela Colombini
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Seyi Soremekun
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Karen Devries
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
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Sharma S, Arora K, Chandrashekhar, Sinha RK, Akhtar F, Mehra S. Evaluation of a training program for life skills education and financial literacy to community health workers in India: a quasi-experimental study. BMC Health Serv Res 2021; 21:46. [PMID: 33419442 PMCID: PMC7796593 DOI: 10.1186/s12913-020-06025-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background Accredited Social Health Activists (ASHA) are community health workers responsible for improving the health status of people by facilitating their access to healthcare services. The life skills of ASHA are known to be effective in negotiating behaviour change in the community; however, there has been a meagre focus towards improving them. Considering this gap, we adopted a comprehensive training program, known as Personal Advancement and Career Enhancement (P.A.C.E.), to empower ASHAs on life skills and financial literacy. The present study intends to assess the training program in two districts of Uttar Pradesh, India, by examining changes in knowledge, perceptions, and practices of ASHAs about life skills and financial literacy. Methods We conducted a quasi-experimental, non-randomized, controlled study with pre-and post-test assessments. Data were collected on socio-demographic characteristics, knowledge, and practices related to life skills (communication skills, self-confidence, problem–solving and decision-making skills, time and stress management skills) and financial literacy. Additionally, change perceptions on gender-, life skills-, and savings-related practices at the personal, community, and workplace levels were assessed in the intervention group. Factor analysis was performed to obtain the change patterns by assessing the degree to which the four life skills, financial literacy, and change perceptions on practices were correlated. A general linear regression model was performed to assess associations among change pattern scores and socio-demographic variables. Results We analyzed the data of 171 ASHAs (intervention group:86 and control group:85). There was a significant improvement in the average post-test scores of all the life skills and financial literacy in the intervention group (p < 0.001). Three distinct change patterns were found post-training in the intervention group. Factor 1 (high loadings for change perceptions on practices) was positively associated with ASHAs aged 38 and above and with experience of ≤12 years. On the contrary, the change in financial literacy and self-confidence scores was common among ASHAs with more than 12 years of experience. Conclusions The P.A.C.E training program was found effective in improving the life skills and financial literacy of ASHAs in India. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06025-4.
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Affiliation(s)
- Shantanu Sharma
- Department of Clinical Sciences, Lund University, Skåne University Hospital, S-20502 Malmö, Sweden & Assistant Director, MAMTA Health Institute for Mother and Child, Delhi, India.
| | - Kanishtha Arora
- Reproductive, Maternal, Newborn, Child and Adolescent Health Division, MAMTA Health Institute for Mother and Child, Delhi, India
| | - Chandrashekhar
- MAMTA Health Institute for Mother and Child, Delhi, India
| | - Rajesh Kumar Sinha
- Reproductive, Maternal, Newborn, Child and Adolescent Health Division, MAMTA Health Institute for Mother and Child, Delhi, India
| | - Faiyaz Akhtar
- Reproductive, Maternal, Newborn, Child and Adolescent Health Division, MAMTA Health Institute for Mother and Child, Delhi, India
| | - Sunil Mehra
- MAMTA Health Institute for Mother and Child, Delhi, India
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Krishna D, Muthukaruppan SS, Bharathwaj A, Ponnusamy R, Poomariappan BM, Mariappan S, Beevi A, MacLachlan J, Campbell Z, Anthonypillai C, Brien M, Cameron C, Flatman M, Perlman L, Seilman S, Jeyapragash A, van der Haar L, Krapels J, Srinivasan SR. Rapid-Cycle Evaluation in an Early Intervention Program for Children With Developmental Disabilities in South India: Optimizing Service Providers' Quality of Work-Life, Family Program Engagement, and School Enrollment. Front Public Health 2020; 8:567907. [PMID: 33330314 PMCID: PMC7734086 DOI: 10.3389/fpubh.2020.567907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 11/02/2020] [Indexed: 11/18/2022] Open
Abstract
