Moving From Community-Based to Health-Centre Based Management: Impact on Urban Community Health Worker Performance in Ethiopia

2021 ◽  
Author(s):  
Teralynn Ludwick ◽  
Misganu Endrias ◽  
Alison Morgan ◽  
Sumit Kane ◽  
Barbara McPake
Keyword(s):  
Community Health ◽  
Health Center ◽  
Health Worker ◽  
Community Health Worker ◽  
Health Workers ◽  
Qualitative Content Analysis ◽  
Health Centre ◽  
Structured Interviews ◽  
Community Based ◽  
Trade Offs

Abstract Community health worker (CHW) performance is influenced by the way in which management arrangements are configured vis-a-vis the community and health services. While low/middle-income contexts are changing, the literature provides few examples of country efforts to strategically modify management arrangements to support evolving CHW roles (e.g. chronic disease care) and operating environments (e.g. urbanization). This paper aims to understand the performance implications of changing from community-based to health centre-based management, on Ethiopia’s Urban Health Extension Professionals (UHEPs), and the tensions/trade-offs associated with the respective arrangements. We conducted semi-structured interviews/focus groups to gather perspectives and preferences from those involved with the transition (13 managers/administrators, 5 facility-based health workers, 20 UHEPs). Using qualitative content analysis, we deductively coded data to four program elements impacted by changed management arrangements and known to affect CHW performance (work scope; community legitimacy; supervision/oversight/ownership; facility linkages) and inductively identified tensions/trade-offs. Community-based management was associated with wider work scope, stronger ownership/regular monitoring, weak technical support, and weak health center linkages, with opposite patterns observed for health center-led management. Practical trade-offs included: heavy UHEP involvement in political/administrative activities under Kebele-based management; resistance to working with UHEPs by facility-based workers; and, health centre capacity constraints in managing UHEPs. Whereas the Ministry of Health/UHEPs favoured health centre-led management to capitalize on UHEPs’ technical skills, Kebele officials were vested in managing UHEPs and argued for community interests over UHEPs’ professional interests; health facility managers/administrators held divided opinions. Management arrangements influence the nature of CHW contributions towards the achievement of health, development, and political goals. Decisions about appropriate management arrangements should align with the nature of CHW roles and consider implementation setting, including urbanization, political decentralization, and relative capacity of managing institutions.

scholarly journals Risk Factors for Tuberculosis in the Work Area Community Health Center Sabang, Dampelas District, Donggala Regency

2021 ◽  
Vol 9 (E) ◽  
pp. 530-534
Author(s):  
Dedi Mahyudin Syam ◽  
Ros Arianty ◽  
Djunaidil Syukur Sulaeman ◽  
Indro Subagyo
Keyword(s):  
Risk Factors ◽  
Community Health ◽  
Health Center ◽  
Health Workers ◽  
Smoking Habit ◽  
Health Centre ◽  
Community Health Center ◽  
Structured Interviews ◽  
Work Area ◽  
Healthy Housing

BACKGROUND: The prevalence of tuberculosis (TB) globally is still very high, TB is an infectious disease that causes many deaths in Indonesia, in 2016 there were 274 cases of death per day in Indonesia and reached 1,020,000 people. The proportion of TB in Puskesmas Sabang in 2014 there were 13 cases, 29 cases in 2015, 23 cases in 2016, 27 cases in 2017, and in 2018 as many as 30 cases, TB was caused by several risk factors such as smoking, Housing conditions, and education. AIM: Research aims to know the risk factors incidence of TB disease in Sabang Regional Public Health Center, District Dampelas, Donggala. MATERIALS AND METHODS: Study case-control using a document of TB as well as structured interviews using a questionnaire, the case was a patient who suffered from TB in Puskesmas Sabang in 2017, and control is one that has the same sex that is at the Community Health Centre (Puskesmas) Sabang, comparison cases and controls were 1:1, 30 cases and 30 controls. RESULTS: Smoking habit with p = 0.020 (odds ratio [OR] = 7.120, confidence interval [CI] = 1.358–37.337) and house humidity with p = 0.000 (OR = 26.318, CI = 4.399–157.474) were the most dominant risk factors for TB incidence, while the type of gender, education and knowledge are protective against the incidence of TB. CONCLUSION: Smoking habits and house humidity are the most dominant risk factors for the incidence of TB in the work area of the Sabang Health Center, Dampelas District, Donggala Regency. Health workers should increase education to the public about the dangers of smoking and the requirements of healthy housing.

scholarly journals Who is not linked to primary care public health facilities for cardiovascular disease prevention, and why-not: A community based follow up study from urban slums in India

2020 ◽  
Author(s):  
Abhijit P Pakhare ◽  
Ankur Joshi ◽  
Rasha Anwar ◽  
Khushbu Dubey ◽  
Sanjeev Kumar ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Treatment Initiation ◽  
Health Centre ◽  
Health Facilities ◽  
Community Based ◽  
Public Health Facilities

