scholarly journals Role of community health workers in improving cost efficiency in an active case finding tuberculosis programme: an operational research study from rural Bihar, India

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e036625
Author(s):  
Tushar Garg ◽  
Manish Bhardwaj ◽  
Sarang Deo
Keyword(s):  
Health System ◽  
Community Health ◽  
Cost Efficiency ◽  
Health Workers ◽  
Case Finding ◽  
Active Case Finding ◽  
Notification Rate ◽  
Intervention Region ◽  
Cost Efficient ◽  
The Cost

ObjectivesCost-efficient active case finding (ACF) approaches are needed for their large-scale adoption in national tuberculosis (TB) programmes. Our aim was to assess if community health workers’ (CHW) knowledge about families’ health status can improve the cost efficiency of the ACF programme without adversely affecting the delivery of other health services for which they are responsible.DesignQuasi-experimental design.InterventionsWe evaluated an ACF programme in the Samastipur district in Bihar, India, between July 2017 and June 2018. CHWs called Accredited Social Health Activists generated referrals of individuals at risk of TB and conducted symptom-based screening to identify patients with presumptive TB. They also helped them undergo testing and provided treatment support for confirmed TB cases.Primary and secondary outcome measuresWe compared the notification rate from the intervention region with that from a control region in the same district with similar characteristics. We analysed operational data to calculate the cost per TB case diagnosed. We used routine programmatic data from the public health system to estimate the impact on other services provided by CHWs.FindingsCHWs identified 9895 patients with presumptive TB. Of these, 5864 patients were tested for TB, and 1236 were confirmed as TB cases. Annual public case notification rate increased sharply in the intervention region from 45.8 to 105.8 per 100 000 population, whereas it decreased from 50.7 to 45.3 in the control region. There was no practically or statistically significant impact on other output indicators of the CHWs, such as institutional deliveries (−0.04%). The overall cost of the intervention was about US$134 per diagnosed case. Main cost drivers were human resources, and commodities (drugs and diagnostics), which contributed 37.4% and 32.5% of the cost, respectively.ConclusionsACF programmes that use existing CHWs in the health system are feasible, cost efficient and do not adversely affect other healthcare services delivered by CHWs.

scholarly journals Enablers and Challenges in the Implementation of Active Case Findings in a Selected District of Karnataka, South India: A Qualitative Study

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Amrita N. Shamanewadi ◽  
Poonam R. Naik ◽  
Pruthu Thekkur ◽  
Suwarna Madhukumar ◽  
Abhay Subhashrao Nirgude ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
General Health ◽  
South India ◽  
Health Workers ◽  
Case Finding ◽  
Rural District ◽  
Health Staff ◽  
Active Case Finding ◽  
Active Case

Background. Active case finding (ACF) for tuberculosis (TB) is a promising tool to enhance early case detection among marginalized populations. As opposed to passive case finding, it involves systematically searching for TB in individuals who would not spontaneously present for care. The National TB Program (NTP) of India has initiated ACF for TB through the existing general health system since the end of 2017. However, prior to scale-up, there is need for exploring the implementation challenges and solutions to improve the efficiency of this program. Objectives. (1) To explore the enablers and challenges in the implementation of ACF for TB by NTP in the Bengaluru rural district of Karnataka, South India, and (2) to explore the perceived solutions to improve the efficiency of ACF activity. Methods. A qualitative descriptive study was conducted in the Bengaluru rural district during July 2018. In-depth interviews using purposively selected health care providers involved in active case finding (n=9) and presumptive TB patients (n=8) were conducted. Manual content analysis was conducted by two independent researchers to generate categories and themes. Results. The challenges in conduct of ACF were as follows: inadequate training of health care workers, shortage of staff, indifferent attitude of community due to stigma, lack of awareness about TB, illiteracy, inability to convince patients for sputum test, and delay in getting CBNAAT results. The field staff recommended the installation of mobile CBNAAT machine, involvement of general health staff in activity, training of health workers on counseling of patients, and issue of identity cards for community health workers/volunteers so that people recognize them. Conclusion. The health system challenges in conduct of ACF need to be addressed by training the health staff involved in activity and also improving the access to TB diagnostics.

