Training, supervision, and performance of Community Health Workers in the delivery of ear and hearing care to 321 community members in rural Uganda

Addressing the issue of HIV-stigma is recognised as essential to reducing the spread of HIV and AIDS, enabling community members to access prevention, treatment and care. Often the very people who are able to contribute to solving the problem, are marginalised and do not see ways to insert themselves into dialogues related to combating stigma. Community health workers in rural South Africa are one such group. At the heart of the research discussed in this article is an intervention based on participatory analysis through participatory archiving ( Shilton and Srinivasan 2008 ). Drawing on participatory work with thirteen community health workers in rural KwaZulu-Natal, we use a digital archive containing HIV-stigma visual data - generated five years earlier by youth in the community - to engage the participants in the analysis. Drawing on such participatory work as Jenkins’ participatory cultures framework, we focus on the idea of re-using, re-coding, and re-mixing visual data. One participant stated that “these pictures talk about the real issues faced by our communities”, highlighting the value of resources generated by community members themselves. They also indicate that they “could use [the resources] to teach the cons of stigmatising”. A key concern in work related to visual images (particularly in projects such as ours where a large amount of visual data is produced) is to consider ways of extending its life through the use of community-based digital archives.

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Connecting communities to primary care: a qualitative study on the roles, motivations and lived experiences of community health workers in the Philippines

BMC Health Services Research ◽

10.1186/s12913-020-05699-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Eunice Mallari ◽

Gideon Lasco ◽

Don Jervis Sayman ◽

Arianna Maever L. Amit ◽

Dina Balabanova ◽

...

Keyword(s):

Qualitative Study ◽

Community Health ◽

Community Health Workers ◽

Financial Incentives ◽

Lived Experiences ◽

Health Workers ◽

The Philippines ◽

Community Members ◽

Cross Sectional ◽

The Impact

Abstract Background Community health workers (CHWs) are an important cadre of the primary health care (PHC) workforce in many low- and middle-income countries (LMICs). The Philippines was an early adopter of the CHW model for the delivery of PHC, launching the Barangay (village) Health Worker (BHW) programme in the early 1980s, yet little is known about the factors that motivate and sustain BHWs’ largely voluntary involvement. This study aims to address this gap by examining the lived experiences and roles of BHWs in urban and rural sites in the Philippines. Methods This cross-sectional qualitative study draws on 23 semi-structured interviews held with BHWs from barangays in Valenzuela City (urban) and Quezon province (rural). A mixed inductive/ deductive approach was taken to generate themes, which were interpreted according to a theoretical framework of community mobilisation to understand how characteristics of the social context in which the BHW programme operates act as facilitators or barriers for community members to volunteer as BHWs. Results Interviewees identified a range of motivating factors to seek and sustain their BHW roles, including a variety of financial and non-financial incentives, gaining technical knowledge and skill, improving the health and wellbeing of community members, and increasing one’s social position. Furthermore, ensuring BHWs have adequate support and resources (e.g. allowances, medicine stocks) to execute their duties, and can contribute to decisions on their role in delivering community health services could increase both community participation and the overall impact of the BHW programme. Conclusions These findings underscore the importance of the symbolic, material and relational factors that influence community members to participate in CHW programmes. The lessons drawn could help to improve the impact and sustainability of similar programmes in other parts of the Philippines and that are currently being developed or strengthened in other LMICs.

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

International Health ◽

10.1093/inthealth/ihz082 ◽

2019 ◽

Vol 12 (4) ◽

pp. 281-286 ◽

Cited By ~ 2

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.

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How should community health workers in fragile contexts be supported: Qualitative evidence from Sierra Leone, Liberia and Democratic Republic of Congo

10.21203/rs.3.rs-27544/v2 ◽

2020 ◽

Author(s):

Joanna Raven ◽

Haja Wurie ◽

Ayesha Idriss ◽

Abdulai Jawo Bah ◽

Amuda Baba ◽

...