We designed and conducted a community based longitudinal study in 16 urban slum clusters in context of a community health worker (CHW) led screening and preventive therapy initiation initiative for CVD prevention. Linkage to public health systems primary care facilities was a key outcome indicator for this initiative. In this paper, we have investigated predictors and barriers to non-linkage. CHWs screened all adults aged 30 years through for hypertension as well as diabetes. Referrals were advised and facilitated to nearby Urban Primary Health Centre (PHC) clinic for either treatment initiation or continuation or optimization. CHWs screened a total of 6174 individuals, and physicians identified 1449 participants (23.46%; 95% CI 22.42-24.54) as high-risk who required linkage to public-health facilities for pharmacotherapy . Out of these, 943(65%) attended health facilities with 801(55.2 %) being adherent to pharmacotherapy. Those who were not linked were young men belonging to low socio-economic position, living farther from UPHC, engaged late by CHW and identified to be in denial mode and reported lack of family support. This study highlights importance of early engagement through CHWs after positive screening, necessity to address denial of newly diagnosed and increase male participation in order to reduce detection to treatment initiation gap. Keywords- hypertension, diabetes, adherence, community health worker, cardio vascular diseases, population-based screening

scholarly journals Integrating a nationally scaled workforce of community health workers in primary care: a modelling study

2018 ◽  
Vol 111 (12) ◽  
pp. 453-461 ◽  
Author(s):  
Benedict Hayhoe ◽  
Thomas E Cowling ◽  
Virimchi Pillutla ◽  
Priya Garg ◽  
Azeem Majeed ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Community Health ◽  
Health Worker ◽  
Community Health Workers ◽  
Community Health Worker ◽  
Health Workers ◽  
Pilot Studies ◽  
Cancer Screenings ◽  
Home Based

Objective To model cost and benefit of a national community health worker workforce. Design Modelling exercise based on all general practices in England. Setting United Kingdom National Health Service Primary Care. Participants Not applicable. Data sources Publicly available data on general practice demographics, population density, household size, salary scales and screening and immunisation uptake. Main outcome measures We estimated numbers of community health workers needed, anticipated workload and likely benefits to patients. Results Conservative modelling suggests that 110,585 community health workers would be needed to cover the general practice registered population in England, costing £2.22bn annually. Assuming community health workerss could engage with and successfully refer 20% of eligible unscreened or unimmunised individuals, an additional 753,592 cervical cancer screenings, 365,166 breast cancer screenings and 482,924 bowel cancer screenings could be expected within respective review periods. A total of 16,398 additional children annually could receive their MMR1 at 12 months and 24,716 their MMR2 at five years of age. Community health workerss would also provide home-based health promotion and lifestyle support to patients with chronic disease. Conclusion A scaled community health worker workforce integrated into primary care may be a valuable policy alternative. Pilot studies are required to establish feasibility and impact in NHS primary care.

scholarly journals Ketidakhadiran tenaga kesehatan di puskesmas: analisis data IFLS 2012 di Wilayah Indonesia Timur

2016 ◽  
Vol 32 (12) ◽  
pp. 481
Author(s):  
Candra Candra ◽  
Lutfan Lazuardi ◽  
Mubasysyir Hasanbasri
Keyword(s):  
Health Center ◽  
Health Worker ◽  
Rural Areas ◽  
Quantitative Research ◽  
Health Workers ◽  
Health Centre ◽  
Multivariable Analysis ◽  
Secondary Data ◽  
Cross Sectional ◽  
East Kalimantan

Absenteeism among primary health center workers: an analysis of the 2012 IFLS in Eastern IndonesiaPurposeThe study aimed to determine the determinants for absence of health centre employees in urban and rural areas in the eastern Indonesian region using data IFLS East 2012.MethodsThis study was a quantitative research using secondary data analysis of Indonesian family life survey (IFLS) East 2012 with health professionals using a cross-sectional design. The population was all health workers in seven provinces in Eastern Indonesia (Nusa Tenggara Timur, East Kalimantan, South East Sulawesi, Maluku, North Maluku, Papua, West Papua). The research sample totaled 1809 health workers. Analysis used STATA version 12.ResultsThe results of bivariable analysis on the variables gender, type of health worker, tenure, health center locations showed a significant relationship with absenteeism the health center employee. The results showed from the multivariable analysis showed higher odds ratio at rural health centers versus urban locations with absenteeism of health center employee, but there was no significant difference.ConclusionThe absenteeism of health center employees is influenced by various multi-factors especially gender, types of health worker, tenure and health center locations. Increased capacity in the management by health center managers, broader authority to enforce discipline, and monitoring by the community is expected to decrease absenteeism of health center employees.

scholarly journals An analysis of the services provided by Community Health Workers within an urban district in South Africa: a key contribution towards universal access to care.