Background: This paper explores how implementation and refinement of an early intervention (EI) program for children with delayed development was informed by an iterative, intentional and structured process of measurement. Providing access to early intervention therapy for children in rural areas of India is challenging due to a lack of rehabilitation therapists and programs. Following a biopsychosocial framework and principles of community-based rehabilitation, a non-governmental organization, Amar Seva Sangam (ASSA), overcame those barriers by designing a digital technology supported EI program in rural Tamil Nadu, India. Program objectives included providing service access; supporting program engagement, child development and school enrollment; and positioning the intervention for scale-up. This paper contributes to a growing body of literature on how program design and implementation can be informed through a cyclical process of data collection, analysis, reflection, and adaptation. Methods: Through several strands of data collection, the design and implementation of the EI program was adapted and improved. This included qualitative data from focus groups and interviews with caregivers and service providers, and a mobile application that collected and monitored longitudinal quantitative data, including program engagement rates, developmental progression, caregiver outcomes, and school enrollment status. Results: Measurements throughout the program informed decision-making by identifying facilitators and barriers to service providers' quality of work-life, family program engagement, and school enrollment. Consultation with key stakeholders, including caregivers and service providers, and data driven decision making led to continual program changes that improved service provider quality of work-life, program engagement and school enrollment. These changes included addressing gender-related work challenges for service providers; forming caregiver support networks; introducing psychological counseling for caregivers; providing medical consultations and assistive devices; creating community awareness programs; improving access to therapy services; focusing on caregiver education, motivation and support; and advocacy for accessibility in schools. Conclusion: The process of using evidence-informed and stakeholder driven adaptations to the early intervention program, led to improved service provider quality of work-life, greater program engagement, improved school enrollment and positioned the intervention for scale-up, providing lessons that may be beneficial in other contexts.
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Affiliation(s)
- Dinesh Krishna
- Early Intervention Program, Amar Seva Sangam, Ayikudy, India.,International Center for Disability and Rehabilitation, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Handi-Care Intl., Toronto, ON, Canada
| | | | | | | | | | | | - Ayesha Beevi
- Early Intervention Program, Amar Seva Sangam, Ayikudy, India
| | - Janna MacLachlan
- International Center for Disability and Rehabilitation, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Handi-Care Intl., Toronto, ON, Canada
| | | | | | - Marie Brien
- Early Intervention Program, Amar Seva Sangam, Ayikudy, India.,Handi-Care Intl., Toronto, ON, Canada
| | - Cathy Cameron
- International Center for Disability and Rehabilitation, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | | | | | - Stephanie Seilman
- International Center for Disability and Rehabilitation, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Handi-Care Intl., Toronto, ON, Canada
| | - Abhinayaa Jeyapragash
- International Center for Disability and Rehabilitation, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Handi-Care Intl., Toronto, ON, Canada
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Nair S, Adhikari T, Juneja A, Gulati KB, Kaur A, Rao MVV. Community Perspectives on Men's Role in the Utilisation of Maternal Health Services Among Saharia Tribes in Gwalior, Madhya Pradesh, India: Insights from a Qualitative Study. Matern Child Health J 2020; 25:769-776. [PMID: 33215331 DOI: 10.1007/s10995-020-03029-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Utilization of maternal health care services by tribal population could be detrimental in reducing high maternal mortality in Madhya Pradesh, India. A growing body of evidence indicates the positive association between male involvement and increased use of antenatal care services. Further research is required to understand barriers and possible solutions to develop culturally appropriate interventions to engage men to promote the utilization of maternal health care services. METHODS The study used qualitative data collected through 8 focus group discussions with men and women and 8 key informant interviews with either a community representative or health worker in two blocks dominated by Saharia tribes in Gwalior district, Madhya Pradesh, India in 2018. Information on the perception of utilization of maternal and child health services, male involvement, challenges and opportunities were elicited using a structured guide. Framework analysis was used to analyse the data. RESULTS Findings document barriers at the individual (poor knowledge, fear of loss of wage, choice of home as a place of delivery), community (practices that reinforced the prevailing gender norms) and health care facility level (quality and attitude of health care providers) to male engagement in utilization of maternal health services. Community perceptions on possible solutions to address these were more likely to be gender exploitative interventions. CONCLUSION To promote utilization of maternal health care services among Saharia tribes, this study highlights the importance of developing gender sensitive interventions that addresses the individual, community and health care facility level barriers of male involvement and do not reinforce existing gender norms.
