Technology and rehabilitation training for community health workers: Strengthening health systems in Malawi

2020 ◽  
Vol 28 (3) ◽  
pp. 833-841
Author(s):  
Ellen Wilson ◽  
Lydia Lee ◽  
Rachel Klas ◽  
Kathryn C. Nesbit
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Systems ◽  
Health Workers ◽  
Rehabilitation Training

Level of Integration of Community Health Workers in Missouri Health Systems

2016 ◽  
Vol 42 (3) ◽  
pp. 598-604 ◽  
Author(s):  
Darson Rhodes ◽  
Joseph Visker ◽  
Carol Cox ◽  
J. Christian Banez ◽  
Anna Wang
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Systems ◽  
Health Workers

scholarly journals Delivering comprehensive HIV services across the HIV care continuum: a comparative analysis of survival and progress towards 90-90-90 in rural Malawi

2018 ◽  
Vol 3 (1) ◽  
pp. e000552 ◽  
Author(s):  
Emily B Wroe ◽  
Elizabeth L Dunbar ◽  
Noel Kalanga ◽  
Luckson Dullie ◽  
Chiyembekezo Kachimanga ◽  
...  
Keyword(s):  
Community Health ◽  
Social Determinants Of Health ◽  
Community Health Workers ◽  
Health Systems ◽  
Social Determinants ◽  
Health Workers ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Facility Level

IntroductionPartners In Health and the Malawi Ministry of Health collaborate on comprehensive HIV services in Neno, Malawi, featuring community health workers, interventions addressing social determinants of health and health systems strengthening. We conducted an observational study to describe the HIV care continuum in Neno and to compare facility-level HIV outcomes against health facilities nationally.MethodsWe compared facility-level outcomes in Neno (n=13) with all other districts (n=682) from 2013 to 2015 using mixed-effects linear regression modelling. We selected four outcomes that are practically useful and roughly mapped on to the 90-90-90 targets: facility-based HIV screenings relative to population, new antiretroviral therapy (ART)enrolments relative to population, 1-year survival rates and per cent retained in care at 1 year.ResultsIn 2013, the average number of HIV tests performed, as a per cent of the adult population, was 11.75%, while the average newly enrolled patients was 10.03%. Percent receiving testing increased by 4.23% over 3 years (P<0.001, 95% CI 2.98% to 5.49%), while percent enrolled did not change (P=0.28). These results did not differ between Neno and other districts (P=0.52), despite Neno having a higher proportion of expected patients enrolled. In 2013, the average ART 1-year survival was 80.41% nationally and 91.51% in Neno, which is 11.10% higher (P=0.002, 95% CI 4.13% to 18.07%). One-year survival declined by 1.75% from 2013 to 2015 (P<0.001, 95% CI −2.61% to −0.89%); this was similar in Neno (P=0.83). Facility-level 1-year retention was 85.43% nationally in 2013 (P<0.001, 95% CI 84.2% to 86.62%) and 12.07% higher at 97.50% in Neno (P=0.001, 95% CI 5.08% to19.05%). Retention declined by 2.92% (P<0.001, 95% CI −3.69% to −2.14%) between 2013 and 2015, both nationally and in Neno.ConclusionThe Neno HIV programme demonstrated significantly higher survival and retention rates compared with all other districts in Malawi. Incorporating community health workers, strengthening health systems and addressing social determinants of health within the HIV programme may help Malawi and other countries accelerate progress towards 90-90-90.

scholarly journals Community health workers for pandemic response: a rapid evidence synthesis

2020 ◽  
Author(s):  
S Bhaumik ◽  
S Moola ◽  
J Tyagi ◽  
D Nambiar ◽  
M Kakoti
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Systems ◽  
Primary Healthcare ◽  
Child Support ◽  
Health Workers ◽  
Psychosocial Support ◽  
Evidence Synthesis ◽  
List Type ◽  
New Findings

AbstractIntroductionCoronavirus disease (COVID-19), a respiratory illness, first discovered in China in December 2019 has now spread to 213 countries or territories affecting millions across the globe. We received a request from National Health Systems Resource Centre, a public agency in India, for a Rapid Evidence Synthesis (RES) on community health workers (CHWs) for COVID-19 prevention and control.MethodsWe searched PubMed, websites of ministries, public agencies, multilateral institutions, COVID-19 resource aggregators and pre-prints (without language restrictions) for articles on the role, challenges and enablers for CHWs in pandemics. Two reviewers screened the records independently with a third reviewer resolving disagreements. One reviewer extracted data in a consensus data extraction form 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.ResultsWe retrieved 211 records and finally included 36 articles on the role, challenges and enablers for CHWs in pandemics. We found that CHWs play an important role in building awareness, countering stigma and maintaining essential primary healthcare service delivery. It is essential that CHWs are provided adequate Personal Protective Equipment (PPE) and appropriately trained in its usage in the early stages of the pandemic. Wide range of policies and guidance is required to ensure health systems functioning. A clear guidance for prioritizing essential activities, postponing non-essential ones and additional pandemic related activities is crucial. CHWs experience stigmatization, isolation and social exclusion. Psychosocial support, non-performance-based incentives, additional transport allowance, accommodation, child-support, awards and recognition programs have been used in previous pandemics.We also created inventories of resources with guiding notes for quick utility by decision makers 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).ConclusionsCHWs play a critical role in pandemics like COVID-19. It is important to ensure role clarity, training, supportive supervision, as well as their work satisfaction, health and well-being. There is a need for more implementation research on CHWs in pandemics like COVID-19.Summary BoxWhat is already known?COVID-19 is a pandemic which has now strained health systems across the world. Community health workers (CHWs) are being deployed in many countries for COVID-19 prevention and control. However, there is no evidence synthesis on the issue.What are the new findings?CHWs can play an important role in creating awareness, countering stigma, and maintaining essential primary healthcare delivery.Adequate provisions for personal protective equipment are essential for CHWsGovernments should provide a clear guidance to CHWs for prioritizing essential activities, postponing non-essential ones and for additional pandemic related activities, while also ensuring their health and safetyCHWs experienced stigmatization, isolation and were socially ostracized in previous pandemics. Psychosocial support, non-performance-based incentives, additional transport allowance, accommodation, child-support, awards and recognition programs have been used as enablers.What do the new findings imply?Roles of CHWs in a pandemic context must be clear. Apart from clear guidance adequate training and support should be provided. requiring adequate training and guidance is useful. Contact listing and identification should be done by separate trained cadre.Countries without pre-existing CHWs program must consider applicability of available evidence before investing in ambitious new CHW programs.There is a need for more implementation research on CHWs in pandemics like COVID-19.