Keyword(s):

Community Health ◽

Sierra Leone ◽

Community Health Workers ◽

Democratic Republic ◽

Health Workers ◽

Democratic Republic Of Congo ◽

Community Support ◽

Health Coverage ◽

Republic Of Congo ◽

And Performance

Abstract Background: Community Health Workers (CHWs) are critical players in fragile settings, where staff shortages are particularly acute, health indicators are poor and progress towards Universal Health Coverage is slow. Like other health workers, CHWs need support to contribute effectively to health programmes and promote health equity. Yet the evidence base of what kind of support works best is weak. We present evidence from three fragile settings - Sierra Leone, Liberia and Democratic Republic of Congo on managing CHWs, and synthesise recommendations for best approaches to support this critical cadre.Methods: We used a qualitative study design to explore how CHWs are managed, the challenges they face and potential solutions. We conducted interviews with decision makers and managers (n=37), life history interviews with CHWs (n=15) and reviewed policy documents. Results: Fragility disrupts education of community members so that they may not have the literacy levels required for the CHW role. This has implications for the selection, role, training and performance of CHWs. Policy preferences about selection need discussion at the community level, so that they reflect community realities. CHWs scope of work is varied and may change over time, requiring ongoing training. The modular, local, and mix of practical and classroom training approach worked well, helping to address gender and literacy challenges and developing a supportive cohort of CHWs. A package of supervision, community support, regular provision of supplies, performance rewards and regular remuneration is vital to retention and performance of CHWs. But there are challenges with supervision, scarcity of supplies, inadequate community recognition and unfulfilled promises about allowances. Clear communication about incentives with facility staff and communities is required as is their timely delivery.Conclusions: This is the first study that has explored the management of CHWs in fragile settings. CHWs interface role between communities and health systems is critical because of their embedded positionality and the trusting relationships they (often) have. Their challenges are aligned to those generally faced by CHWs but chronic fragility exacerbates them and requires innovative problem solving to ensure that countries and communities are not left behind in reforming the way that CHWs are supported.

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Reactions of community members regarding community health workers’ activities as a measure of the impact of a training program in Amazonas, Brazil

Journal of Rural Medicine ◽

10.2185/jrm.2890 ◽

2015 ◽

Vol 10 (1) ◽

pp. 7-19 ◽

Cited By ~ 1

Author(s):

Ryoko Kawasaki ◽

Toru Sadamori ◽

Terezinha Ferreira de Almeida ◽

Megumi Akiyoshi ◽

Mika Nishihara ◽

...

Keyword(s):

Community Health ◽

Training Program ◽

Community Health Workers ◽

Health Workers ◽

Community Members ◽

The Impact

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Perspectives and experiences of community health workers in Brazilian primary care centers using m-health tools in home visits with community members

Human Resources for Health ◽

10.1186/s12960-017-0245-9 ◽

2017 ◽

Vol 15 (1) ◽

Cited By ~ 6

Author(s):

Julia Schoen ◽

John William Mallett ◽

Rebecca Grossman-Kahn ◽

Alexandra Brentani ◽

Elizabeth Kaselitz ◽

...

Keyword(s):

Primary Care ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Home Visits ◽

Community Members

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Community health workers’ involvement in the prevention and control of non-communicable diseases in Wakiso District, Uganda

Globalization and Health ◽

10.1186/s12992-020-00653-5 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

David Musoke ◽

Edwinah Atusingwize ◽

Deborah Ikhile ◽

Sarah Nalinya ◽

Charles Ssemugabo ◽

...

