Does the availability of free home pregnancy tests affect who seeks reproductive health services from community health workers? Evidence from a randomized experiment in Madagascar

Abstract Background Despite the global agreements on adolescents’ sexual and reproductive health and rights, access to and utilisation of these services among the youth/adolescents remain unsatisfactory in low- and middle-income countries which are a significant barrier to progress in this area. This review established factors influencing access and utilisation of youth-friendly sexual and reproductive health services (YFSRHS) among the youth in sub-Saharan Africa to inform programmatic interventions. Methodology A systematic review of studies published between January 2009 and April 2019 using PubMed, Web of Science, EMBASE, Medline, and Cochrane Library, and Google Scholar databases was conducted. Studies were screened based on the inclusion criteria of barriers and facilitators of implementation of YFSRHS, existing national policies on provision of YFSRHS, and youth’s perspectives on these services. Findings A total of 23,400 studies were identified through database search and additional 5 studies from other sources. After the full-text screening, 20 studies from 7 countries met the inclusion criteria and were included in the final review. Structural barriers were the negative attitude of health workers and their being unskilled and individual barriers included lack of knowledge among youth regarding YFSRHS. Facilitators of utilisation of the services were mostly structural in nature which included community outreaches, health education, and policy recommendations to improve implementation of the quality of health services and clinics for adolescents/youth to fit their needs and preferences. Conclusion Stakeholder interventions focusing on implementing YFSRHS should aim at intensive training of health workers and put in place quality implementation standard guidelines in clinics to offer services according to youth’s needs and preferences. In addition, educating the youth through community outreaches and health education programs for those in schools can facilitate utilisation and scale up of the service.

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Design of Mobile Application for Community Health Workers: A Case Study in Rwanda

International Journal of Interactive Mobile Technologies (iJIM) ◽

10.3991/ijim.v14i11.13307 ◽

2020 ◽

Vol 14 (11) ◽

pp. 271

Author(s):

Gahizi Emmanuel ◽

Andi Wahju Rahardjo Emanuel ◽

Djoko Budiyanto Setyohadi

Keyword(s):

Public Health ◽

Health Services ◽

Community Health ◽

Community Health Workers ◽

Human Service ◽

Mobile Application ◽

Health Workers ◽

User Centered Design ◽

Public Health Services ◽

Adequate Knowledge

Community health workers (CHWs) are the basis of public health services that aim to connect the gap between public health and the human service system. This gap can be completely bridged by navigating the health and human service systems and educating communities on disease prevention. Unfortunately, the way of sharing, accessing information, and delivering health services is still non-digitalized in Rwanda. Community Health workers use a manual system in their daily activities, which is prone to error and falsification. Moreover, these people selected to perform these activities often do not have adequate knowledge about diseases and health systems since they are not professional health workers. To address the above problem, we designed a prototype mobile application to enable these workers to automatically submit reports, transfer knowledge, share information, and receive training from professionals. The design process followed a User-Centered Design approach to meet the users’ requirements. The evaluation of the design showed that 91.7% of the CHWs agreed with the designed application prototype. This finding shows that CHWs has an interest in using the mobile application in their work. Using the mobile application will help CHWs to improve data collection, the reporting process, and ease of receiving training.

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Do home pregnancy tests bring women to community health workers for antenatal care counselling? A randomized controlled trial in Madagascar

Health Policy and Planning ◽

10.1093/heapol/czz080 ◽

2019 ◽

Vol 34 (8) ◽

pp. 566-573

Author(s):

Alison B Comfort ◽

Randall C Juras ◽

Sarah E K Bradley ◽

Justin Ranjalahy Rasolofomanana ◽

Anja Noeliarivelo Ranjalahy ◽

...

Keyword(s):

At Risk ◽

Randomized Controlled Trial ◽

Reproductive Health ◽

Health Services ◽

Antenatal Care ◽

Health Workers ◽

Controlled Trial ◽

Control Group ◽

Reproductive Health Services ◽

Randomized Controlled

Abstract Task-shifting the provision of pregnancy tests to community health workers (CHWs) in low-resource settings has the potential to reach significantly more underserved women at risk of pregnancy with essential reproductive health services. This study assessed whether an intervention to supply CHWs with home pregnancy tests brought more clients for antenatal care (ANC) counselling. We implemented a randomized controlled trial among CHWs providing reproductive health services to women in Eastern Madagascar. We used ordinary least squares regressions to estimate the effect of the intervention, with district- and month-fixed effects and CHW baseline characteristics as control variables. Our outcomes of interest included whether the intervention increased: (1) the number of women at risk of pregnancy who sought services from CHWs; (2) the number of these women who knew they were pregnant by the end of visit; and (3) the number of these women who received ANC counselling during visit. We found that providing pregnancy tests to CHWs to distribute to their clients for free significantly increased the number of women at risk of pregnancy who sought services from CHWs. At follow-up, treatment-group CHWs provided services to 6.3 clients compared with 4.2 clients among control-group CHWs, which represents a 50% relative increase from the control-group mean. A significantly higher number of these clients knew they were pregnant by the end of the visit, with a mean of 0.95 in treatment compared with 0.10 in control (Coeff. 0.86; 95% CI 0.59–1.13). A significantly higher number of these clients received antenatal counselling at the visit (Coeff. 0.4; 95% CI 0.14–0.64). Introducing free home pregnancy tests as part of community-based health services can improve pregnancy care by attracting more clients at risk of pregnancy to services at the community level, enabling more women to confirm they are pregnant and receive antenatal counselling.

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Evaluation of the effectiveness of community health workers in the fight against malaria in the Central African Republic (2012–2017)

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/trz104 ◽

2019 ◽

Vol 114 (3) ◽

pp. 173-184

Author(s):

Djerandouba Yotobumbeti Ferdinand ◽

Bessimbaye Nadlaou ◽

Nzalapan Samuel ◽

Bekaka Youlet Oscar ◽

Mbailao Raphael ◽

...

Keyword(s):

Health Services ◽

Community Health ◽

Community Health Workers ◽

Health Care Access ◽

Central African Republic ◽

Health Workers ◽

Preventive Health Services ◽

Structured Interviews ◽

Adequate Treatment ◽

Care Access

Abstract Background This last decade’s ongoing conflict in the Central African Republic (CAR) has led to gradual and continuous destruction of health services. With severe gaps in qualified health professionals, community health workers (CHWs) have become essential to ensuring health care access to the affected population. This article aims to evaluate the effectiveness of a 10-y CHW program in the CAR. Methods Routine case management data from CHWs were collected in the Paoua district from January 2012 to December 2017 and analysed. Structured interviews were conducted in the Paoua and Carnot health districts among individuals from three different groups (health service beneficiaries, CHWs and health facility managers). Results From 2012 to 2017, 353 948 people consulted for malaria suspicion with CHWs and 86% were found to be malaria positive after a rapid diagnostic test. Among those diagnosed patients, 98.5% received adequate treatment and nearly 1.5% were referred to health facilities. Also, 94.5% of respondents identified fever as the major malaria symptom. About 70% of the population could identify three malaria signs/symptoms and 84.4% accepted and used CHW services. Interviews with CHWs revealed that 45.8% of them received at least four training sessions per month as part of their capacity building. Conclusions CHWs can be a resourceful solution when other health professional are scarce. This study showed that CHWs are not only able to deliver curative and preventive health services, but they are also well accepted by the served communities.

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