scholarly journals Understanding the importance of non-material factors in retaining community health workers in low-income settings: a qualitative case-study in Ethiopia

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037989
Author(s):  
Nikita Arora ◽  
Kara Hanson ◽  
Neil Spicer ◽  
Abiy Seifu Estifanos ◽  
Dorka Woldesenbet Keraga ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Low Income ◽  
Financial Incentives ◽  
Health Workers ◽  
Healthcare Delivery ◽  
Analysis Data ◽  
Social Needs ◽  
Health Extension Worker ◽  
Factors Influencing

ObjectivesThe motivation and retention of community health workers (CHWs) is a challenge and inadequately addressed in research and policy. We sought to identify factors influencing the retention of CHWs in Ethiopia and ways to avert their exit.DesignA qualitative study was undertaken using in-depth interviews with the study participants. Interviews were audio-recorded, and then simultaneously translated into English and transcribed for analysis. Data were analysed in NVivo 12 using an iterative inductive-deductive approach.SettingThe study was conducted in two districts each in the Tigray and Southern Nations, Nationalities and People’s Republic (SNNPR) regions in Ethiopia. Respondents were located in a mix of rural and urban settings.ParticipantsLeavers of health extension worker (HEW) positions (n=20), active HEWs (n=16) and key informants (n=11) in the form of policymakers were interviewed.ResultsWe identified several extrinsic and intrinsic motivational factors affecting the retention and labour market choices of HEWs. While financial incentives in the form of salaries and material incentives in the form of improvements to health facility infrastructure, provision of childcare were reported to be important, non-material factors like HEWs’ self-image, acceptance and validation by the community and their supervisors were found to be critical. A reduction or loss of these non-material factors proved to be the catalyst for many HEWs to leave their jobs.ConclusionOur study contributes new empirical evidence to the global debate on factors influencing the motivation and retention of CHWs, by being the first to include job leavers in the analysis. Our findings suggest that policy interventions that appeal to the social needs of CHWs can prove to be more acceptable and potentially cost-effective in improving their retention in the long run. This is important for government policymakers in resource constrained settings like Ethiopia that rely heavily on lay workers for primary healthcare delivery.

scholarly journals “We wouldn't leave if our jobs changed a little”: Understanding the labour market choices of community health workers in Ethiopia

2020 ◽  
Author(s):  
Nikita Arora ◽  
Kara Hanson ◽  
Neil Spicer ◽  
Abiy Seifu Estifanos ◽  
Dorka Woldesenbet Keraga ◽  
...  
Keyword(s):  
Community Health ◽  
Labour Market ◽  
Community Health Workers ◽  
Financial Incentives ◽  
Social Preferences ◽  
Work Motivation ◽  
Health Workers ◽  
Effective Means ◽  
Social Needs ◽  
Factors Affecting

Abstract Background The motivation and retention of community health workers is a challenge and inadequately addressed in research and policy. In Ethiopia, as part of the country’s Health Extension Program, Health Extension Workers (HEWs) deliver essential primary healthcare services to communities, but low retention of experienced HEWs threatens sustained service delivery and efficient use of their health budget. We sought to identify factors influencing HEW retention and ways to mitigate their exit. Methods Following a review of literature on work motivation and community health worker (CHW) retention to identify a conceptual and theoretical framework to guide analysis, exploratory qualitative work was conducted using in-depth interviews with leavers of HEW positions (n=20), active HEWs (n=16), and key informants (n=11) in two regions in Ethiopia. Interviews were audio recorded, and simultaneously translated into English and transcribed for analysis. Data were analysed in NVivo 12 using an iterative inductive-deductive approach. Results The conceptual framework by Ormel et al, 2019, was adapted to analyse our results thematically. We identified a number of extrinsic and intrinsic motivational factors affecting the retention and labour market choices of HEWs. While financial incentives in the form of salaries, and material incentives in the form of improvements in health facility infrastructure and provision of childcare were reported to be important, non-material factors like HEWs’ self-image, acceptance and validation by the community were found to be critical. A reduction or loss of these non-material factors proved to be the catalysts for many HEWs to leave their jobs. We also found a strong professional self-identity among HEWs, which influenced their willingness to remain in their jobs. Conclusion This is the first study to include job leavers in an analysis of factors affecting motivation of CHWs, aimed to improve retention. In addition to material incentives, our findings suggest that these workers are also socially motivated and identify strongly with their profession. Policy interventions, which also appeal to their social needs, could represent a simpler and more cost-effective means of improving retention of this workforce, especially in resource-constrained settings. Keywords Community health workers, labour market choices, motivation, Ethiopia, pro-social preferences, retention

scholarly journals Impact of Different Levels of Supervision on the Recovery of Severely Malnourished Children Treated by Community Health Workers in Mali

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 367
Author(s):  
Pilar Charle-Cuéllar ◽  
Noemí López-Ejeda ◽  
Mamadou Traore ◽  
Adama Balla Coulibaly ◽  
Aly Landouré ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Low Income ◽  
Community Intervention ◽  
Health Workers ◽  
Acute Malnutrition ◽  
Control Group ◽  
Supportive Supervision ◽  
Supervision Group ◽  
Different Levels

