Can the financial burden of being a community health volunteer in western Kenya exacerbate poverty?

2018 ◽  
Vol 35 (1) ◽  
pp. 93-101
Author(s):  
Alyssa Kelly ◽  
Sanjana Mitra ◽  
Justus Elung’at ◽  
Julia Songok ◽  
Suzanne Jackson ◽  
...  
Keyword(s):  
Community Health ◽  
Health Workers ◽  
Financial Burden ◽  
Health Service Delivery ◽  
Middle Income ◽  
Western Kenya ◽  
Roles And Responsibilities ◽  
Community Health Volunteers ◽  
Incentive Model ◽  
Community Health Volunteer

Summary Community health volunteers (CHVs) act as vital links between communities and health facilities, bridging the health service delivery gap common in low- and middle-income countries. In 2013, changes in funding in western Kenya left most CHVs without their individual monthly stipend. In this article, we explore how the implementation of a pooled incentive model had an impact on the lives of CHVs from two counties in western Kenya. Participation in this form of table banking was meant to allow CHVs to pool their resources together and invest in income-generating activities to offset the costs of unpaid health work. A pre-post qualitative study, consisting of focus group discussions and in-depth interviews explored CHV compensation, motivations and challenges experienced in 2013 and 2015, prior to and after the implementation of this pooled incentive model. Following withdrawal of the monthly stipend, we found that CHVs continued to take on roles and responsibilities of paid health workers, motivated by shared social identities and connections to their communities. However, replacing the stipend with a pooled-group incentive model seemingly exacerbated the financial burden already experienced by this vulnerable population. This study brings into question the sustainability and viability of a volunteer community health worker programme and highlights the need to address the financial burden associated with the CHV role in western Kenya.

Stock-Outs of Essential Medicines Among Community Health Workers (CHWs) In Low- And Middle-Income Countries (LMICs): A Systematic Literature Review of The Extent, Reasons, And Consequences

2021 ◽  
Author(s):  
Abimbola Olaniran ◽  
Jane Briggs ◽  
Ami Pradhan ◽  
Erin Bogue ◽  
Benjamin Schreiber ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Grey Literature ◽  
Community Level ◽  
Health Centers ◽  
Essential Medicines ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Background: This paper explores the extent of community-level stock-out of essential medicines among Community Health Workers (CHWs) in Low- and Middle-Income Countries (LMICs) and identifies the reasons for and consequences of essential medicine stock-outs. Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Five electronic databases were searched with a prespecified strategy and the grey literature examined, January 2006 - March 2021. Papers containing information on (i) the percentage of CHWs stocked out or (ii) reasons for stock-outs along the supply chain and consequences of stock-out were included and appraised for risk of bias. Outcomes were quantitative data on the extent of stock-out, summarized using descriptive statistics, and qualitative data regarding reasons for and consequences of stock-outs, analyzed using thematic content analysis and narrative synthesis. Results: Two reviewers screened 1083 records; 78 evaluations were included. Over the last fifteen years, CHWs experienced stock-outs of essential medicines nearly one third of the time and at a significantly (p < 0.01) higher rate than the health centers to which they are affiliated (28.93% [CI 95%: 28.79 - 29.07] vs 9.17 % [CI 95%: 8.64 - 9.70], respectively). A comparison of the period 2006-2015 and 2016-2021 showed a significant (p < 0.01) increase in CHW stock-out level from 26.36% [CI 95%: 26.22 -26.50] to 48.65% [CI 95%: 48.02- 49.28] while that of health centers increased from 7.79% [95% CI: 7.16 - 8.42] to 14.28% [95% CI: 11.22- 17.34]. Distribution barriers were the most cited reasons for stock-outs. Ultimately, patients were the most affected: stock-outs resulted in out-of-pocket expenses to buy unavailable medicines, poor adherence to medicine regimes, dissatisfaction, and low service utilization. Conclusion: Community-level stock-out of essential medicines constitutes a serious threat to achieving universal health coverage and equitable improvement of health outcomes. This paper suggests stock-outs are getting worse, and that there are particular barriers at the last mile. There is an urgent need to address the health and non-health system constraints that prevent the essential medicines procured for LMICs by international and national stakeholders from reaching the people who need them the most.

