OA55 Impact of community health workers for continuum care of palliative care at community level integrated in rwanda public health system

Background: PIERS on the Move (POM) is a mobile health application developed to support community health workers identification and management of women at risk of adverse outcomes from pre-eclampsia. The objective of this study was to evaluate the impact of using POM in Pakistan on Lady Health Workers' (LHWs) knowledge and self-efficacy related to caring for women with pre-eclampsia, and their perception of usefulness of the tool.Methodology: An evaluation was designed for health care workers involved in the Community-Level Intervention for Pre-eclampsia (CLIP) cluster randomized trial from 2014 to 2016 in Sindh Province, Pakistan (NCT01911494). A semi-structured focus group guide was developed based on the Technology Acceptance Model (TAM), which theorizes that an individual's behavioral intention to use a system is determined by perceived usefulness and ease of use. Preliminary qualitative analysis was undertaken by the Pakistan and Canadian teams to create a coding framework for full qualitative analysis, which was completed using NVivo12.Results: Three key informant interviews were conducted with two Lady Health Supervisors and one Senior Medical Officer. Sixty-two LHWs were included in three focus group discussions. LHWs found the POM app easy to use and useful for their work as a helpful repository for maternal health information and guiding counseling and management of pre-eclampsia. LHWs reported increased knowledge and confidence in their work. Availability of clinical homecare, including postpartum, was felt to positively impact healthcare provided to pregnant and postpartum women. Potential community level impacts included strengthening relationships between health care providers and communities and between LHWs and the health system. LHWs shared reports of earlier care-seeking and increased awareness of maternal health issues by community members.Conclusions: LHWs carry a large burden of responsibility for community health in rural Pakistan and appreciated the investment in their skills and capacity during the CLIP trial with the POM app. Investing in communications technology for community health workers through improved referrals and follow up may strengthen cohesiveness of the health system overall.

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Community health workers & medical students: a strategic partnership for Brazilian public health

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.645 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Faria de Moura Villela ◽

F Morato de Oliveira

Keyword(s):

Public Health ◽

Medical Students ◽

Focus Groups ◽

Health System ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Role Playing ◽

Strategic Partnership ◽

The Public

Abstract Introduction Family Health Strategy represents a successful initiative for reorganization of primary care in Brazil. A differential is the Community Health Workers (CHW), who act facilitating community access to effective professional care in the form of health-promoting actions. However, the way CHW receive training to manage epidemics, as dengue, is almost unknown. In this context, this project addresses the importance of bringing together medical students and CHW in order to strengthening not only continuing education of CHW, but also the experienced learning of future physicians. Methods An exploratory study of qualitative approach was done. Two focus groups were conducted with ten CHW in a primary health care unit (PHCU) in Brazilian Midwest. The focus groups were conducted by the tutor and students previously trained on dengue prevention and management. Results Students identified difficulties in daily work and informational/ communicational gaps based on what was said by CHW if compared with the Ministry of Health protocol towards dengue control. These gaps were the basis for an action strategy to develop with CHW. Students developed strategies based on knowledge acquired on public health and experienced practices in medical school: meetings with CHW and other health professionals using lectures, conversation circles, role-playing and problem-situations. All activities were previously prepared by students under supervision. After all, we held the second focus group with the same CHW to evaluate the impact of the strategies adopted. 60% said their routine is now more dynamic and effective, only 10% state that their routine remains difficult. 80% said that after the training meetings the manager of the PHCU invited them to participate more actively. Conclusions This project brought the students to the reality of CHW health practices, what is a great opportunity to increase their commitment with the local health system and social accountability. Key messages The partnership between academy and health service is a challenge but when succeeded it enables changes in and may result in improvement processes in the public health system. The role of community health workers to achieve behavioral change in the community and to improve the public health of a country.

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An innovative approach to improve the detection and treatment of risk factors in poor urban settings: a feasibility study in Argentina

BMC Public Health ◽

10.1186/s12889-021-10569-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Poggio Rosana ◽

Goodarz Danaei ◽

Laura Gutierrez ◽

Ana Cavallo ◽

María Victoria Lopez ◽

...

Keyword(s):

