Village health workers as health diplomats: negotiating health and study participation in a malaria elimination trial in The Gambia

Background Although many success stories exist of Village Health Workers (VHWs) improving primary health care, critiques remain about the medicalisation of their roles in disease-specific interventions. VHWs are placed at the bottom of the health system hierarchy as cheap and low-skilled volunteers, irrespective of their highly valued social and political status within communities. In this paper, we shed light on the political role VHWs play and investigate how this shapes their social and medical roles, including their influence on community participation. Method The study was carried out within the context of a malaria elimination trial implemented in rural villages in the North Bank of The Gambia between 2016 and 2018. The trial aimed to reduce malaria prevalence by treating malaria index cases and their potentially asymptomatic compound members, in which VHWs took an active role advocating their community and the intervention, mobilising the population, and distributing antimalarial drugs. Mixed-methods research was used to collect and analyse data through qualitative interviews, group discussions, observations, and quantitative surveys. Results and discussion We explored the emic logic of participation in a malaria elimination trial and found that VHWs played a pivotal role in representing their community and negotiating with the Medical Research Council to bring benefits (e.g. biomedical care service) to the community. We highlight this representative role of VHWs as ‘health diplomats’, valued and appreciated by community members, and potentially increasing community participation in the trial. We argue that VHWs aspire to be politically present and be part of the key decision-makers in the community through their health diplomat role. Conclusion It is thus likely that in the context of rural Gambia, supporting VHWs beyond medical roles, in their social and political roles, would contribute to the improved performance of VHWs and to enhanced community participation in activities the community perceive as beneficial.

Pengaruh Aplikasi PPA Kader terhadap Pengetahuan Kader tentang Deteksi Dini Stunting

Stunting is a growth disorder due to a lack of nutritional intake for a long time. Data from the World Health Organization (WHO), the prevalence of stunting in Indonesia is the third highest in Southeast Asia. The PPA Kader application is one solution in helping to overcome the stunting problem because cadres can get information on nutritional status assessments so fast and can detect stunting early. PPA Kader application for monitoring the growth is an android-based application based on the Z-Score value (BB/U, TB/U, BMI/U, and BB/TB), an imaginative and provocative medium for health education. To find out the effect of the PPA Kader application on the knowledge of village health workers about early stunting detection. This research was using pre-experimental research in one group pre-test post-test design. The research sample is 35 respondents taken from the village health worker population at the Integrated Services Post (Posyandu) in the area of the Public Health Center (Puskesmas) in Balik Bukit District with purposive sampling technique. This research was conducted from March to April. The intervention in this study was carried out using the PPA Kader application in which there was an educational explanation video about stunting. The data in this study were obtained through questionnaires that have been prepared for the pre-test and post-test to find out the knowledge of village health workers about early detection of stunting. Statistical test knowledge in this study is using Wilcoxon test. PPA Kader application can increase knowledge (p=0.000) of village health workers about early detection of stunting. The PPA Kader application affects the knowledge level of village health workers in the target area of the Balik Bukit District Health Center.

Penerapan Manajemen Terpadu Balita Sakit (MTBS) Pada Kader Posyandu Dan Masyarakat

ABSTRAK Salah satu langkah dalam pencapaian target Millenium Development Goals/MDG’s (goal ke-4) adalah menurunkan kematian anak menjadi 2/3 bagian dari tahun 1990 sampai pada 2020. Dalam mencapai target tersebut, pemerintah salah satunya menerapkan Majemen Terpadu Balita Sakit (MTBS) yaitu merupakan pendekatan keterpaduan dalam tatalaksana balita sakit yang datang berobat ke fasilitas rawat jalan. Saat ini banyak tenaga kesehatan, kader dan masyarakat yang tidak mengetahui secara menyeluruh tentang penerapan MTBS. Tujuan kegiatan pengabdian dilakukan untuk meningkatkan pengetahuan kader dalam menerapkan MTBS. Metode pelaksanaan adalah dengan pemberdayaan kader dalam penerapan MTBS sehingga dapar dilakukan upara preventif dan kuratif pada balita sakit. Hasil kegiatan menunjukkan kegiatan diikuti oleh 100% sasaran kegiatan dan peserta mampu mengikuti kegiatan sampai akhir. Kata Kunci : Manajemen Terpadu Balita Sakit, Diare, Oralit, Kader Posyandu ABSTRACT One of the steps in achieving the Millennium Development Goals / MDG's target (goal 4) is to reduce child mortality to 2/3 parts from 1990 to 2020. In achieving this target, the government is one of them implementing the Integrated Management of Sick Toddlers (MTBS), which is an integrated approach in management. sick toddlers who come for treatment at outpatient facilities. Currently, many village health workers and the community do not know thoroughly about the implementation of MTBS. The purpose of this service activity is to increase the knowledge of village health workers in implementing MTBS. The method of implementation is by empowering village health workers in the implementation of MTBS so that preventive and curative measures can be carried out for sick toddlers. The results of the activity showed that the activity was followed by 100% of the target of the activity and the participants were able to follow the activity until the end. Keywords: Integrated Management of Sick Toddlers, Diarrhea, ORS, village health worker