(1) Background: The Ministry of Health in Mali included the treatment of severe acute malnutrition (SAM) into the package of activities of the integrated community case management (iCCM). This paper evaluates the most effective model of supervision for treating SAM using community health workers (CHWs). Methods (2): This study was a prospective non-randomized community intervention trial with two intervention groups and one control group with different levels of supervision. It was conducted in three districts in rural areas of the Kayes Region. In the high supervision group, CHWs received supportive supervision for the iCCM package and nutrition-specific supervision. In the light supervision group, CHWs received supportive supervision based on the iCCM package. The control group had no specific supervision. (3) Results: A total of 6112 children aged 6–59 months with SAM without medical complications were included in the study. The proportion of cured children was 81.4% in those treated by CHWs in the high supervision group, 86.2% in the light supervision group, and 66.9% in the control group. Children treated by the CHWs who received some supervision had better outcomes than those treated by unsupervised CHWs (p < 0.001). There was no difference between areas with light and high supervision, although those with high supervision performed better in most of the tasks analyzed. (4) Conclusions: Public policies in low-income countries should be adapted, and their model of supervision of CHWs for SAM treatment in the community should be evaluated.

Abstract 16462: Using Geospatial Mapping to Target Risk and Facilitate Placement of Community Health Workers, Educational Tools, and AHA Field Teams

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zoe L Zwecker ◽  
Susan Spratt ◽  
Benjamin A Goldstien ◽  
Bradi B Granger
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Undiagnosed Diabetes ◽  
Median Income ◽  
Educational Tools ◽  
Public Data ◽  
Neighborhood Boundaries

Introduction: Diabetes is a chronic condition that affects 34.2 million Americans. Long-lasting or undiagnosed diabetes increases the risk of developing cardiovascular disease (CVD). Geographic Information Systems (GIS) inform healthcare delivery interventions to target patients, clinicians, health systems and communities at highest risk. A gap remains in how data and GIS are applied and leveraged in the context of value-based care delivery systems. This spatial analysis demonstrates the application of a generalizable methodology for allocating resources such as AHA Field Teams, community health workers (CHWs), and educational tools to areas most burdened by diabetes and CVD. Methods: The automated geocoding infrastructure from the Duke Medicine electronic data warehouse was developed to standardize and scale geocoding addresses for a population of people with type 2 diabetes from the Southeastern Diabetes Initiative (SEDI) in 2017. While maintaining accuracy and assuring that patients’ protected health information was secure, we used geocoded data and public data (public health data, census tract data, and information on the built environment) to assess risk and identify accessible resources. Results and Discussion: Using this method to understand racial distribution, level of education, and income,we identified high risk communities in Durham County. We correlated geospatial patterns of health risk, illness burden, and determined accessible resources for diabetes and CVD.We calculated a resource ratio of one CHW to 100 patient-population and identified a central hub for fixed resource access. Using neighborhood boundaries, we identified a community where the burden of diabetes reached 17%, 60% of inhabitants were African American, median income was $55,945, and just 17.7% had a bachelor’s degree. Understanding risk using these social determinants (Figure 1) supports the intentional allocation of resources and hiring of CHWs.

scholarly journals Ongoing training of community health workers in low-income andmiddle-income countries: a systematic scoping review of the literature

BMJ Open ◽  
2018 ◽  
Vol 8 (4) ◽  
pp. e021467 ◽  
Author(s):  
James O’Donovan ◽  
Charles O’Donovan ◽  
Isla Kuhn ◽  
Sonia Ehrlich Sachs ◽  
Niall Winters
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Scoping Review ◽  
Low Income ◽  
Health Workers ◽  
Review Of The Literature ◽  
Ongoing Training

scholarly journals Strategies Used By Community Health Workers to Influence Adoption of Maternal Nutrition Behaviors in Rural Bangladesh: A Focused Ethnographic Study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1359-1359
Author(s):  
Gargi Wable Grandner ◽  
Katherine Dickin ◽  
Purnima Menon ◽  
Tiffany Yeh ◽  
John Hoddinott
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Low Income ◽  
Maternal Nutrition ◽  
Health Workers ◽  
Ethnographic Study ◽  
Low Income Countries ◽  
Cultural Congruence ◽  
Healthy Tree ◽  
Diet Diversity