scholarly journals Prediagnostic loss to follow-up in an active case finding tuberculosis programme: a mixed-methods study from rural Bihar, India

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e033706 ◽  
Author(s):  
Tushar Garg ◽  
Vivek Gupta ◽  
Dyuti Sen ◽  
Madhur Verma ◽  
Miranda Brouwer ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Health System ◽  
Health Workers ◽  
Case Finding ◽  
Diagnostic Evaluation ◽  
Active Case Finding ◽  
Loss To Follow Up ◽  
The Public ◽  
Active Case

ObjectiveTo quantify the prediagnostic loss to follow-up (PDLFU) in an active case finding tuberculosis (TB) programme and identify the barriers and enablers in undergoing diagnostic evaluation.DesignExplanatory mixed-methods design.SettingA rural population of 1.02 million in the Samastipur district of Bihar, India.ParticipantsBased on their knowledge of health status of families, community health workers or CHWs (called accredited social health activist or locally) and informal providers referred people to the programme. The field coordinators (FCs) in the programme screened the referrals for TB symptoms to identify presumptive TB cases. CHWs accompanied the presumptive TB patients to free diagnostic evaluation, and a transport allowance was given to the patients. Thereafter, CHWs initiated and supported the treatment of confirmed cases. We included 13 395 community referrals received between January and December 2018. To understand the reasons of the PDLFU, we conducted in-depth interviews with patients who were evaluated (n=3), patients who were not evaluated (n=4) and focus group discussions with the CHWs (n=2) and FCs (n=1).Outcome measuresProportion and characteristics of PDLFU and association of demographic and symptom characteristics with diagnostic evaluation.ResultsA total of 11 146 presumptive TB cases were identified between January and December 2018, out of which 4912 (44.1%) underwent diagnostic evaluation. In addition to the free TB services in the public sector, the key enablers were CHW accompaniment and support. The major barriers identified were misinformation and stigma, deficient family and health provider support, transport challenges and poor services in the public health system.ConclusionFinding the missing cases will require patient-centric diagnostic services and urgent reform in the health system. A community-oriented intervention focusing on stigma, misinformation and patient support will be critical to its success.

scholarly journals Active case finding: community health workers' activity related to tuberculosis control in a large city, brazil

2014 ◽  
Vol 23 (2) ◽  
pp. 261-269 ◽  
Author(s):  
Beatriz Estuque Scatolin ◽  
Erika Simone Galvão Pinto ◽  
Ricardo Alexandre Arcêncio ◽  
Rubia Laine de Paula Andrade ◽  
Anneliese Domingues Wysocki ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Large City ◽  
Secondary Data ◽  
Cross Sectional Study ◽  
Case Finding ◽  
Active Case Finding ◽  
Cross Sectional ◽  
Active Case

This study analyzed the Community Health Workers' activity in active case finding in Ribeirão Preto-SP. Cross sectional study, conducted in 2009-2010, with the use of a structured form, which was applied to 105 Community Health Workers and research of secondary data. Indicators were created based on the variable means that used the Likert scale for the answers, being dissatisfactory (scores 1 and 2), regular (3) and satisfactory (4 and 5). Deficiencies in the activity of the Community Workers in the active case finding were identified (mean=3.0), in the discussion with the community about the tuberculosis (mean=1.5) and in the establishment of partnership in the region for the active case finding (mean=1.9). Only 6% of the expected respiratory symptoms in the areas where the units of the participants are located were examined. The results reinforced the need for nursing supervision, a new work logic, with advances in the intersectional articulation, aimed at increasing the detection of tuberculosis cases.

scholarly journals Cost Analysis of a Novel Method for Ecological Compensation—A Study of the Translocation of Dead Wood

2021 ◽  
Vol 13 (11) ◽  
pp. 6075
Author(s):  
Ola Lindroos ◽  
Malin Söderlind ◽  
Joel Jensen ◽  
Joakim Hjältén
Keyword(s):  
Cost Efficiency ◽  
Dead Wood ◽  
Road Transportation ◽  
Ecological Value ◽  
Ecological Compensation ◽  
Work Time ◽  
Delivery Times ◽  
Novel Method ◽  
Cost Efficient ◽  
The Cost