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Affiliation(s)
- Saritha Nair
- ICMR-National Institute of Medical Statistics (NIMS), ICMR-NIMS, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| | - Tulsi Adhikari
- ICMR-National Institute of Medical Statistics (NIMS), ICMR-NIMS, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India.
| | - Atul Juneja
- ICMR-National Institute of Medical Statistics (NIMS), ICMR-NIMS, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| | - K Bal Gulati
- ICMR-National Institute of Medical Statistics (NIMS), ICMR-NIMS, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| | - Ashpinder Kaur
- ICMR-National Institute of Medical Statistics (NIMS), ICMR-NIMS, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| | - M Vishnu Vardhana Rao
- ICMR-National Institute of Medical Statistics (NIMS), ICMR-NIMS, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
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Betron M, Thapa A, Amatya R, Thapa K, Arlotti-Parish E, Schuster A, Bhattarai J, Limbu S, Chiweshe MT, Rishal P, Dhital R. Should female community health volunteers (FCHVs) facilitate a response to gender-based violence (GBV)? A mixed methods exploratory study in Mangalsen, Nepal. Glob Public Health 2020; 16:1604-1617. [PMID: 33186506 DOI: 10.1080/17441692.2020.1839929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ABSTRACTAs part of a multisectoral response to gender-based violence (GBV), Nepal is testing the feasibility of having female community health volunteers (FCHVs) play a formal role in identifying GBV survivors and referring them to specialised services at health facilities. This study followed 116 FHCVs in Mangalsen municipality who attended a one-day orientation on GBV. Over the following year, data were collected from knowledge and attitude assessments of FCHVs, focus group discussions with FCHVs, and members of Mothers' Groups for Health. Most Significant Change stories were collected from FCHVs, in-depth interviews with stakeholders, and service statistics. Results show that the FCHVs' knowledge increased, attitudes changed, and confidence in addressing GBV grew. During the study period, FCHVs identified 1,253 GBV survivors and referred 221 of them to health facilities. In addition to assisting GBV survivors, FCHVs worked to prevent GBV by mediating conflicts and curbing harmful practices such as menstrual isolation. Stakeholders viewed FCHVs as a sustainable resource for identifying and referring GBV survivors to services, while women trusted them and looked to them for help. Results show that, with proper training and safety mechanisms, FCHVs can raise community awareness about GBV, facilitate support for survivors, and potentially help prevent harmful practices.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Poonam Rishal
- Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu, Nepal
| | - Rolina Dhital
- Health Action and Research Lazimpat, Kathmandu, Nepal
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Arora N, Hanson K, Spicer N, Estifanos AS, Keraga DW, Welearegay AT, Tela FG, Hussen YA, Mandefro YS, Quaife M. Understanding the importance of non-material factors in retaining community health workers in low-income settings: a qualitative case-study in Ethiopia. BMJ Open 2020; 10:e037989. [PMID: 33033092 PMCID: PMC7545659 DOI: 10.1136/bmjopen-2020-037989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The motivation and retention of community health workers (CHWs) is a challenge and inadequately addressed in research and policy. We sought to identify factors influencing the retention of CHWs in Ethiopia and ways to avert their exit. DESIGN A qualitative study was undertaken using in-depth interviews with the study participants. Interviews were audio-recorded, and then simultaneously translated into English and transcribed for analysis. Data were analysed in NVivo 12 using an iterative inductive-deductive approach. SETTING The study was conducted in two districts each in the Tigray and Southern Nations, Nationalities and People's Republic (SNNPR) regions in Ethiopia. Respondents were located in a mix of rural and urban settings. PARTICIPANTS Leavers of health extension worker (HEW) positions (n=20), active HEWs (n=16) and key informants (n=11) in the form of policymakers were interviewed. RESULTS We identified several extrinsic and intrinsic motivational factors affecting the retention and labour market choices of HEWs. While financial incentives in the form of salaries and material incentives in the form of improvements to health facility infrastructure, provision of childcare were reported to be important, non-material factors like HEWs' self-image, acceptance and validation by the community and their supervisors were found to be critical. A reduction or loss of these non-material factors proved to be the catalyst for many HEWs to leave their jobs. CONCLUSION Our study contributes new empirical evidence to the global debate on factors influencing the motivation and retention of CHWs, by being the first to include job leavers in the analysis. Our findings suggest that policy interventions that appeal to the social needs of CHWs can prove to be more acceptable and potentially cost-effective in improving their retention in the long run. This is important for government policymakers in resource constrained settings like Ethiopia that rely heavily on lay workers for primary healthcare delivery.