Keyword(s):

Risk Factors ◽

Community Health ◽

Community Health Workers ◽

Prevention And Control ◽

Health Workers ◽

Communicable Diseases ◽

Community Mobilisation ◽

Community Members ◽

Non Communicable Diseases ◽

And Control

Abstract Background Community health workers (CHWs) are an important cadre of the global health workforce as they are involved in providing health services at the community level. However, evidence on the role of CHWs in delivering interventions for non-communicable diseases (NCDs) in Uganda is limited. This study, therefore, assessed the involvement of CHWs in the prevention and control of NCDs in Wakiso District, Uganda with a focus on their knowledge, attitudes and practices, as well as community perceptions. Methods A cross-sectional study using mixed methods was conducted which involved a structured questionnaire among 485 CHWs, and 6 focus group discussions (FGDs) among community members. The study assessed knowledge, perceptions including the importance of the various risk factors, and the current involvement of CHWs in NCDs, including the challenges they faced. Quantitative data were analysed in STATA version 13.0 while thematic analysis was used for the qualitative data. Results The majority of CHWs (75.3%) correctly defined what NCDs are. Among CHWs who knew examples of NCDs (87.4%), the majority mentioned high blood pressure (77.1%), diabetes (73.4%) and cancer (63.0%). Many CHWs said that healthy diet (86.2%), physical activity (77.7%), avoiding smoking/tobacco use (70.9%), and limiting alcohol consumption (63.7%) were very important to prevent NCDs. Although more than half of the CHWs (63.1%) reported being involved in NCDs activities, only 20.9 and 20.6% had participated in community mobilisation and referral of patients respectively. The majority of CHWs (80.1%) who were involved in NCDs prevention and control reported challenges including inadequate knowledge (58.4%), lack of training (37.6%), and negative community perception towards NCDs (35.1%). From the FGDs, community members were concerned that CHWs did not have enough training on NCDs hence lacked enough information. Therefore, the community did not have much confidence in them regarding NCDs, hence rarely consulted them concerning these diseases. Conclusions Despite CHWs having some knowledge on NCDs and their risk factors, their involvement in the prevention and control of the diseases was low. Through enhanced training and community engagement, CHWs can contribute to the prevention and control of NCDs, including health education and community mobilisation.

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How should community health workers in fragile contexts be supported: Qualitative evidence from Sierra Leone, Liberia and Democratic Republic of Congo

10.21203/rs.3.rs-27544/v1 ◽

2020 ◽

Author(s):

Joanna Raven ◽

Haja Wurie ◽

Ayesha Idriss ◽

Abdulai Jawo Bah ◽

Amuda Baba ◽

...

Keyword(s):

Community Health ◽

Sierra Leone ◽

Community Health Workers ◽

Democratic Republic ◽

Health Workers ◽

Democratic Republic Of Congo ◽

Community Support ◽

Health Coverage ◽

Republic Of Congo ◽

And Performance

Abstract Background Community Health Workers (CHWs) are critical players in fragile settings, where staff shortages are particularly acute, health indicators are poor and progress towards Universal Health Coverage is slow. Like other health workers, CHWs need support to contribute effectively to health programmes and promote health equity. Yet the evidence base of what kind of support works best is weak. We present evidence from three fragile settings - Sierra Leone, Liberia and Democratic Republic of Congo on managing CHWs, and synthesise recommendations for best approaches to support this critical cadre.Methods We used a qualitative study design to explore how CHWs are managed, the challenges they face and potential solutions. We conducted interviews with decision makers and managers (n = 37), life history interviews with CHWs (n = 15) and reviewed policy documents.Results Fragility disrupts education of community members so that they may not have the literacy levels required for the CHW role. This has implications for selection, role, training and performance of CHWs. Policy preferences about selection need discussion at the community level, so that they reflect community realities. CHWs scope of work is varied and may change over time, requiring ongoing training. The modular, local, and mix of practical and classroom training approach worked well, helping to address gender and literacy challenges and develop a supportive cohort of CHWs. A package of supervision, community support, regular provision of supplies, performance rewards and regular remuneration is vital to retention and performance of CHWs. But there are challenges with supervision, scarcity of supplies, inadequate community recognition and unfulfilled promises about allowances. Clear communication about incentives with facility staff and communities is required as is their timely delivery.Conclusions This is the first study that has explored the management of CHWs in fragile settings. CHWs interface role between communities and health systems is critical because of their embedded positionality and the trust they (often) have. Their challenges are aligned to those generally faced by CHWs but chronic fragility exacerbates them and requires innovative problem solving to ensure that countries and communities are not left behind in reforming the way that CHWs are supported.