TRAINING NEEDS ON HEALTH COMMUNICATION AND EDUCATION ABOUT DIABETES AMONG VILLAGE HEALTH WORKERS IN VU THU DISTRICT, THAI BINH PROVINCE IN 2020

Objective: Identify training needs on health communication and education about diabetes among village health workers in Vu Thu district, Thai Binh province in 2020.Subjects: Village Health Worker and Head of Commune Health Station in the communes of Vu Thu district, Thai Binh province.Method: the epidemiological method described through the cross-sectional investigation, combine quantitative research and qualitative research.Results: 70.2% of village health workers had participated in training courses on communication skills - health education; The highest proportion of respondents saying that the training period was enough (76.8%), 95.6% of the respondents think that the content of each training course was appropriate for them, and 62.3% evaluated organizational form of the training class to attract students; 50.4% ofvillage health workers needed to be trained in health communication skills, 49.5% of village health workers needed to be trained in health counseling skills, 26.2% hoped to train communication skillsthrough loudspeakers, radio; The most difficulty of village health workers when participating in training / training was due to a matter of time (41.1%).

THE PRACTICE OF HEALTH COMMUNICATION AND EDUCATION ABOUT DIABETES AMONG VILLAGE HEALTH WORKERS IN VU THU DISTRICT, THAI BINH PROVINCE IN 2020

Objective: Describe the practice of health communication and education about diabetes among village health workers in Vu Thu district, Thai Binh province in 2020. Subjects: Village Health Worker and Head of Commune Health Station in the communes of Vu Thu district, Thai Binh province. Method: the epidemiological method described through the cross-sectional investigation, combine quantitative research and qualitative research. Results: 69.5% of village health workers had carried out communication and health education for villagers about diabetes in the past year; Over 80% of village health workers had a plan and over 60% cooperate in communicating and educating about diabetes about diabetes; 15/15 opinion of the head of the station said that the communication and education about diabetes in the commune was small, not continuous, mainly indirect communication; 13/15 comments that the biggest difficulty in health communication and education was that the village health workers were still limited in knowledge and skills.

Chronic Disease in the Community (CDCom) Program: Hypertension and non-communicable disease care by village health workers in rural Uganda

Background Although hypertension, the largest modifiable risk factor in the global burden of disease, is prevalent in sub-Saharan Africa, rates of awareness and control are low. Since 2011 village health workers (VHWs) in Kisoro district, Uganda have been providing non-communicable disease (NCD) care as part of the Chronic Disease in the Community (CDCom) Program. The VHWs screen for hypertension and other NCDs as part of a door-to-door biannual health census, and, under the supervision of health professionals from the local district hospital, also serve as the primary providers at monthly village-based NCD clinics. Objective/Methods We describe the operation of CDCom, a 10-year comprehensive program employing VHWs to screen and manage hypertension and other NCDs at a community level. Using program records we also report hypertension prevalence in the community, program costs, and results of a cost-saving strategy to address frequent medication stockouts. Results/Conclusions Of 4283 people ages 30–69 screened for hypertension, 22% had a blood pressure (BP) ≥140/90 and 5% had a BP ≥ 160/100. All 163 people with SBP ≥170 during door-to-door screening were referred for evaluation in CDCom, of which 91 (59%) had repeated BP ≥170 and were enrolled in treatment. Of 761 patients enrolled in CDCom, 413 patients are being treated for hypertension and 68% of these had their most recent blood pressure below the treatment target. We find: 1) The difference in hypertension prevalence between this rural, agricultural population and national rates mirrors a rural-urban divide in many countries in sub-Saharan Africa. 2) VHWs are able to not only screen patients for hypertension, but also to manage their disease in monthly village-based clinics. 3) Mid-level providers at a local district hospital NCD clinic and faculty from an academic center provide institutional support to VHWs, stream-line referrals for complicated patients and facilitate provider education at all levels of care. 4) Selective stepdown of medication doses for patients with controlled hypertension is a safe, cost-saving strategy that partially addresses frequent stockouts of government-supplied medications and patient inability to pay. 5) CDCom, free for village members, operates at a modest cost of 0.20 USD per villager per year. We expect that our data-informed analysis of the program will benefit other groups attempting to decentralize chronic disease care in rural communities of low-income regions worldwide.

A Cross-Sectional Survey Analyzing Community Perception and Utilization of Village Health Workers Stratified by the Urban-Rural Divide Within the Kingdom of Bhutan

Village health workers (VHWs) serve as an integral health resource for many resource limited nations, including the Kingdom of Bhutan. As such, we aimed to identify community perceptions as well as utilization rates and types with relation to VHWs based on the urban-rural divide. Our team conducted a randomized survey of 429 community members in 14 villages within the Western region of Bhutan. Our findings indicate VHWs in rural communities are requested for their services twice as much as their urban counterparts. More specifically, urban VHWs are utilized 2.5 times more for general community services, while rural VHWs are utilized more for accessing medications. Additionally, our research indicates a need to increase training of VHWs as well as overall program promotion relating to the specific services that VHWs can provide. These investigations indicate the importance of differentially allocating resources, programming, and training based on the urban-rural divide.