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Affiliation(s)
- Nikita Arora
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kara Hanson
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Spicer
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | | | - Matthew Quaife
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Garg T, Bhardwaj M, Deo S. Role of community health workers in improving cost efficiency in an active case finding tuberculosis programme: an operational research study from rural Bihar, India. BMJ Open 2020; 10:e036625. [PMID: 33004390 PMCID: PMC7536783 DOI: 10.1136/bmjopen-2019-036625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Cost-efficient active case finding (ACF) approaches are needed for their large-scale adoption in national tuberculosis (TB) programmes. Our aim was to assess if community health workers' (CHW) knowledge about families' health status can improve the cost efficiency of the ACF programme without adversely affecting the delivery of other health services for which they are responsible. DESIGN Quasi-experimental design. INTERVENTIONS We evaluated an ACF programme in the Samastipur district in Bihar, India, between July 2017 and June 2018. CHWs called Accredited Social Health Activists generated referrals of individuals at risk of TB and conducted symptom-based screening to identify patients with presumptive TB. They also helped them undergo testing and provided treatment support for confirmed TB cases. PRIMARY AND SECONDARY OUTCOME MEASURES We compared the notification rate from the intervention region with that from a control region in the same district with similar characteristics. We analysed operational data to calculate the cost per TB case diagnosed. We used routine programmatic data from the public health system to estimate the impact on other services provided by CHWs. FINDINGS CHWs identified 9895 patients with presumptive TB. Of these, 5864 patients were tested for TB, and 1236 were confirmed as TB cases. Annual public case notification rate increased sharply in the intervention region from 45.8 to 105.8 per 100 000 population, whereas it decreased from 50.7 to 45.3 in the control region. There was no practically or statistically significant impact on other output indicators of the CHWs, such as institutional deliveries (-0.04%). The overall cost of the intervention was about US$134 per diagnosed case. Main cost drivers were human resources, and commodities (drugs and diagnostics), which contributed 37.4% and 32.5% of the cost, respectively. CONCLUSIONS ACF programmes that use existing CHWs in the health system are feasible, cost efficient and do not adversely affect other healthcare services delivered by CHWs.
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Affiliation(s)
- Tushar Garg
- Research, Innovators In Health, Patna, Bihar, India
| | | | - Sarang Deo
- Operations Management, Indian School of Business, Hyderabad, Telangana, India
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Smittenaar P, Ramesh BM, Jain M, Blanchard J, Kemp H, Engl E, Isac S, Anthony J, Prakash R, Gothalwal V, Namasivayam V, Kumar P, Sgaier SK. Bringing Greater Precision to Interactions Between Community Health Workers and Households to Improve Maternal and Newborn Health Outcomes in India. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:358-371. [PMID: 33008853 PMCID: PMC7541124 DOI: 10.9745/ghsp-d-20-00027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 07/13/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Community health workers (CHWs) play a key role in the health of mothers and newborns in low- and middle-income countries. However, it remains unclear by what actions and messages CHWs enable good outcomes and respectful care. METHODS We collected a uniquely linked set of questions on behaviors, beliefs, and care pathways from recently delivered women (n=5,469), their husbands (n=3,064), mothers-in-law (n=3,626), and CHWs (accredited social health activists; n=1,052) in Uttar Pradesh, India. We used logistic regression to study associations between CHW actions and household behaviors during antenatal, delivery, and postnatal periods. RESULTS Pregnant women who were visited earlier in pregnancy and who received multiple visits were more likely to perform recommended health behaviors including attending multiple checkups, consuming iron and folic acid tablets, and delivering in a health facility (ID), compared to women visited later or receiving fewer visits, respectively. Counseling the woman was associated with higher likelihood of attending 3+ checkups and consuming 100+ iron and folic acid tablets, whereas counseling the husband and mother-in-law was associated with higher rates of ID. Certain behavior change messages, such as the danger of complications, were associated with more checkups and ID, but were only used by 50%-80% of CHWs. During delivery, 57% of women had the CHW present, and their presence was associated with respectful care, early initiation of breastfeeding, and exclusive breastfeeding, but not with delayed bathing or clean cord care. The newborn was less likely to receive delayed bathing if the CHW incorrectly believed that newborns could be bathed soon after birth (which is believed by 30% of CHWs). CHW presence was associated with health behaviors more strongly for home than facility deliveries. Home visits after delivery were associated with higher rates of clean cord care and exclusive breastfeeding. Counseling the mother-in-law (but not the husband or woman) was associated with exclusive breastfeeding. CONCLUSION We identified potential ways in which CHW impact could be improved, specifically by emphasizing the importance of home visits, which household members are targeted during these visits, and what messages are shared. Achieving this change will require training CHWs in counseling and behavior change and providing supervision and modern tools such as apps that can help the CHW keep track of her beneficiaries, suggest behavior change strategies, and direct attention to households that stand to gain the most from support.