scholarly journals Pemberdayaan Masyarakat melalui Pelatihan Komunikasi Efektif bagi Kader Posyandu

2020 ◽  
Vol 5 (1) ◽  
pp. 167-174
Author(s):  
Ngatoiatu Rohmani ◽  
Dewi Utari
Keyword(s):  
Health Promotion ◽  
Community Health ◽  
Effective Communication ◽  
Community Empowerment ◽  
Communication Training ◽  
Health Development ◽  
Good Communication ◽  
Community Health Volunteers ◽  
Communication Techniques ◽  
Community Health Volunteer

COMMUNITY EMPOWERMENT TROUGH EFFECTIVE COMMUNICATION TRAINING FOR COMMUNITY HEALTH VOLUNTEER (CADRE) OF POSYANDU. Community participation for creating Indonesia’s health development is necessary. One of manifestation of community empowerment is through Posyandu activities that are managed by community health volunteers (cadre) with the aim of providing facilities to the public in obtaining basic health services as a promotive and preventive health strategy in community. Cadres as the driving agent need to be equipped with health promotion skills as an attempt to create national health development optimally. The purpose of this community service is to provide knowledge of effective communication, and to introduce of communication media for promoting of health information. The methods of conducting communication training include: survey activities, communication training, preparing health promotion media and evaluation. The results of the training showed that participants had good communication skills, participants were able to practice effective communication techniques and realized the importance of the media to promote Posyandu activities.

scholarly journals Contextual factors affecting the integration of community health workers into the health system in Limpopo Province, South Africa

2019 ◽  
Vol 12 (4) ◽  
pp. 281-286 ◽  
Author(s):  
Geoffrey Jobson ◽  
Nireshni Naidoo ◽  
Nthabiseng Matlakala ◽  
Gert Marincowitz ◽  
Jean Railton ◽  
...  
Keyword(s):  
South Africa ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Limpopo Province ◽  
Community Members ◽  
Middle Income ◽  
Factors Affecting ◽  
Challenges And Opportunities ◽  
Decision Making Processes

Abstract Background Community health workers (CHWs) are an essential cadre in the health systems of many low- and middle-income countries. These workers provide a wide variety of services and are key to ongoing processes of task shifting within human immunodeficiency virus programmes in particular. Ward-based outreach teams (WBOTs) are South Africa’s latest iteration of the CHW programme and have been introduced as part of the National Department of Health’s Primary Health Care Re-engineering programme. Methods In order to assess the perceived effectiveness of the WBOTs in supporting the ongoing rollout of antiretroviral therapy, tuberculosis care and patient support, we conducted a qualitative investigation focusing on the perceived successes and challenges of the programme among CHWs, community leaders, healthcare workers and community members in the Mopani district, Limpopo province, South Africa. Results The CHW programme operates across these contexts, each associated with its own set of challenges and opportunities. Conclusions While these challenges may be interrelated, a contextual analysis provides a useful means of understanding the programme’s implementation as part of ongoing decision-making processes.

Supervising Community Health Workers in Community-Based Delivery of Primary Health/Family Planning Services: Experiences in Mexico, 1977–1982

1986 ◽  
Vol 6 (4) ◽  
pp. 309-322 ◽  
Author(s):  
Michele G. Shedlin ◽  
Joe D. Wray ◽  
Sergio Correu
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Program ◽  
Health Workers ◽  
Community Based ◽  
Family Planning Services ◽  
Roles And Responsibilities ◽  
Primary Health ◽  
Wide Range

The supervision of CHWs in the Mexican Rural Health Program (1977–82) illustrates a wide range of problems and strengths because it was developed within a program based on a strong political mandate to deliver services to an extremely large, as well as culturally and geographically diverse population. This article presents an in-depth perspective on the issues involved in the supervision of community health workers with a focus on the myriad roles and responsibilities which are expected from supervisory personnel. The information and observations which are offered come from program evaluation materials as well as the long-term, first hand experience of the authors with the program discussed.

scholarly journals Performance of community health workers and associated factors in a rural community in Wakiso district, Uganda