Abstract Objectives Efforts to integrate nutrition into antenatal health promotion in low income countries have led to increased involvement of community health workers (CHWs) in counseling on maternal nutrition. Little is known about how CHWs “package” messages in resource-poor communities to increase adoption of recommended maternal nutrition behaviors. We developed focused ethnographic techniques to explore this. Methods We interviewed 35 randomly selected CHWs providing monthly counseling to pregnant women and their families in 7 ‘Alive & Thrive’ intervention sites in Bangladesh. Two sorting exercises explored CHW strategies for promoting and perceptions of adoption of messages on micronutrient supplements, maternal dietary adequacy, and rest during pregnancy. In-depth probing on messages identified as “difficult” to deliver or adopt revealed how CHWs addressed barriers. Analysis of quantitative sorting data complemented thematic coding of qualitative textual data using grounded theory. Results CHW communication strategies involved 3 themes: feasibility (attitudes, norms, agency, poverty), audience (influence, motivators, support), and linguistic choice (emotional appeals, metaphors, logic, sellable but inaccurate arguments). CHWs viewed micronutrient messages as least difficult to adopt, requiring minimal “packaging”. Dietary messages were moderately difficult to adopt, prompting CHWs to leverage cultural congruence to target family members with different strategies. For example, messaging on diet diversity targeted husbands—the primary food-buyers—with logical arguments highlighting costs of inaction. When mothers-in-law held beliefs restricting gestational food intake, CHWs used metaphors (‘healthy tree, healthy fruit’) or faith-based appeals. Some CHWs used inaccurate messages (‘mother rests, baby rests’) to promote rest during pregnancy because it was seen as the least feasible behavior to adopt. Conclusions Where behavior change is viewed as feasible, CHWs use culturally resonant strategies to enhance adoption of maternal nutrition behaviors. Cultural congruence, or shared beliefs, language and cultural identity, is key to CHW effectiveness, but unhelpful for contextually infeasible behaviors. BCC programs co-designed with CHWs could improve messaging and effectiveness. Funding Sources Cornell AWARE Travel Grant.

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

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.

Assessing community health workers’ conditions for delivering care to patients in low-income communities

2020 ◽  
Vol 82 ◽  
pp. 102944 ◽  
Author(s):  
Alessandro Jatobá ◽  
Hugo Cesar Bellas ◽  
Bárbara Bulhões ◽  
Isabella Koster ◽  
Rodrigo Arcuri ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Low Income ◽  
Health Workers

scholarly journals Screening and Referral for Postpartum Depression among Low-Income Women: A Qualitative Perspective from Community Health Workers

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Rhonda C. Boyd ◽  
Marjie Mogul ◽  
Deena Newman ◽  
James C. Coyne
Keyword(s):  
Mental Health ◽  
Postpartum Depression ◽  
Focus Groups ◽  
Community Health ◽  
Community Health Workers ◽  
Low Income ◽  
Health Workers ◽  
Academic Community ◽  
Barriers And Facilitators ◽  
Postpartum Women

Postpartum depression is a serious and common psychiatric illness. Mothers living in poverty are more likely to be depressed and have greater barriers to accessing treatment than the general population. Mental health utilization is particularly limited for women with postpartum depression and low-income, minority women. As part of an academic-community partnership, focus groups were utilized to examine staff practices, barriers, and facilitators in mental health referrals for women with depression within a community nonprofit agency serving low-income pregnant and postpartum women. The focus groups were analyzed through content analyses and NVIVO-8. Three focus groups with 16 community health workers were conducted. Six themes were identified: (1) screening and referral, (2) facilitators to referral, (3) barriers to referral, (4) culture and language, (5) life events, and (6) support. The study identified several barriers and facilitators for referring postpartum women with depression to mental health services.

scholarly journals Formerly Incarcerated Community Health Workers Engaging Individuals Returning From Incarceration Into Primary Care: Results From the Transition Clinic Network

2021 ◽  
Vol 9 ◽  
Author(s):  
Jenerius A. Aminawung ◽  
Tyler D. Harvey ◽  
Jerry Smart ◽  
Joseph Calderon ◽  
Anna Steiner ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Outcomes ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Primary Care Clinic ◽  
Social Needs ◽  
Care Clinic ◽  
Primary Care Teams ◽  
Improve Health

Over half a million individuals return from United States prisons and millions more from jails every year, many of whom with complex health and social needs. Community health workers (CHWs) perform diverse roles to improve health outcomes in disadvantaged communities, but no studies have assessed their role as integrated members of a primary care team serving individuals returning from incarceration. Using data from participants who received primary care through the Transitions Clinic Network, a model of care that integrates CHWs with a lived experienced of incarceration into primary care teams, we characterized how CHWs address participant health and social needs during interactions outside of clinic visits for 6 months after participants established primary care. Among the 751 participants, 79% had one or more CHW interactions outside of the clinic documented. Participants with more comorbid conditions, longer stays during their most recent incarceration, and released with a prescription had more interactions with CHWs compared to those with fewer comorbidities, shorter stays, and no prescription at release. Median number of interactions was 4 (interquartile range, IQR 2–8) and 56% were in person. The most common issues addressed (34%) were social determinants of health, with the most common being housing (35%). CHWs working in interdisciplinary primary care teams caring for people with histories of incarceration perform a variety of functions for clients outside of scheduled primary care visits. To improve health outcomes among disadvantaged populations, CHWs should be able to work across multiple systems, with supervision and support for CHW activities both in the primary care clinic and within the community.

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