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Affiliation(s)
| | - B M Ramesh
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - James Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | - Shajy Isac
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,India Health Action Trust, Lucknow, Uttar Pradesh, India
| | - John Anthony
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,India Health Action Trust, Lucknow, Uttar Pradesh, India
| | - Ravi Prakash
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,India Health Action Trust, Lucknow, Uttar Pradesh, India
| | - Vikas Gothalwal
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,India Health Action Trust, Lucknow, Uttar Pradesh, India
| | - Vasanthakumar Namasivayam
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Pankaj Kumar
- National Health Mission, Government of Uttar Pradesh, Lucknow, Uttar Pradesh, India
| | - Sema K Sgaier
- Surgo Foundation, Washington, DC, USA. .,Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
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Hill Z, Scheelbeek P, Hamza Y, Amare Y, Schellenberg J. Are We Using the Right Approach to Change Newborn Care Practices in the Community? Qualitative Evidence From Ethiopia and Northern Nigeria. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:383-395. [PMID: 32709596 PMCID: PMC7541120 DOI: 10.9745/ghsp-d-19-00410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 06/12/2020] [Indexed: 11/25/2022]
Abstract
In Ethiopia, high community-level exposure to consistent messages and the perceptions of community health workers and relationships with them drove newborn care behavior change. In Nigeria, exposure to messages was limited, community health workers were less trusted, and behavior change was reported less frequently. Changing behaviors is usually a core component of the role of community health workers (CHWs), but little is known about the mechanisms through which they change behavior. We collected qualitative data from 8 sites in Ethiopia and northern Nigeria where CHWs were active to understand how they change newborn care behaviors. In each country, we conducted 12 narrative interviews and 12–13 in-depth interviews with recent mothers and 4 focus group discussions each with mothers, fathers, grandmothers, and CHWs. We identified 2 key mechanisms of behavior change. The first was linked to the frequency and consistency of hearing messages that led to a perception that change had occurred in community-wide behaviors, collective beliefs, and social expectations. The second was linked to trust in the CHW, obligation, and hierarchy. We found little evidence that constructs that often inform the design of counseling approaches, such as knowledge of causality and perceived risks and benefits, were mechanisms of change.