Translocation of dead wood is a novel method for ecological compensation and restoration that could, potentially, provide a new important tool for biodiversity conservation. With this method, substrates that normally have long delivery times are instantly created in a compensation area, and ideally many of the associated dead wood dwelling organisms are translocated together with the substrates. However, to a large extent, there is a lack of knowledge about the cost efficiency of different methods of ecological compensation. Therefore, the costs for different parts of a translocation process and its dependency on some influencing factors were studied. The observed cost was 465 SEK per translocated log for the actual compensation measure, with an additional 349 SEK/log for work to enable evaluation of the translocation’s ecological results. Based on time studies, models were developed to predict required work time and costs for different transportation distances and load sizes. Those models indicated that short extraction and insertion distances for logs should be prioritized over road transportation distances to minimize costs. They also highlighted a trade-off between costs and time until a given ecological value is reached in the compensation area. The methodology used can contribute to more cost-efficient operations and, by doing so, increase the use of ecological compensation and the benefits from a given input.

scholarly journals Capacitação de agentes comunitários de saúde: integração entre universidade e atenção básica

2020 ◽  
Vol 11 (3) ◽  
pp. 349-359
Author(s):  
Amanda Brait Zerbeto ◽  
Leonardo De Carvalho ◽  
Thaís Amanda Rossa ◽  
Daniel De Paula
Keyword(s):  
Health System ◽  
Continuing Education ◽  
Community Health ◽  
Engineering Students ◽  
Health Workers ◽  
Unified Health System ◽  
Local Problems ◽  
Health Concept ◽  
Institutional Relations ◽  
Training Community

O Projeto Rondon tem criado oportunidades, especialmente na saúde, para que universitários interajam com comunidades vulneráveis, socializando saberes e discutindo soluções coletivamente. O Agente Comunitário de Saúde (ACS) é um personagem fundamental na implementação do Sistema Único de Saúde (SUS), fortalecendo a integração entre os serviços de saúde e a comunidade. Mesmo com muitos avanços, a formação dos ACS permanece um desafio. Este estudo relata a experiência de um projeto de extensão na elaboração, desenvolvimento e realização de uma capacitação para ACS no município de Lindoeste, Paraná. As oficinas foram elaboradas multidisciplinarmente por acadêmicos de enfermagem, nutrição, psicologia e engenharia ambiental. Adotou-se o conceito ampliado de saúde, abordando conceitos do SUS, promoção e prevenção, educação ambiental, nutrição, humanização, além de demandas locais. A utilização de metodologias ativas e de temas relacionados à comunidade permitiram a troca de saberes, criando um espaço em que todos puderam expor suas opiniões e assim buscar soluções para os problemas locais. O desconhecimento dos ACS sobre os conceitos do SUS foi um desafio para o aprofundamento da discussão, moldando o debate muitas vezes num modelo pedagógico clássico. Um ponto positivo foi a integração e colaboração entre os ACS a partir do entendimento dos impactos que o processo de trabalho pode trazer ao município. A partir da capacitação dos ACS, ficou evidente a importância de os projetos de extensão estarem em consonância com as necessidades do território que, no presente trabalho, revelou a necessidade de elaboração e realização da educação continuada dos ACS. Palavras-chave: Sistema Único de Saúde; Atenção Primária à Saúde; Educação Continuada; Relações Comunidade-Instituição Training community health workers: integration between university and primary healthcare   Abstract: The Rondon Project has provided opportunities, especially in the health area, for university students to interact with vulnerable communities, share knowledge, and discuss solutions collectively. The Community Health Worker (CHW) plays a key role in implementing the Brazilian Unified Health System (Sistema Único de Saúde - SUS), strengthening the integration between health services and the community. Even with many advances, the education of CHWs remains a challenge. This study reports an extension project's experience in elaborating, developing, and accomplishing training for CHW in Lindoeste, Paraná state, Brazil. The workshops were developed in a multidisciplinary manner by nursing, nutrition, psychology, and environmental engineering students. The expanded health concept was adopted, addressing SUS concepts, health promotion, prevention, environmental education, nutrition, humanization, and local demands. The use of active learning methods and community-related themes allowed for knowledge sharing, creating an environment where everyone could express their opinions and seek solutions to local problems. CHW's lack of knowledge about SUS concepts was a challenge to deepen the discussion, often shaping the debate in a traditional way. A positive point was the integration and collaboration among CHW, which were carried out in understanding the value of the collaborative workflow for their community. This experience highlighted the importance of the extension project being in tune with the demand of the territory, which in the present work revealed the need to elaborate and carry out continuing education of the CHW. Keywords: : Unified Health System; Primary Health Care; Continuing Education; Community Institutional Relations

