Antenatal depression case finding by community health workers in South Africa: feasibility of a mobile phone application

Abstract Background Tuberculosis is a top-10 cause of under-5 mortality, despite policies promoting tuberculosis preventive therapy (TPT). We previously conducted a cluster randomized trial to evaluate the effectiveness of symptom-based versus tuberculin skin-based screening on child TPT uptake. Symptom-based screening did not improve TPT uptake and nearly two-thirds of child contacts were not identified or not linked to care. Here we qualitatively explored healthcare provider perceptions of factors that impacted TPT uptake among child contacts. Methods Sixteen in-depth interviews were conducted with key informants including healthcare providers and administrators who participated in the trial in Matlosana, South Africa. The participants’ experience with symptom-based screening, study implementation strategies, and ongoing challenges with child contact identification and linkage to care were explored. Interviews were systematically coded and thematic content analysis was conducted. Results Participants’ had mixed opinions about symptom-based screening and high acceptability of the study implementation strategies. A key barrier to optimizing child contact screening and evaluation was the supervision and training of community health workers. Conclusions Symptom screening is a simple and effective strategy to evaluate child contacts, but additional pediatric training is needed to provide comfort with decision making. New clinic-based child contact files were highly valued by providers who continued to use them after trial completion. Future interventions to improve child contact management will need to address how to best utilize community health workers in identifying and linking child contacts to care. Trial registration The results presented here were from research related to NCT03074799, retrospectively registered on 9 March 2017.

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Fidelity of HIV programme implementation by community health workers in rural Mopani district, South Africa: a community survey

BMC Public Health ◽

10.1186/s12889-018-5927-2 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Nireshni Naidoo ◽

Jean P. Railton ◽

Sellina N. Khosa ◽

Nthabiseng Matlakala ◽

Gert Marincowitz ◽

...

Keyword(s):

South Africa ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Community Survey ◽

Programme Implementation

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Compensation Models for Community Health Workers: Comparison of Legal Frameworks across Five Countries

10.21203/rs.3.rs-36222/v1 ◽

2020 ◽

Author(s):

Madeleine Ballard ◽

Carey Westgate ◽

Rebecca Alban ◽

Nandini Choudhury ◽

Rehan Adamjee ◽

...

Keyword(s):

South Africa ◽

Public Sector ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Legal Framework ◽

Law Firms ◽

Advantages And Disadvantages ◽

Compensation Mechanisms ◽

Legal Frameworks

Abstract Background Despite the life-saving work they perform, community health workers (CHWs) have long been subject to global debate about their remuneration. There is now, however, an emerging consensus that CHWs should be paid. As the discussion evolves from whether to financially remunerate CHWs to how to do so, there is an urgent need to better understand the types of CHW payment models and their implications. Methods This study examines the legal framework on CHW compensation in five countries: Brazil, Ghana, Nigeria, Rwanda, and South Africa. In order to map the characteristics of each approach, a standardized questionnaire was developed and targeted at local law firms. The questionnaire covered legal structures and requirements for compensation of CHWs, CHW compensation mechanisms, CHW legal protections and benefits, and alignment of national CHW policies with global guidelines. Results The five countries profiled represent possible archetypes for CHW compensation: Brazil (public), Ghana (volunteer-based), Nigeria (private), Rwanda (cooperatives with performance based incentives) and South Africa (hybrid public/private). Advantages and disadvantages of each model with respect to (i) CHWs, in terms of financial protection, and (ii) the public sector, in terms of ease of implementation, are outlined. Conclusions While a strong legal framework does not necessarily translate into high-quality implementation, it is the first necessary step. While certain approaches to CHW compensation - particularly public-sector or hybrid models with public sector wage floors - best institutionalize recommended CHW protections, political will and long-term financing often remain obstacles. Removing ecosystem barriers - such as multilateral and bilateral restrictions on the payment of salaries - can help governments institutionalize CHW payment.