Global health's durable dreams: ethnography, ‘community health workers’ and health without health infrastructure

Africa ◽  
2020 ◽  
Vol 90 (1) ◽  
pp. 95-111
Author(s):  
Ramah McKay
Keyword(s):  
Public Health ◽  
Global Health ◽  
Community Health ◽  
Community Health Workers ◽  
Health Systems ◽  
Social Relations ◽  
Health Workers ◽  
Health Coverage ◽  
Global Health Policy ◽  
Public Health Officials

AbstractTracing the persistence of community health workers (CHWs) as a key category in both global health policy and anthropological representation, this article asks how enduring scholarly investments in CHWs can reveal changing political stakes for both health work and ethnographic research. Amid renewed calls for a focus on health systems and universal health coverage, the article suggests that the durability of attention to CHWs is instructive. It simultaneously points to the imbrication of health with political and social relations and clinical and technological infrastructures as well as to how ethnographic investments in health systems can sometimes obscure the ambivalent politics of health. Drawing on fieldwork with CHWs, NGO staff and public health officials, and on public health literature on CHWs, it argues for greater attention to the political ambivalence of health labour. It suggests that the experiences of health workers themselves can serve as analytical examples in this regard, pointing to analyses that begin not with normative notions of health systems or the conceptual boundaries of global health ‘projects’ but with a focus on the contested relations through which health labour is realized over time. Such attention can also indicate possibilities for health beyond dreams of projects, clinics or health systems.

scholarly journals Performance of community health workers: situating their intermediary position within complex adaptive health systems

2017 ◽  
Vol 15 (1) ◽  
Author(s):  
Maryse C. Kok ◽  
Jacqueline E. W. Broerse ◽  
Sally Theobald ◽  
Hermen Ormel ◽  
Marjolein Dieleman ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Systems ◽  
Health Workers ◽  
Complex Adaptive

scholarly journals Community Health Workers Can Provide Psychosocial Support to the People During COVID-19 and Beyond in Low- and Middle- Income Countries

2021 ◽  
Vol 9 ◽  
Author(s):  
Sabuj Kanti Mistry ◽  
Ben Harris-Roxas ◽  
Uday Narayan Yadav ◽  
Sadia Shabnam ◽  
Lal Bahadur Rawal ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Services ◽  
Community Health ◽  
Community Health Workers ◽  
Health Systems ◽  
Health Workers ◽  
Psychosocial Support ◽  
Middle Income ◽  
Middle Income Countries ◽  
The People

The COVID-19 pandemic has been the most challenging public health issue which not only affected the physical health of the global population but also aggravated the mental health conditions such as stress, anxiety, fear, depression and anger. While mental health services are seriously hampered amid this COVID-19 pandemic, health services, particularly those of Low- and Middle- Income Countries (LMICs) are looking for alternatives to provide psychosocial support to the people amid this COVID-19 and beyond. Community Health Workers (CHWs) are an integral part of the health systems in many LMICs and played significant roles such as health education, contact tracing, isolation and mobilization during past emergencies and amid COVID-19 in many LMICs. However, despite their potentials in providing psychosocial support to the people amid this COVID-19 pandemic, they have been underutilized in most health systems in LMICs. The CHWs can be effectively engaged to provide psychosocial support at the community level. Engaging them can also be cost-saving as they are already in place and may cost less compared to other health professionals. However, they need training and supervision and their safety and security needs to be protected during this COVID-19. While many LMICs have mental health policies but their enactment is limited due to the fragility of health systems and limited health care resources. CHWs can contribute in this regard and help to address the psychosocial vulnerabilities of affected population in LMICs during COVID-19 and beyond.

scholarly journals Community Health Workers as Influential Health System Actors and not "Just Another Pair Of Hands"

2020 ◽  
Author(s):  
Sumit Kane ◽  
Anjali Radkar ◽  
Mukta Gadgil ◽  
Barbara McPake
Keyword(s):  
Health System ◽  
Community Health ◽  
Community Health Workers ◽  
Health Systems ◽  
Work Experience ◽  
Health Workers ◽  
Human Resources For Health ◽  
Research Question ◽  
Large Body ◽  
Optimal Strategies

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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