scholarly journals A Randomized Control Trial to Test Effect of Cash Incentives and Training on Active Casefinding for Tuberculosis among Community Health Workers in Nigeria

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1154
Author(s):  
Christie Akwaowo ◽  
Victor Umoh ◽  
Idongesit Umoh ◽  
Eno Usoroh ◽  
Olugbemi Motilewa ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Case Finding ◽  
P Value ◽  
Case Detection ◽  
High Burden ◽  
Cash Incentives ◽  
Case Notification ◽  
And Training

Background: Case detection for Tuberculosis remains low in high burden communities. Community Health Workers (CHWs) are the first point of contact for many Nigerians in the rural areas and have been found useful in active case finding. This study assessed the effect of cash incentives and training on tuberculosis case detection by CHWs in six Local Government Areas in Nigeria. Materials and Methods: A randomised control trial was conducted in three PHC clusters. The intervention Arm (A) received cash incentives for every presumptive case referred. The Training Arm(B) had no cash incentives and the control had neither training nor cash incentives. Case notification rates from the TB program were used to assess the effect of cash incentives on TB case finding. Data was analyzed using Graph Pad Prism. Descriptive data was presented in tables and bivariate data was analyzed using chi square. Mean increases in case notification rates was calculated Statistical significance was set as P=0.05. Results: The intervention identified 394 presumptive TB cases, contributing 30.3% of all presumptive cases notified in the LGAs. Findings also showed an increase of 14.4% (ꭓ2=2.976, P value=0.2258) in case notification rates for the Arm A that received cash incentives alongside training, there was also an increase of 7.4% (ꭓ2= 1.999, P value=0.1575) in Arm B that received Training only. Secondary outcomes indicated a 144.8%(ꭓ2= 4.147, P value=0.1258)  increase in community outreaches conducted in the Arm that were given cash incentives. Conclusion: The study demonstrated an increase in TB control activities of case notification and outreaches among community health workers that received cash incentives and training.  These findings support the use training and cash incentives for CHWs in high burden TB settings to improve TB case detection rates.

scholarly journals Cost efficiency of the Czech and Slovak banking sectors: an application of the data envelopment analysis

2016 ◽  
Author(s):  
Iveta Palecková
Keyword(s):  
Data Envelopment Analysis ◽  
Cost Efficiency ◽  
Commercial Banks ◽  
Banking Sector ◽  
Banking Industry ◽  
Returns To Scale ◽  
Data Envelopment ◽  
Cost Efficient ◽  
The Cost ◽  
Variable Returns To Scale

The aim of the paper is to estimate the cost efficiency of the Czech and Slovak commercial banks within the period 2010-2014. For empirical analysis the Data Envelopment Analysis input-oriented model with variable returns to scale is applied on the data of the commercial banks. The intermediation approach is adopted to define the inputs and outputs. The Czech commercial banks are more cost efficient than Slovak commercial banks. The development of average cost efficiency is similar in the Czech and Slovak banking industry. The most efficient Czech banks are Ceská sporitelna and Sberbank in the Czech banking sector, the most efficient Slovak bank is Privatbanka with 100% efficiency.

scholarly journals Global Prospects of the Cost-Efficiency of Broiler Welfare in Middle-Segment Production Systems