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A Randomized Control Trial to Test Effect of Cash Incentives and Training on Active Casefinding for Tuberculosis among Community Health Workers in Nigeria

F1000Research ◽

10.12688/f1000research.53822.1 ◽

2021 ◽

Vol 10 ◽

pp. 1154

Author(s):

Christie Akwaowo ◽

Victor Umoh ◽

Idongesit Umoh ◽

Eno Usoroh ◽

Olugbemi Motilewa ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Case Finding ◽

P Value ◽

Case Detection ◽

High Burden ◽

Cash Incentives ◽

Case Notification ◽

And Training

Background: Case detection for Tuberculosis remains low in high burden communities. Community Health Workers (CHWs) are the first point of contact for many Nigerians in the rural areas and have been found useful in active case finding. This study assessed the effect of cash incentives and training on tuberculosis case detection by CHWs in six Local Government Areas in Nigeria. Materials and Methods: A randomised control trial was conducted in three PHC clusters. The intervention Arm (A) received cash incentives for every presumptive case referred. The Training Arm(B) had no cash incentives and the control had neither training nor cash incentives. Case notification rates from the TB program were used to assess the effect of cash incentives on TB case finding. Data was analyzed using Graph Pad Prism. Descriptive data was presented in tables and bivariate data was analyzed using chi square. Mean increases in case notification rates was calculated Statistical significance was set as P=0.05. Results: The intervention identified 394 presumptive TB cases, contributing 30.3% of all presumptive cases notified in the LGAs. Findings also showed an increase of 14.4% (ꭓ2=2.976, P value=0.2258) in case notification rates for the Arm A that received cash incentives alongside training, there was also an increase of 7.4% (ꭓ2= 1.999, P value=0.1575) in Arm B that received Training only. Secondary outcomes indicated a 144.8%(ꭓ2= 4.147, P value=0.1258) increase in community outreaches conducted in the Arm that were given cash incentives. Conclusion: The study demonstrated an increase in TB control activities of case notification and outreaches among community health workers that received cash incentives and training. These findings support the use training and cash incentives for CHWs in high burden TB settings to improve TB case detection rates.

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Perceived mHealth barriers and benefits for home-based HIV testing and counseling and other care: Qualitative findings from health officials, community health workers, and persons living with HIV in South Africa

Social Science & Medicine ◽

10.1016/j.socscimed.2017.04.046 ◽

2017 ◽

Vol 183 ◽

pp. 97-105 ◽

Cited By ~ 17

Author(s):

Alastair van Heerden ◽

Danielle M. Harris ◽

Heidi van Rooyen ◽

Ruanne V. Barnabas ◽

Nithya Ramanathan ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Hiv Testing And Counseling ◽

Home Based ◽

Persons Living With Hiv ◽

Living With Hiv ◽

Testing And Counseling

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“Through their eyes, I can work” – rural physicians' perceptions about mobile phone use among community health workers – a qualitative analysis

Health Education ◽

10.1108/he-12-2020-0123 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Manjula Venkataraghavan ◽

Padma Rani ◽

Lena Ashok ◽

Chythra R. Rao ◽

Varalakshmi Chandra Sekaran ◽

...

Keyword(s):

Mobile Phone ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Primary Care Providers ◽

Stakeholder Group ◽

Care Providers ◽

Content Type ◽

Mobile Phone Use ◽

Rural Physicians

PurposePhysicians who are primary care providers in rural communities form an essential stakeholder group in rural mobile health (mHealth) delivery. This study was exploratory in nature and was conducted in Udupi district of Karnataka, India. The purpose of this study is to examine the perceptions of rural medical officers (MOs) (rural physicians) regarding the benefits and challenges of mobile phone use by community health workers (CHWs).Design/methodology/approachIn-depth interviews were conducted among 15 MOs belonging to different primary health centers of the district. Only MOs with a minimum five years of experience were recruited in the study using purposive and snowball sampling. This was followed by thematic analysis of the data collected.FindingsThe perceptions of MOs regarding the CHWs' use of mobile phones were largely positive. However, they reported the existence of some challenges that limits the potential of its full use. The findings were categorized under four themes namely, benefits of mobile phone use to CHWs, benefits of mobile phone-equipped CHWs, current mobile phone use by CHWs and barriers to CHWs' mobile phone use. The significant barriers reported in the CHWs' mobile phone use were poor mobile network coverage, technical illiteracy, lack of consistent technical training and call and data expense of the CHWs. The participants recommend an increased number of mobile towers, frequent training in mobile phone use and basic English language for the CHWs as possible solutions to the barriers.Originality/valueStudies examining the perceptions of doctors who are a primary stakeholder group in mHealth as well as in the public health system scenario are limited. To the authors’ knowledge, this is one of the first studies to examine the perception of rural doctors regarding CHWs' mobile phone use for work in India.

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