Perceptions of Community Health Workers during Two Concurrent National Health Crises: Opioid Use Disorder and COVID-19

BackgroundDespite increasing evidence for the benefits of psychological treatments (PTs) in low- and middle-income countries, few national health systems have adopted PTs as standard care. We aimed to evaluate the effectiveness of a group interpersonal psychotherapy (IPT-G) intervention, when delivered by lay community health workers (LCHWs) in a low-resource government health system in Uganda. The intended outcome was reduction of depression among caregivers of children with nodding syndrome, a neuropsychiatric condition with high morbidity, mortality and social stigma.MethodsA non-randomized trial design was used. Caregivers in six villages (n = 69) received treatment as usual (TAU), according to government guidelines. Caregivers in seven villages (n = 73) received TAU as well as 12 sessions of IPT-G delivered by LCHWs. Primary outcomes were caregiver and child depression assessed at 1 and 6 months post-intervention.ResultsCaregivers who received IPT-G had a significantly greater reduction in the risk of depression from baseline to 1 month [risk ratio (RR) 0.25, 95% confidence interval (CI) 0.10–0.62] and 6 months (RR 0.33, 95% CI 0.11–0.95) post-intervention compared with caregivers who received TAU. Children of caregivers who received IPT-G had significantly greater reduction in depression scores than children of TAU caregivers at 1 month (Cohen's d = 0.57, p = 0.01) and 6 months (Cohen's d = 0.54, p = 0.03). Significant effects were also observed for psychological distress, stigma and social support among caregivers.ConclusionIPT-G delivered within a low-resource health system is an effective PT for common mental health problems in caregivers of children with a severe neuropsychiatric condition and has psychological benefits for the children as well. This supports national health policy initiatives to integrate PTs into primary health care services in Uganda.

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Sustaining the National Health Insurance Scheme in South Africa: The Roles and Challenges of Community Health Workers

The Open Public Health Journal ◽

10.2174/1874944501811010494 ◽

2018 ◽

Vol 11 (1) ◽

pp. 494-506 ◽

Cited By ~ 2

Author(s):

Takalani G. Tshitangano ◽

Foluke C. Olaniyi

Keyword(s):

South Africa ◽

Health Insurance ◽

Community Health ◽

Community Health Workers ◽

National Health Insurance ◽

National Health ◽

Universal Health Coverage ◽

Health Workers ◽

Health Coverage ◽

Universal Health

Background:The provision of universal health coverage is acknowledged as a priority goal for healthcare systems globally. In South Africa, the National Health Insurance system has been endorsed as a funding model for the provision of universal health coverage for South Africans. Community Health Workers have contributed to better universal health coverage outcomes in many countries. A study in India revealed that coverage of health care practices is positively correlated with the knowledge level of Community Health Workers. In South Africa, there is a difference in the duration of training of Community Health Workers in different provinces, especially in Vhembe District.Objective:This study aimed to assess Community Health Workers’ knowledge regarding their roles and describe their challenges within the context of National Health Insurance.Methods:Qualitative design was used to collect data from 33 participants who formed five focus groups comprising six to eight members each. Ethical principles of research such as permission, informed consent, voluntary participation and anonymity were observed. Data was analysed using thematic data analysis technique guided by Tesch open coding method.Results:The findings revealed that Community Health Workers lack adequate knowledge regarding the roles they are expected to play within Ward Based Outreach teams. Some of the challenges they face include transportation to clients’ homes and poor reception in households.Conclusion:A review of the South African Qualification Authority health promoter unit standards is recommended coupled with the mentorship of Community Health Workers by retired nurses to help them understand their roles better.

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