Animals ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. 473 ◽  
Author(s):  
Luuk S.M. Vissers ◽  
Ingrid C. de Jong ◽  
Peter L.M. van Horne ◽  
Helmut W. Saatkamp
Keyword(s):  
United States ◽  
The Netherlands ◽  
Animal Welfare ◽  
Cost Efficiency ◽  
Production Systems ◽  
Production Costs ◽  
Middle Segment ◽  
Efficient Manner ◽  
Cost Efficient ◽  
The Cost

In the 2000s, the idea of a so-called middle-segment arose in North-West Europe to address the criticism on intensive broiler production systems. Middle-segment systems being indoor housing of slower-growing broiler strains at a stocking density ≤38 kg/m2. Previous literature showed that Dutch middle-segment systems entail a relatively large gain in animal welfare at a relatively low increase in costs, i.e., have a high cost-efficiency. The question is to what extent these findings are applicable to other countries. Therefore, the aim of this study is to gain insight in the global prospects of middle-segment systems by exploring the cost-efficiency of these systems in other parts of the world. A set of representative countries, containing the Netherlands, United States and Brazil were selected. Cost-efficiency was defined as the ratio of the change in the level of animal welfare and the change in production costs. The level of animal welfare was measured by the Welfare Quality (WQ) index score. Data was collected from literature and consulting experts. Results show that in the Netherlands, United States and Brazil a change from conventional towards a middle-segment system improves animal welfare in a cost-efficient manner (the Netherlands 9.1, United States 24.2 and Brazil 12.1). Overall, it can be concluded that in general middle-segment production systems provide a considerable increase in animal welfare at a relatively small increase in production costs and therefore offer good prospects for a cost-efficient improvement of broiler welfare.

What are the roles of community health workers? Looking back at the philosophies of primary health care

2019 ◽  
Vol 27 (2) ◽  
pp. 117-120
Author(s):  
Marietou Niang
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Community Development ◽  
Health System ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Primary Health ◽  
Looking Back

This commentary discusses the different roles of community health workers (CHWs), their challenges and limitations in a historical perspective of primary health care (PHC). We first try to show that the comprehensive philosophy of PHC promulgated in Alma-Ata proposed the role of CHWs as actors who work in community development. On the other hand, in the 1980s, with the emergence of the selective philosophy of PHC, CHWs’ role was more affiliated with the health system. We conclude our pitch about the balance that can exist between these different roles by suggesting that CHWs can work in continuity with the health system, but they should not be considered as affordable labor. Also, they must be supported in their activities to develop their communities, allowing them to participate effectively in programs and policies that concern them and their community.

scholarly journals Cost-efficient inter-robot delivery for resource-constrained and interdependent multi-robot schedules

2019 ◽  
Vol 16 (1) ◽  
pp. 172988141982804 ◽  
Author(s):  
Yin Chen ◽  
Xinjun Mao ◽  
Shuo Yang ◽  
Qiuzhen Wang
Keyword(s):  
Cost Efficiency ◽  
Resource Constrained ◽  
Task Execution ◽  
Robot System ◽  
Sequential Execution ◽  
Constrained Environments ◽  
Cost Efficient ◽  
The Cost ◽  
Multi Robot

A multi-robot system in resource-constrained environments needs to obtain resources for task execution. Typically, resources can be fetched from fixed stations, which, however, can be costly and even impossible when fixed stations are unavailable, depleted or distant from task execution locations. We present a method that allows robots to acquire urgently required resources from those robots with superfluous residual resources, by conducting rendezvouses with these robots. We consider a scenario where tasks are organised into a schedule on each robot for sequential execution, with cross-schedule dependencies for inter-robot collaboration. We design an algorithm to systematically generate such rendezvouses for entire multi-robot system to increase the proportion of tasks whose resource demands are satisfied. We also design an algorithm that periodically reallocates tasks among robots to improve the cost-efficiency of schedules. Our experiment shows the synergetic effectiveness of both algorithms, when fixed stations are unavailable and all resources are fetched through inter-robot delivery. We also investigate the effectiveness of inter-robot delivery in scenarios where fixed stations are existent but distant from the locations of tasks.

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