2021 ◽  
Author(s):  
Leena Susan Thomas ◽  
Eric Buch ◽  
Yogan Pillay
Keyword(s):  
South Africa ◽  
Access To Care ◽  
Community Health ◽  
Health Worker ◽  
Social Services ◽  
Community Health Workers ◽  
Community Health Worker ◽  
Health Workers ◽  
Urban Setting ◽  
Early Screening

Abstract Introduction: Community health worker teams are potential game-changers in ensuring access to care in vulnerable communities. Who are they? What do they actually do? Can they help South Africa realize universal health coverage? As the proactive arm of the health services, community health workers teams provide household and community education, early screening, tracing and referrals for a range of health and social services. There is little local or global evidence on the household services provided by such teams, beyond specific disease-oriented activities such as for HIV and TB. This paper seeks to address this gap.Methods: Descriptive secondary data analysis of community health worker team activities in the Ekurhuleni health district, South Africa covering approximately 280 000 households with one million people. Results: Study findings illustrated that community health workers in these teams provided early screening and referrals for pregnant women and children under five. They distributed condoms and chronic medication to homes. They screened and referred for hypertension, diabetes mellitus, HIV and TB. The teams also undertook defaulter and contact tracing, the majority of which was for HIV & TB clients. Psychosocial support provided was in the form of access to social grants, access to child and gender-based violence protection services, food parcels and other services.Conclusion: Community Health Workers form the core of these teams and perform several health and psychosocial services in households and poor communities in South Africa, in addition to general health education. The teams studied provided a range of activities across many health conditions (mother & child related, HIV & TB, non-communicable diseases), as well as social services. These teams provided comprehensive care in a large-scale urban setting and can improve access to care.

scholarly journals Development of a tool for assessing quality of comprehensive care provided by community health workers in a community-based care programme in South Africa

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e030677
Author(s):  
Frances Griffiths ◽  
Olukemi Babalola ◽  
Celia Brown ◽  
Julia de Kadt ◽  
Hlologelo Malatji ◽  
...  
Keyword(s):  
South Africa ◽  
Quality Of Care ◽  
Community Health ◽  
Health Worker ◽  
Community Health Workers ◽  
Community Health Worker ◽  
Health Workers ◽  
Comprehensive Care ◽  
Household Visit

ObjectiveTo develop a tool for use by non-clinical fieldworkers for assessing the quality of care delivered by community health workers providing comprehensive care in households in low- and middle-income countries.DesignWe determined the content of the tool using multiple sources of information, including interactions with district managers, national training manuals and an exploratory study that included observations of 70 community health workers undertaking 518 household visits collected as part of a wider study. We also reviewed relevant literature, selecting relevant domains and quality markers. To refine the tool and manual we worked with the fieldworkers who had undertaken the observations. We constructed two scores summarising key aspects of care: (1) delivering messages and actions during household visit, and (2) communicating with the household; we also collected contextual data. The fieldworkers used the tool with community health workers in a different area to test feasibility.SettingSouth Africa, where community health workers have been brought into the public health system to address the shortage of healthcare workers and limited access to healthcare. It was embedded in an intervention study to improve quality of community health worker supervision.Primary and secondary outcomesOur primary outcome was the completion of a tool and user manual.ResultsThe tool consists of four sections, completed at different stages during community health worker household visits: before setting out, at entry to a household, during the household visit and after leaving the household. Following tool refinement, we found no problems on field-testing the tool.ConclusionsWe have developed a tool for assessing quality of care delivered by community health workers at home visits, often an unobserved part of their role. The tool was developed for evaluating an intervention but could also be used to support training and management of community health workers.

scholarly journals Impacts of community lay-leader health worker training & practice (Uttarakhand, India)

2017 ◽  
Vol 4 (2) ◽  
pp. 43-52
Author(s):  
Nicole Butcher ◽  
Nathan Grills
Keyword(s):  
Community Health ◽  
Health Worker ◽  
Course Design ◽  
Health Workers ◽  
North India ◽  
Structured Interviews ◽  
Data Set ◽  
Worker Training ◽  
Training Post ◽  
Pastoral Support

This study has investigated the impacts of the Community Lay-Leaders Health Training Certificate course on trainees and their communities, specific to the state of Uttarakhand, north India. A suite of semi-structured interviews and focus group discussions were conducted among course stakeholders and graduates respectively, and textual data was added to the data set. Thematic analysis of the results revealed four themes, including: (1) the effectiveness of course design and delivery, together with the key role of the Coordinating Facilitator; (2) the match between graduates’ practices, the providing institution’s objectives and general expectations of community health worker; (3) the strengthening of the health system through skills multiplication, collaboration with existing authorities, and advocacy for higher quality in professional practice; and (4) the need for ongoing support and training post-graduation. The findings are consistent with literature concerning community health workers’ roles and challenges, although some potentially unique outcomes were noted with respect to the pastoral support provided to trainees and the pro-active transfer of graduates’ knowledge and skills to fellow villagers.

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