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Affiliation(s)
| | | | | | - Yared Amare
- Consultancy for Social Development, Addis Ababa, Ethiopia
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Walker C, Burtscher D, Myeni J, Kerschberger B, Schausberger B, Rusch B, Dlamini N, Whitehouse K. "They have been neglected for a long time": a qualitative study on the role and recognition of rural health motivators in the Shiselweni region, Eswatini. HUMAN RESOURCES FOR HEALTH 2020; 18:66. [PMID: 32958066 PMCID: PMC7504860 DOI: 10.1186/s12960-020-00504-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Community health workers (CHWs) are increasingly engaged to address human resource shortages and fill primary healthcare gaps. In Eswatini, a cadre of CHWs called Rural Health Motivators (RHM) was introduced in 1976 to respond to key public health challenges. However, the emergence of health needs, particularly HIV/TB, has been met with inadequate programme amendments, and the role of RHMs has become marginalised following the addition of other CHWs supported by non-governmental organisations. This study was implemented to understand the role of RHMs in decentralised HIV/TB activities. In this paper, we explore the findings in relation to the recognition of RHMs and the programme. METHODS This exploratory qualitative study utilised individual in-depth interviews, group and focus group discussions, participatory methods (utilising a game format) and observations. Participants were purposively selected and comprised RHM programme implementers, community stakeholders and local and non-governmental personnel. Data collection took place between August and September 2019. Interviews were conducted in English or siSwati and transcribed. SiSwati interviews were translated directly into English. All interviews were audio-recorded, manually coded and thematically analysed. Data was validated through methodical triangulation. RESULTS Suboptimal organisational structure and support, primarily insufficient training and supervision for activities were factors identified through interviews and observation activities. Significant confusion of the RHM role was observed, with community expectations beyond formally endorsed tasks. Community participants expressed dissatisfaction with receiving health information only, preferring physical assistance in the form of goods. Additionally, gender emerged as a significant influencing factor on the acceptability of health messages and the engagement of RHMs with community members. Expectations and structurally limiting factors shape the extent to which RHMs are recognised as integral to the health system, at all social and organisational levels. CONCLUSIONS Findings highlight the lack of recognition of RHMs and the programme at both community and national levels. This, along with historical neglect, has hindered the capacity of RHMs to successfully contribute to positive health outcomes for rural communities. Renewed attention and support mechanisms for this cadre are needed. Clarification of the RHM role in line with current health challenges and clearer role parameters is essential.
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Affiliation(s)
| | - Doris Burtscher
- Vienna Evaluation Unit/Anthropology, Médecins Sans Frontières, Vienna, Austria
| | - John Myeni
- Prevention and Promotion Programme, Ministry of Health, Mbabane, Eswatini
| | | | | | | | | | - Katherine Whitehouse
- Luxembourg Operational Research Unit (LuxOr), Médecins Sans Frontières, Brussels, Belgium
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Bhaumik S, Moola S, Tyagi J, Nambiar D, Kakoti M. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health 2020; 5:bmjgh-2020-002769. [PMID: 32522738 PMCID: PMC7292038 DOI: 10.1136/bmjgh-2020-002769] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction Coronavirus disease (COVID-19), affects 213 countries or territories globally. We received a request from National Health Systems Resource Centre, a public agency in India, to conduct rapid evidence synthesis (RES) on community health workers (CHWs) for COVID-19 prevention and control in 3 days. Methods We searched PubMed, websites of ministries (n=3), public agencies (n=6), multilateral institutions (n=3), COVID-19 resource aggregators (n=5) and preprints (n=1) (without language restrictions) for articles on CHWs in pandemics. Two reviewers screened the records independently with a third reviewer resolving disagreements. One reviewer extracted data with another reviewer cross-checking it. A framework on CHW performance in primary healthcare not specific to pandemic was used to guide data extraction and narrative analysis. Results We retrieved 211 records and finally included 36 articles. Most of the evidence was from low-and middle-income countries with well-established CHW programmes. Evidence from CHW programmes initiated during pandemics and for CHW involvement in pandemic response in high-income countries was scant. CHW roles and tasks change substantially during pandemics. Clear guidance, training for changed roles and definition of what constitutes essential activities (ie, those that must to be sustained) is required. Most common additional activities during pandemics were community awareness, engagement and sensitisation (including for countering stigma) and contact tracing. CHWs were reported to be involved in all aspects of contact tracing - this was reported to affect routine service delivery. CHWs have often been stigmatised or been socially ostracised during pandemics. Providing PPE, housing allowance, equal training opportunities, transportation allowance, improving salaries (paid on time and for a broad range of services) and awards in high-profile public events contributed to better recruitment and retention. We also created inventories of resources with guiding notes on guidelines for health workers (n=24), self-isolation in the community (n=10) and information, education and counselling materials on COVID-19 (n=16). Conclusions CHWs play a critical role in pandemics. It is important to ensure role clarity, training, supportive supervision, as well as their work satisfaction, health and well-being. More implementation research on CHWs in pandemics is required.
