Association between dehydroepiandrosterone levels and cardiovascular risk in public sector health workers in a Peruvian region

Abstract Background Nurturing care interventions have the potential to promote health and development in early childhood. Amagugu Asakhula was designed to promote developmentally important dietary and movement behaviours among children of preschool age (3–5 years) in South Africa. An initial formative study in Cape Town found the intervention to be feasible and acceptable when delivered by community health workers (CHWs) linked to a community-based organisation. This study evaluated the delivery of the Amagugu Asakhula intervention by CHWs linked to a public sector primary health care facility in Soweto, as this mode of delivery could have more potential for sustainability and scalability. Methods A qualitative design was utilised to assess feasibility, acceptability, adoption, appropriateness, implementation, fidelity and context. CHWs (n = 14) delivered the intervention to caregivers (n = 23) of preschool-age children in Soweto over 6 weeks. Following the completion of the intervention, focus group discussions were held with CHWs and caregivers. Further data were obtained through observations, study records and key informant interviews (n = 5). Data were analysed using deductive thematic analysis guided by a process evaluation framework. Results The delivery of the Amagugu Asakhula intervention through CHWs linked to a primary health care facility in Soweto was not found to be feasible due to contextual challenges such as late payment of salaries influencing CHW performance and willingness to deliver the intervention. CHWs expressed dissatisfaction with their general working conditions and were thus reluctant to take on new tasks. Despite barriers to successful delivery, the intervention was well received by both CHWs and caregivers and was considered a good fit with the CHWs’ scope of work. Conclusions Based on these findings, delivery of the Amagugu Asakhula intervention is not recommended through public sector CHWs in South Africa. This feasibility study informs the optimisation of implementation and supports further testing of the intervention’s effectiveness when delivered by CHWs linked to community-based organisations. The present study further demonstrates how implementation challenges can be identified through qualitative feasibility studies and subsequently addressed prior to large-scale trials, avoiding the wasting of research and resources.

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Compensation Models for Community Health Workers: Comparison of Legal Frameworks across Five Countries

10.21203/rs.3.rs-36222/v1 ◽

2020 ◽

Author(s):

Madeleine Ballard ◽

Carey Westgate ◽

Rebecca Alban ◽

Nandini Choudhury ◽

Rehan Adamjee ◽

...

Keyword(s):

South Africa ◽

Public Sector ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Legal Framework ◽

Law Firms ◽

Advantages And Disadvantages ◽

Compensation Mechanisms ◽

Legal Frameworks

Abstract Background Despite the life-saving work they perform, community health workers (CHWs) have long been subject to global debate about their remuneration. There is now, however, an emerging consensus that CHWs should be paid. As the discussion evolves from whether to financially remunerate CHWs to how to do so, there is an urgent need to better understand the types of CHW payment models and their implications. Methods This study examines the legal framework on CHW compensation in five countries: Brazil, Ghana, Nigeria, Rwanda, and South Africa. In order to map the characteristics of each approach, a standardized questionnaire was developed and targeted at local law firms. The questionnaire covered legal structures and requirements for compensation of CHWs, CHW compensation mechanisms, CHW legal protections and benefits, and alignment of national CHW policies with global guidelines. Results The five countries profiled represent possible archetypes for CHW compensation: Brazil (public), Ghana (volunteer-based), Nigeria (private), Rwanda (cooperatives with performance based incentives) and South Africa (hybrid public/private). Advantages and disadvantages of each model with respect to (i) CHWs, in terms of financial protection, and (ii) the public sector, in terms of ease of implementation, are outlined. Conclusions While a strong legal framework does not necessarily translate into high-quality implementation, it is the first necessary step. While certain approaches to CHW compensation - particularly public-sector or hybrid models with public sector wage floors - best institutionalize recommended CHW protections, political will and long-term financing often remain obstacles. Removing ecosystem barriers - such as multilateral and bilateral restrictions on the payment of salaries - can help governments institutionalize CHW payment.

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Public-Sector Health Spending May Aid Competitiveness

Health Affairs ◽

10.1377/hlthaff.9.2.235-a ◽

1990 ◽

Vol 9 (2) ◽

pp. 235-236

Author(s):

V. Navarro

Keyword(s):

Public Sector ◽

Health Spending ◽

Public Sector Health

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What is the Meaning of Public Sector Health? Translating Discourse into New Organizational Practices

Journal of Change Management ◽

10.1080/14697017.2013.822673 ◽

2013 ◽

Vol 13 (3) ◽

pp. 283-307 ◽

Cited By ~ 10

Author(s):

Susanne Boch Waldorff

Keyword(s):

Public Sector ◽

Organizational Practices ◽

Public Sector Health

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Increasing Trends in Physical and Mental Health Problems among US Workers in Different Job Sectors During the COVID-19 Pandemic

International Journal of Translational Medical Research and Public Health ◽

10.21106/ijtmrph.351 ◽

2021 ◽

Vol 5 (2) ◽

pp. 90-102

Author(s):

Gopal K Singh ◽

Hyunjung Lee ◽

Romuladus E. Azuine

Keyword(s):

Mental Health ◽

Public Sector ◽

Family Business ◽

Mental Health Problems ◽

Health Workers ◽

Health Problems ◽

The Self ◽

Physical And Mental Health ◽

Non Profit ◽

The Government

Background: The COVID-19 pandemic has had a substantial adverse impact on workers’ employment and physical and mental health. However, job losses, job-related household income shocks, and their related physical and mental health problems have not been well-documented. Using temporal, nationally representative data, this study examines inequalities in job-related income losses and their resultant health impact among US workers aged 18-64 years in different job sectors during the pandemic. Methods: Using April, August, and December 2020 rounds of the US Census Bureau’s Household Pulse Survey (N=56,156, 82,173, and 51,500), job-related income losses among workers in various job sectors and associated impacts on self-assessed health, depression, anxiety, worry, and lack of interest were analyzed by multivariable logistic regression. Results: In December 2020, 64.0% of self-employed and 66.3% of unemployed adults reported that they or someone in their household experienced a loss of employment income since the start of the pandemic in March 2020. This percentage was the lowest for the public sector (35.2%) and non-profit-sector (45.0%) workers. Job/income losses increased by 26% between April and December for workers in the private and non-profit sectors. Prevalence of fair/poor overall health, serious depression, serious anxiety, serious worry, and serious lack of interest increased substantially during the pandemic for workers in all sectors, with the self-employed, those in the family business, and the unemployed experiencing the highest risk and those in the government/public and non-profit sectors experiencing the lowest risk of poor physical and mental health. Workers in all sectors reporting job-related income losses experienced approximately 2-to-4-fold higher odds of poor overall health, serious depression, serious anxiety, serious worry, and serious lack of interest, compared to public-sector workers with no job/income losses, controlling for covariates. Conclusion and Implications for Translation: Job-related income losses and prevalence of poor overall health and mental health among workers in all sectors increased markedly during the pandemic, with the self-employed, family business, and unemployed workers being especially vulnerable to poor health, depression, anxiety, and stress. Copyright © 2021 Singh, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

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