Are community health workers cost-effective for childhood vaccination in India?

Community health workers (CHWs) have a longstanding role in improving the health and well-being of underserved populations in resource-limited settings. CHWs are trusted in the communities they serve and are often able to see through solutions on community challenges that outside persons cannot. Notwithstanding, such solutions often must be low-cost, easily implementable, and permit knowledge gaps among CHWs to be filled via appropriate training. In this sense, use of cost-effective information technology (IT) solutions can be key to increasing access to knowledge for these community agents. This paper highlights insights gleaned from a pilot study performed in Detroit, Michigan with a group of CHWs in basic grant-writing training via an e-platform, the Community Health Innovator Program (CHIP). The results are discussed within the context of learning theory. It is concluded that e-platforms are necessary for CHWs to leverage knowledge from multiple sources in an adaptive environment towards addressing ever-evolving global health challenges.

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Effectiveness of service models and organisational structures supporting tuberculosis identification and management in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review

BMJ Open ◽

10.1136/bmjopen-2017-019642 ◽

2018 ◽

Vol 8 (9) ◽

pp. e019642 ◽

Cited By ~ 1

Author(s):

Charlotte C Heuvelings ◽

Patrick F Greve ◽

Sophia G de Vries ◽

Benjamin Jelle Visser ◽

Sabine Bélard ◽

...

Keyword(s):

Systematic Review ◽

European Union ◽

Cost Effectiveness ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Cost Effective ◽

Service Models ◽

Hard To Reach Populations ◽

Organisational Structures

ObjectiveTo determine which service models and organisational structures are effective and cost-effective for delivering tuberculosis (TB) services to hard-to-reach populations.DesignEmbase and MEDLINE (1990–2017) were searched in order to update and extend the 2011 systematic review commissioned by National Institute for Health and Care Excellence (NICE), discussing interventions targeting service models and organisational structures for the identification and management of TB in hard-to-reach populations. The NICE and Cochrane Collaboration standards were followed.SettingEuropean Union, European Economic Area, European Union candidate countries and Organisation for Economic Co-operation and Development countries.ParticipantsHard-to-reach populations, including migrants, homeless people, drug users, prisoners, sex workers, people living with HIV and children within vulnerable and hard-to-reach populations.Primary and secondary outcome measuresEffectiveness and cost-effectiveness of the interventions.ResultsFrom the 19 720 citations found, five new studies were identified, in addition to the six discussed in the NICE review. Community health workers from the same migrant community, street teams and peers improved TB screening uptake by providing health education, promoting TB screening and organising contact tracing. Mobile TB clinics, specialised TB clinics and improved cooperation between healthcare services can be effective at identifying and treating active TB cases and are likely to be cost-effective. No difference in treatment outcome was detected when directly observed therapy was delivered at a health clinic or at a convenient location in the community.ConclusionsAlthough evidence is limited due to the lack of high-quality studies, interventions using peers and community health workers, mobile TB services, specialised TB clinics and improved cooperation between health services can be effective to control TB in hard-to-reach populations. Future studies should evaluate the (cost-)effectiveness of interventions on TB identification and management in hard-to-reach populations and countries should be urged to publish the outcomes of their TB control systems.PROSPERO registration numberCRD42015017865.

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Community health workers highly cost effective in India

PharmacoEconomics & Outcomes News ◽

10.1007/s40274-019-5842-5 ◽

2019 ◽

Vol 827 (1) ◽

pp. 4-4

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Cost Effective

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Multi-level community interventions for primary stroke prevention: A conceptual approach by the World Stroke Organization

International Journal of Stroke ◽

10.1177/1747493019873706 ◽

2019 ◽

Vol 14 (8) ◽

pp. 818-825 ◽

Cited By ~ 1

Author(s):

Michael Brainin ◽

Valery Feigin ◽

Philip M Bath ◽

Epifania Collantes ◽

Sheila Martins ◽

...

Keyword(s):

Primary Prevention ◽

Community Health ◽

Community Health Workers ◽

Stroke Prevention ◽

Health Workers ◽

Cost Effective ◽

Lifestyle Changes ◽

Prevention Strategy ◽

Lipid Lowering ◽

Prevention Strategies

The increasing burden of stroke and dementia emphasizes the need for new, well-tolerated and cost-effective primary prevention strategies that can reduce the risks of stroke and dementia worldwide, and specifically in low- and middle-income countries (LMICs). This paper outlines conceptual frameworks of three primary stroke prevention strategies: (a) the “polypill” strategy; (b) a “population-wide” strategy; and (c) a “motivational population-wide” strategy. (a) A polypill containing generic low-dose ingredients of blood pressure and lipid-lowering medications (e.g. candesartan 16 mg, amlodipine 2.5 mg, and rosuvastatin 10 mg) seems a safe and cost-effective approach for primary prevention of stroke and dementia. (b) A population-wide strategy reducing cardiovascular risk factors in the whole population, regardless of the level of risk is the most effective primary prevention strategy. A motivational population-wide strategy for the modification of health behaviors (e.g. smoking, diet, physical activity) should be based on the principles of cognitive behavioral therapy. Mobile technologies, such as smartphones, offer an ideal interface for behavioral interventions (e.g. Stroke Riskometer app) even in LMICs. (c) Community health workers can improve the maintenance of lifestyle changes as well as the adherence to medication, especially in resource poor areas. An adequate training of community health workers is a key point. Conclusion An effective primary stroke prevention strategy on a global scale should integrate pharmacological (polypill) and lifestyle modifications (motivational population-wide strategy) interventions. Side effects of such an integrative approach are expected to be minimal and the benefits among individuals at low-to-moderate risk of stroke could be significant. In the future, pragmatic field trials will provide more evidence.