2019 ◽  
Vol 19 (3) ◽  
pp. 2784-2797
Author(s):  
David Musoke ◽  
Rawlance Ndejjo ◽  
Edwinah Atusingwize ◽  
Trasias Mukama ◽  
Charles Ssemugabo ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Rural Community ◽  
Associated Factors ◽  
High Performance ◽  
Health Workers ◽  
Health Service Delivery ◽  
Cross Sectional Study ◽  
Essential Medicines ◽  
Cross Sectional

Background: Community health workers (CHWs) continue to play a crucial role in supporting health service delivery globally. Several CHW programmes around the world face vast challenges which affect their performance.Objectives: This study assessed the performance of CHWs and associated factors in a rural community in Wakiso district, Uganda.Methods: This was a cross-sectional study that employed a structured questionnaire to collect quantitative data from 201 CHWs in Wakiso district. The main study variable was CHW performance based on various roles carried out by CHWs. Multivariable logistic regression in STATA was used to establish the predictors of CHW performance.Results: Only 40 (19.9%) of the CHWs had a high performance which was associated with having attended additional / refresher trainings [AOR=12.79 (95% CI: 1.02-159.26)], and having attained secondary level education and above [AOR=3.93 (95% CI: 1.17-13.24)]. CHWs who were married [AOR=0.29 (95% CI: 0.09-0.94)] were less likely to perform highly. Among CHWs who had received essential medicines for treatment of childhood illnesses, the majority 90.3% (112/124) had experienced stock-outs in the 6 months preceding the study. Despite the majority of CHWs, 198 (98.5%), stating that being motivated was very important in their work, only 91 (45%) said that they were motivated.Conclusion: Additional / refresher trainings are necessary to enhance performance of CHWs. In addition, level of education should be considered while selecting CHWs. The health system challenges of low motivation of CHWs as well as stock-out of medicines need to be addressed to support their work.Keywords: Community health workers, performance, motivation, satisfaction, stock-outs, village health teams, Uganda.

scholarly journals Community Perceptions of Vaccination Among Influential Stakeholders: Qualitative Research in Rural India

2020 ◽  
Author(s):  
Baldeep K. Dhaliwal ◽  
Riti Chandrashekhar ◽  
Ananya Rattani ◽  
Rajeev Seth ◽  
Svea Closser ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Vaccine Coverage ◽  
Vaccine Uptake ◽  
Health Improvement ◽  
Religious Leaders ◽  
Vaccine Acceptance ◽  
Middle Income ◽  
Expectant Mothers

AbstractBackgroundIn India and other low- and middle-income countries, multiple family and community members are influential in caregivers’ perceptions of vaccination. Existing literature indicates the primary caregiver, typically the mother, is instrumental in vaccine decision-making, but this may vary in contexts. We investigated the role of stakeholders in India who influence caregivers’ vaccination perceptions, as this is essential to developing strategies to promote vaccine acceptance and improve uptake.MethodsThis research was conducted in 2019 in Mewat District in Haryana, an area in India with extremely low vaccination coverage. We conducted six focus group discussions with 60 participants in the following categories: fathers of children under-5 years old, expectant mothers, mothers-in-law, community health workers, and community influencers such as locally elected officials and religious leaders.ResultsOur results highlighted four themes that influence vaccine uptake. First, while caregivers associated vaccination with reductions in specific diseases, they also noted that vaccination services brought broad health gains, including improved nutrition, antenatal guidance, and social support. Second, community health workers critically influenced, positively or negatively, caregivers’ vaccination perceptions. Third, community health workers faced gaps in their education such as limited training on vaccine side-effects, placing them at a disadvantage when dealing with families. Finally, we found that mothers-in-law, fathers, and religious leaders influence caregivers’ perceptions of vaccination.ConclusionsCommunication of broader benefits of vaccines and vaccination services by community health workers could be impactful in increasing vaccine acceptance. Vaccine uptake could potentially be improved by facilitating community health workers’ ownership over vaccine acceptance and uptake by involving them in the design and implementation of interventions to target mothers and mothers-in-law. A ‘bottom-up’ approach, leveraging community health workers’ knowledge to design interventions, and giving a voice to key members of the household and society beyond mothers alone, may sustain health improvement in low vaccine coverage areas.

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