Conclusion

2021 ◽  
pp. 195-202
Author(s):  
Laura Hakimi ◽  
Anne Geniets ◽  
James O’Donovan ◽  
Niall Winters
Keyword(s):  
Community Health ◽  
Case Studies ◽  
Health Worker ◽  
Community Health Worker ◽  
Middle Income ◽  
Middle Income Countries ◽  
Methodological Research ◽  
Training And Supervision ◽  
Low And Middle Income

Training and supervision are paramount to well-functioning, adaptable Community Health Worker (CHW) programmes. Balancing theoretical and methodological research, lessons from health worker practice, and case studies, this volume has sought to provide a resource to practitioners, policymakers and academics striving to design equitable, participatory CHW programmes. Weaving together interdisciplinary and multiregional perspectives, this book has focussed on the design, implementation and evaluation of technology-based programmes for training and supervision of CHWs, particularly in low- and middle income countries. In doing so, it has set out a roadmap for future equitable, pedagogy-driven CHW programmes.

scholarly journals The Governance of National Community Health Worker Programmes in Low- and Middle-Income Countries: An Empirically Based Framework of Governance Principles, Purposes and Tasks

2018 ◽  
Vol 8 (1) ◽  
pp. 18-27 ◽  
Author(s):  
Helen Schneider
Keyword(s):  
Health System ◽  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Political Support ◽  
Community Based ◽  
Middle Income ◽  
National Community ◽  
Middle Income Countries ◽  
Low And Middle Income

Background: National community health worker (CHW) programmes are increasingly regarded as an integral component of primary healthcare (PHC) in low- and middle-income countries (LMICs). At the interface of the formal health system and communities, CHW programmes evolve in context specific ways, with unique cadres and a variety of vertical and horizontal relationships. These programmes need to be appropriately governed if they are to succeed, yet there is little evidence or guidance on what this entails in practice. Based on empirical observations of South Africa’s community-based health sector and informed by theoretical insights on governance, this paper proposes a practical framework for the design and strengthening of CHW programme governance at scale. Methods: Conceptually, the framework is based on multi-level governance thinking, that is, the distributed, negotiated and iterative nature of decision-making, and the rules, processes and relationships that support this in health systems. The specific purposes and tasks of CHW programme governance outlined in the framework draw from observations and published case study research on the formulation and early implementation of the Ward Based Outreach Team strategy in South Africa. Results: The framework is presented as a set of principles and a matrix of 5 key governance purposes (or outputs). These purposes are: a negotiated fit between policy mandates and evidence, histories and strategies of community-based services; local organisational and accountability relationships that provide community-based actors with sufficient autonomy and power to act; aligned and integrated programme management systems; processes that enable system learning, adaptation and change; and sustained political support. These purposes are further elaborated into 17 specific tasks, distributed across levels of the health system (national, regional, and local). Conclusion: In systematising the governance functions in CHW programmes, the paper seeks to shed light on how best to support and strengthen these functions at scale.

Design & Development of a digital assistant to support teleconsultations between remote doctors and frontline health workers in low and middle-income countries (Preprint)

2020 ◽  
Author(s):  
Neha Verma ◽  
Harold Lehmann ◽  
Amal Afroz Alam ◽  
Youseph Yazdi ◽  
Soumyadipta Acharya
Keyword(s):  
Community Health ◽  
Health Worker ◽  
Community Health Workers ◽  
Unmet Needs ◽  
Health Workers ◽  
User Needs ◽  
Middle Income ◽  
Middle Income Countries ◽  
Frontline Health Workers ◽  
Low And Middle Income

BACKGROUND Many low and middle-income countries (LMICs) have adopted telemedicine programs that connect frontline health workers (FHWs) such as nurses, midwives, or community health workers in rural and remote areas with doctors in urban areas to deliver care to patients. By leveraging technology to reduce temporal, financial, and geographic barriers, these health worker-to-doctor telemedicine programs have the potential to increase quality, to expand the specialties available to patients, and to reduce the time and cost required to deliver care. OBJECTIVE We aimed to identify, validate, prioritize unmet needs in this healthcare space of health worker-to-doctor telemedicine programs, and develop and refine a solution that addresses those needs. METHODS We collected information regarding user needs through ethnographic research, direct observation, and semi-structured interviews with 37 stakeholders (5 doctors, 1 public health program manager, 12 community health workers, and 19 patients) at two telemedicine clinics in rural West Bengal, India. We used the Spiral-Innovative Iteration model to design and develop a prototype solution to meet these needs. RESULTS We identified 74 unmet needs through our immersion in health worker-to-doctor telemedicine programs. We identified a critical unmet need that achieving optimal teleconsultations in LMICs often requires shifting tasks such as history taking and physical examination, from high-skilled remote doctors to the frontline health worker (FHW). To solve this need, we developed a prototype digital assistant that would allow frontline health workers to assume some of the tasks carried out by remote clinicians. The user needs of multiple stakeholder groups (patients, FHWs, doctors, and health organizations) informed this task-shifting tool. CONCLUSIONS The final prototype developed was released as an open source digital public good and may improve the quality and efficiency of care delivery in health worker-to-doctor telemedicine programs.

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 Challenges to implementing national comprehensive sexuality education curricula in low- and middle-income countries: Case studies of Ghana, Kenya, Peru and Guatemala

PLoS ONE ◽  
2018 ◽  
Vol 13 (7) ◽  
pp. e0200513 ◽  
Author(s):  
Sarah C. Keogh ◽  
Melissa Stillman ◽  
Kofi Awusabo-Asare ◽  
Estelle Sidze ◽  
Ana Silvia Monzón ◽  
...  
Keyword(s):  
Case Studies ◽  
Sexuality Education ◽  
Middle Income ◽  
Comprehensive Sexuality Education ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals The Evolution of Mentorship Capacity Development in Low- and Middle-Income Countries: Case Studies from Peru, Kenya, India, and Mozambique

2019 ◽  
Vol 100 (1_Suppl) ◽  
pp. 29-35 ◽  
Author(s):  
Emilia Noormahomed ◽  
Pamela Williams ◽  
Andrés G. Lescano ◽  
Tony Raj ◽  
Elizabeth A. Bukusi ◽  
...  
Keyword(s):  
Case Studies ◽  
Capacity Development ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals The impact of introducing new vaccines on the health system: Case studies from six low- and middle-income countries

Vaccine ◽  
2014 ◽  
Vol 32 (48) ◽  
pp. 6505-6512 ◽  
Author(s):  
Helen E.D. Burchett ◽  
Sandra Mounier-Jack ◽  
Sergio Torres-Rueda ◽  
Ulla K. Griffiths ◽  
Pierre Ongolo-Zogo ◽  
...  
Keyword(s):  
Health System ◽  
Case Studies ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Impact ◽  
New Vaccines ◽  
Low And Middle Income
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