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Barriers and Facilitators of Engaging Community Health Workers in Non-Communicable Disease (NCD) Prevention and Control in China: A Systematic Review (2006–2016)

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15112378 ◽

2018 ◽

Vol 15 (11) ◽

pp. 2378 ◽

Cited By ~ 5

Author(s):

Hongfei Long ◽

Wenting Huang ◽

Pinpin Zheng ◽

Jiang Li ◽

Sha Tao ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Communicable Disease ◽

Cost Effective ◽

Barriers And Facilitators ◽

Community Based Interventions ◽

Cost Effective Approach ◽

Dominant Disease ◽

Implementation Effect

Background: Non-communicable diseases (NCDs) have become a dominant disease burden in China. Although China has a prevention-centered NCD strategy, the implementation effect in the community has been subjected to manpower and financial difficulties. Engaging community health workers (CHWs) in community-based interventions may be a cost-effective approach to relieve the resource shortage and improve health. This review aimed to synthesize evidence on types of NCD-related care that was provided by CHWs in China, and to identify relevant barriers and facilitators. Methods: A literature search was conducted in Medline, PubMed, ProQuest, and Google Scholar databases for English-written, peer-reviewed articles published from 1996 to 2016 that reported findings from NCD-related interventions delivered by CHWs in China. Each article was extracted independently by two researchers. Results: Twenty distinct studies met the inclusion criteria. The two most common types of CHW-led NCD-related care were diabetes and hypertension management (n = 7) and mental health care (n = 7). Thirteen studies discussed the barriers and 16 studies reported facilitators. The most common barriers included lack of support (n = 6), lack of resources (n = 4), and heavy reliance on technology (n = 4). The common facilitators included an integrated health system (n = 9), community and patient trust (n = 5), high quality training (n = 5), and CHWs’ capacity (n = 5). Fourteen studies mentioned training content, while only eight described detailed procedures and duration. Conclusions: This review suggests that trained and supervised Chinese CHWs had the capacity to provide grassroots NCDs preventive interventions. In order to increase the generalizability and sustainability of such programs, studies with robust designs are needed to explore the effectiveness of CHW-led programs, and the intervention strategies to improve the practice of CHWs in various settings.

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Community health workers to improve adherence to anti‐seizure medication in rural South Africa: Is it cost‐effective?

Epilepsia ◽

10.1111/epi.16756 ◽

2020 ◽

Author(s):

Ryan G. Wagner ◽

Fredrik Norström ◽

Melanie Y. Bertram ◽

Stephen Tollman ◽

Lars Forsgren ◽

...

Keyword(s):

South Africa ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Cost Effective ◽

Rural South ◽

Rural South Africa

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HOW DO WE DETERMINE WHETHER COMMUNITY HEALTH WORKERS ARE COST-EFFECTIVE? SOME CORE METHODOLOGICAL ISSUES

Journal of Community Health ◽

10.1007/s10900-004-1960-4 ◽

2005 ◽

Vol 30 (3) ◽

pp. 221-229 ◽

Cited By ~ 45

Author(s):

Damian G. Walker ◽

Stephen Jan

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Cost Effective ◽

Methodological Issues

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Evaluating the Impact of Telehealth-Based, Diabetes Medication Training for Community Health Workers on Glycemic Control

Journal of Personalized Medicine ◽

10.3390/jpm10030121 ◽

2020 ◽

Vol 10 (3) ◽

pp. 121

Author(s):

Casey N. Keegan ◽

Craig A. Johnston ◽

Victor J. Cardenas ◽

Elizabeth M. Vaughan

Keyword(s):

Blood Pressure ◽

Community Health ◽

Community Health Workers ◽

Patient Outcomes ◽

Low Income ◽

Health Workers ◽

Cost Effective ◽

Diabetes Medication ◽

Personalized Care ◽

The Impact

Background: Diabetes is a major contributor to morbidity and mortality. Community Health Workers (CHWs) have been instrumental in improving patient outcomes. However, CHW training largely focuses on general diabetes concepts rather than medications. Providing accessible, diabetes medication training for CHWs has the potential to increase patient understanding, personalized care, and adherence, thereby improving outcomes. Objective: To evaluate the impact of a telehealth-based diabetes medication training for CHWs on patient outcomes as measured by HbA1c changes. Methods: We provided a 12-month weekly, telehealth (videoconference) medication training for CHWs who led 6-month diabetes programs for low-income Latino(a)s in community clinics. We measured participant HbA1c (primary outcome), blood pressure, and body mass index (BMI) changes. We evaluated CHW knowledge via two pre/post-tests: medication adverse events/side effects (TEST-1, months 1–6) and dosing, titration, and emergencies (TEST-2, months 7–12). We assessed CHW training application by their ability to identify patient, provider, and healthcare system medication barriers. Results: Participants’ (n = 55) HbA1c improved (9.0% (75 mmol/mol) to 7.8% (62 mmol/mol) (p = 0.001)). Blood pressure and BMI changes were not significant. CHWs improved their knowledge: TEST-1: 10.5-18.2/20.0 (p = 0.002), TEST-2: 10.3–17.3/19.0 (p = 0.0019). CHWs identified 984 patients (n = 610), providers (n = 151), and healthcare systems (n = 223) medication barriers during the 12-month training. Conclusions: Providing a telehealth-based, diabetes medication training program for CHWs allowed a personalized approach to identify barriers to care at several levels, which was associated with significant participant HbA1c reductions and improved CHW knowledge. This is a promising cost-effective, culturally sensitive strategy to improve diabetes care. Larger longitudinal evaluations are needed to fully understand the impact of CHW medication training.

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