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Risk factors for childhood illness and death in rural Uttar Pradesh, India: perspectives from the community, community health workers and facility staff

BMC Public Health ◽

10.1186/s12889-021-12047-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kanchan Srivastava ◽

Ranjana Yadav ◽

Lorine Pelly ◽

Elisabeth Hamilton ◽

Gaurav Kapoor ◽

...

Keyword(s):

Risk Factors ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Uttar Pradesh ◽

Childhood Illness ◽

Severe Illness ◽

Community Members ◽

Vulnerable Children ◽

Facility Staff

Abstract Background Uttar Pradesh (UP), India continues to have a high burden of mortality among young children despite recent improvement. Therefore, it is vital to understand the risk factors associated with under-five (U5) deaths and episodes of severe illness in order to deliver programs targeted at decreasing mortality among U5 children in UP. However, in rural UP, almost every child has one or more commonly described risk factors, such as low socioeconomic status or undernutrition. Determining how risk factors for childhood illness and death are understood by community members, community health workers and facility staff in rural UP is important so that programs can identify the most vulnerable children. Methods This qualitative study was completed in three districts of UP that were part of a larger child health program. Twelve semi-structured interviews and 21 focus group discussions with 182 participants were conducted with community members (mothers and heads of households with U5 children), community health workers (CHWs; Accredited Social Health Activists and Auxiliary Nurse Midwives) and facility staff (medical officers and staff nurses). All interactions were recorded, transcribed and translated into English, coded and clustered by theme for analysis. The data presented are thematic areas that emerged around perceived risk factors for childhood illness and death. Results There were key differences among the three groups regarding the explanatory perspectives for identified risk factors. Some perspectives were completely divergent, such as why the location of the housing was a risk factor, whereas others were convergent, including the impact of seasonality and certain occupational factors. The classic explanatory risk factors for childhood illness and death identified in household surveys were often perceived as key risk factors by facility staff but not community members. However, overlapping views were frequently expressed by two of the groups with the CHWs bridging the perspectives of the community members and facility staff. Conclusion The bridging views of the CHWs can be leveraged to identify and focus their activities on the most vulnerable children in the communities they serve, link them to facilities when they become ill and drive innovations in program delivery throughout the community-facility continuum.

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Overcoming the Digital Divide in the post-COVID “Reset”: Enhancing Group Virtual Visits with Community Health Workers (Preprint)

10.2196/preprints.27682 ◽

2021 ◽

Author(s):

Megha K. Shah ◽

Ashley Christina Gibbs ◽

Mohammed Kumail Ali ◽

K. M. Venkat Narayan ◽

Nadia Islam

Keyword(s):

Community Health ◽

Community Health Workers ◽

Limited English Proficiency ◽

Health Workers ◽

Clinical Care ◽

Community Members ◽

Group Visit ◽

Virtual Visits ◽

Hard To Reach Populations ◽

Virtual Platform

UNSTRUCTURED The COVID-19 pandemic created numerous barriers to implement participant-facing research. For most, the pandemic required quickly transitioning to all virtual platforms. Like clinical care in the pandemic, our most vulnerable populations are at highest risk of falling through the cracks of engagement in research. Yet, we argue that we should reframe the discussion to consider how this transition may create opportunities to engage hard to reach populations. In the following, we present our experience in Atlanta, GA, transitioning a group visit model for South Asian immigrants to a virtual platform and the pivotal role community members in the form of community health workers (CHWs) can play in building capacity among participants. We provide details on how this model helped address common barriers to group visit models in clinical practice and how our CHW team innovatively addressed the digital challenges of working with an elderly population with limited English proficiency.

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