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Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute for Global Health, Vishakhapatnam, India .,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sandeep Moola
- The George Institute for Global Health, Vishakhapatnam, India
| | - Jyoti Tyagi
- The George Institute for Global Health, Vishakhapatnam, India
| | - Devaki Nambiar
- The George Institute for Global Health, Vishakhapatnam, India.,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Misimi Kakoti
- The George Institute for Global Health, Vishakhapatnam, India
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Majee W, Schopp L, Johnson L, Anakwe A, Rhoda A, Frantz J. Emerging from the Shadows: Intrinsic and Extrinsic Factors Facing Community Health Workers in Western Cape, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3199. [PMID: 32375417 PMCID: PMC7246890 DOI: 10.3390/ijerph17093199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/08/2020] [Accepted: 04/20/2020] [Indexed: 11/24/2022]
Abstract
Community health workers (CHWs) have been identified as a key component of the health workforce in South Africa. However, the efficacy of CHW programs continues to be limited by a poor understanding of facilitators and barriers to CHW engagement. This study explores intrinsic and extrinsic factors that CHWs face. We conducted in-depth interviews with 20 CHWs in order to understand the challenges they may face as they implement their duties linked to the primary health care strategy in the Western Cape, South Africa. All interviews were audiotaped, transcribed verbatim, coded and analyzed using NVivo 12. Drawing on narratives of CHWs, we illustrate the complex issues surrounding CHW outreach in poor rural communities. The CHWs identified five key areas of challenges with respect to personal health, gender issues, poor community understanding of CHWs roles, environmental challenges and lack of patient adherence. These all hinder the ability of CHWs to meet their personal and familial needs, as well as those of the community members they support. There is a need to address the intrinsic needs of CHWs in order to ensure their emotional and physical well-being, as well as a need to create an awareness of the roles of CHWs.
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Affiliation(s)
- Wilson Majee
- Department of Health Sciences and Public Health, University of Missouri, Columbia, MO 65211, USA
- Department of Occupational Therapy, Faculty of Community and Health Science, University of the Western Cape, Western Cape, Bellville 7535, South Africa
| | - Laura Schopp
- Department of Health Psychology, University of Missouri, Columbia, MO 65211, USA;
| | - Levona Johnson
- Department of Physiotherapy, Faculty of Community and Health Science, University of the Western Cape, Western Cape, Bellville 7535, South Africa; (L.J.); (A.R.); (J.F.)
| | - Adaobi Anakwe
- Master of Public Health Program, University of Missouri, Columbia, MO 65211, USA;
| | - Anthea Rhoda
- Department of Physiotherapy, Faculty of Community and Health Science, University of the Western Cape, Western Cape, Bellville 7535, South Africa; (L.J.); (A.R.); (J.F.)
| | - Jose Frantz
- Department of Physiotherapy, Faculty of Community and Health Science, University of the Western Cape, Western Cape, Bellville 7535, South Africa; (L.J.); (A.R.); (J.F.)
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Datiko DG, Bunte EM, Birrie GB, Kea AZ, Steege R, Taegtmeyer M, Kumar MB, Kok MC. Community participation and maternal health service utilization: lessons from the health extension programme in rural southern Ethiopia. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Mohajer N, Singh D. Factors enabling community health workers and volunteers to overcome socio-cultural barriers to behaviour change: meta-synthesis using the concept of social capital. HUMAN RESOURCES FOR HEALTH 2018; 16:63. [PMID: 30463573 PMCID: PMC6249815 DOI: 10.1186/s12960-018-0331-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/06/2018] [Indexed: 05/30/2023]
Abstract
BACKGROUND Community-based health workers and volunteers are not just low-level health workforce; their effectiveness is also due to their unique relationship with the community and is often attributed to social capital, an area not well studied or acknowledged in the literature. METHODS A qualitative meta-synthesis was conducted using the SPIDER framework and based on critical interpretive synthesis. The protocol was registered with PROSPERO, ID = CRD42018084130. This article reports on the qualitative data extracted from the final 33 articles selected from 147 full-text articles on social capital and community-based health systems. RESULTS Three constructs were identified that enable community health workers to bring about changes in behaviour in the community: seeing their role as a service or a calling motivated by altruistic values, accompanying community members on their journey and the aim of the journey being empowerment rather than health. Community health workers feel under-resourced to provide for expectations from the community, to fulfil their non-health needs, to meet the expectations of their employers and to be able to deliver health services. CONCLUSION The dichotomy of needs between the community and health services can be resolved if policy makers and programme designers examine the possibility of two cadres of community-based health workforce: full-time workers and part-time volunteers, with clear scopes of practice and supervision. Community health workers would primarily be concerned with task shifting roles demanded by programmes, and volunteers can focus on the wider empowerment-based needs of communities.
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Affiliation(s)
- Nicole Mohajer
- School of Public Health, College of Health and Medical Sciences, Haramaya University, P.O. BOX 138, 3020, Dire Dawa, Ethiopia.
| | - Debra Singh
- Child and Adolescent Health Service, Health Department, Government of Western Australia, 189 Royal Street, East Perth, WA, 6004, Australia
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Steege R, Taegtmeyer M, McCollum R, Hawkins K, Ormel H, Kok M, Rashid S, Otiso L, Sidat M, Chikaphupha K, Datiko DG, Ahmed R, Tolhurst R, Gomez W, Theobald S. How do gender relations affect the working lives of close to community health service providers? Empirical research, a review and conceptual framework. Soc Sci Med 2018; 209:1-13. [PMID: 29777956 DOI: 10.1016/j.socscimed.2018.05.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/26/2018] [Accepted: 05/02/2018] [Indexed: 11/18/2022]
Abstract
Close-to-community (CTC) providers have been identified as a key cadre to progress universal health coverage and address inequities in health service provision due to their embedded position within communities. CTC providers both work within, and are subject to, the gender norms at community level but may also have the potential to alter them. This paper synthesises current evidence on gender and CTC providers and the services they deliver. This study uses a two-stage exploratory approach drawing upon qualitative research from the six countries (Bangladesh, Indonesia, Ethiopia, Kenya, Malawi, Mozambique) that were part of the REACHOUT consortium. This research took place from 2013 to 2014. This was followed by systematic review that took place from January-September 2017, using critical interpretive synthesis methodology. This review included 58 papers from the literature. The resulting findings from both stages informed the development of a conceptual framework. We present the holistic conceptual framework to show how gender roles and relations shape CTC provider experience at the individual, community, and health system levels. The evidence presented highlights the importance of safety and mobility at the community level. At the individual level, influence of family and intra-household dynamics are of importance. Important at the health systems level, are career progression and remuneration. We present suggestions for how the role of a CTC provider can, with the right support, be an empowering experience. Key priorities for policymakers to promote gender equity in this cadre include: safety and well-being, remuneration, and career progression opportunities. Gender roles and relations shape CTC provider experiences across multiple levels of the health system. To strengthen the equity and efficiency of CTC programmes gender dynamics should be considered by policymakers and implementers during both the conceptualisation and implementation of CTC programmes.
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Affiliation(s)
- Rosalind Steege
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK.
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK
| | - Rosalind McCollum
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK
| | - Kate Hawkins
- Pamoja Communications, UK Bishopstone, 36 Crescent Road, Worthing BN11 1RL, UK
| | - Hermen Ormel
- Royal Tropical Institute, KIT Health, P.O. Box 95001, 1090 HA, Amsterdam, The Netherlands
| | - Maryse Kok
- Royal Tropical Institute, KIT Health, P.O. Box 95001, 1090 HA, Amsterdam, The Netherlands
| | - Sabina Rashid
- James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Lilian Otiso
- LVCT Health, Research and Strategic Information Department, P.O Box 19835- 00202, Nairobi, Kenya
| | - Mohsin Sidat
- University Eduardo Mondlane, Department of Community Health, P.O. Box 257, Maputo, Mozambique
| | - Kingsley Chikaphupha
- Research for Equity and Community Health (REACH) Trust, P.O. Box 1597, Lilongwe, Malawi
| | | | - Rukhsana Ahmed
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK; Eijkman Institute for Molecular Biology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia, Jalan Diponegoro 69, Jakarta, 10430, Indonesia
| | - Rachel Tolhurst
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK
| | - Woedem Gomez
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK
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