Public Health ◽

Risk Factors ◽

Primary Care ◽

Community Health ◽

Community Health Workers ◽

Feasibility Study ◽

Health Workers ◽

Health Coverage ◽

Cvd Risk Factors ◽

Cvd Risk

Abstract Background The effective management of cardiovascular (CVD) prevention among the population with exclusive public health coverage in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs). Methods We conducted a non-controlled feasibility study using a mixed methods approach to evaluate acceptability, adoption and fidelity of a multi-component intervention implemented in the public healthcare system. The eligibility criteria were having exclusive public health coverage, age ≥ 40 years, residence in the PCC’s catchment area and 10-year CVD risk ≥10%. The multi-component intervention addressed (1) system barriers through task shifting among the PCC’s staff, protected medical appointments slots and a new CVD form and (2) Provider barriers through training for primary care physicians and CHW and individual barriers through a home-based intervention delivered by community health workers (CHWs). Results A total of 185 participants were included in the study. Of the total number of eligible participants, 82.2% attended at least one clinical visit for risk factor control. Physicians intensified drug treatment in 77% of participants with BP ≥140/90 mmHg and 79.5% of participants with diabetes, increased the proportion of participants treated according to GCP from 21 to 32.6% in hypertensive participants, 7.4 to 33.3% in high CVD risk and 1.4 to 8.7% in very high CVD risk groups. Mean systolic and diastolic blood pressure were lower at the end of follow up (156.9 to 145.4 mmHg and 92.9 to 88.9 mmHg, respectively) and control of hypertension (BP < 140/90 mmHg) increased from 20.3 to 35.5%. Conclusion The proposed CHWs-led intervention was feasible and well accepted to improve the detection and treatment of risk factors in the poor population with exclusive public health coverage and with moderate or high CVD risk at the primary care setting in Argentina. Task sharing activities with CHWs did not only stimulate teamwork among PCC staff, but it also improved quality of care. This study showed that community health workers could have a more active role in the detection and clinical management of CVD risk factors in low-income communities.

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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

10.21203/rs.3.rs-692874/v1 ◽

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.

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Helping communities to manage disaster risk

Setting up Community Health Programmes in Low and Middle Income Settings ◽

10.1093/med/9780198806653.003.0025 ◽

2019 ◽

pp. 432-443

Author(s):

Joel Hafvenstein ◽

Jonathan Stone

Keyword(s):

Community Health ◽

Community Health Workers ◽

Emergency Response ◽

Disaster Response ◽

Health Workers ◽

Disaster Risk ◽

Community Level ◽

Response Team ◽

Health Programmes

This chapter describes how to manage disaster risk and how community-level action is essential when organizing any emergency response action. It outlines the types of hazards that communities face, how they can be reduced and how we can increase the effectiveness and resilience of community health programmes (CHPs) to meet those hazards. It explains how we can train a disaster response team (DRT) and use them and community health workers (CHWs) both to deliver and to help to implement disaster safety messages. It describes in some detail both the types of disaster and ways in which the community can respond and work with others, including government and external providers.

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A sustainable community based model of non-communicable disease risk factor surveillance: “SHRADDHA-JAGRITHI project” (Preprint)

10.2196/preprints.27299 ◽

2021 ◽

Author(s):

Jaideep Menon ◽

Mathews Numpeli ◽

Sajeev.P. Kunjan ◽

Beena.V. Karimbuvayilil ◽

Aswathy Sreedevi ◽

...

Keyword(s):

Public Health ◽

Health System ◽

Public Health System ◽

Health Workers ◽

Communicable Disease ◽

Community Based ◽

Frontline Health Workers ◽

The Individual ◽

Non Communicable Disease

UNSTRUCTURED Abstract: India has a massive non-communicable disease (NCD) burden at an enormous cost to the individual, family, society and health system at large, in spite of which prevention and surveillance is relatively neglected. Risk factors for atherosclerotic cardiovascular disease if diagnosed early and treated adequately would help decrease the mortality and morbidity burden. India is in a stage of rapid epidemiological transition with the state of Kerala being at the forefront, pointing us towards likely disease burden and outcomes for the rest of the country, in the future. A previous study done by the same investigators, in a population of >100,000, revealed poor awareness and treatment of NCDs and also poor adherence to medicines in individuals with CVD. The investigators are looking at a sustainable, community based model of surveillance for NCDs with corporate support wherein frontline health workers check all individuals in the target group ( > age 30 years) with further follow up and treatment planned in a “spoke and hub” model using the public health system of primary health centres (PHCs) as spokes to the hubs of Taluk or District hospitals. All data entry done by frontline health workers would be on a Tab PC ensuring rapid acquisition and transfer of participant health details to PHCs for further follow up and treatment. The model will be evaluated based on the utilisation rate of various services offered at all tier levels. The proportions of the target population screened, eligible individuals who reached the spoke or hub centres for risk stratification and care and community level control for hypertension and diabetes in annual surveys will be used as indicator variables. The model ensures diagnosis and follow up treatment at no cost to the individual entirely through the tiered public health system of the state and country.

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If We Build It, Will They Come? Estimating the Need for Community-Based Palliative Care in a Public Health System (S708)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2017.12.362 ◽

2018 ◽

Vol 55 (2) ◽

pp. 660

Author(s):

Anne Kinderman ◽

Heather Harris ◽

Kathleen Kerr ◽

Michael Rabow ◽

Brian Cassel

Keyword(s):

Public Health ◽

Palliative Care ◽

Health System ◽

Public Health System ◽

Community Based

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Design of Mobile Application for Community Health Workers: A Case Study in Rwanda

International Journal of Interactive Mobile Technologies (iJIM) ◽

10.3991/ijim.v14i11.13307 ◽

2020 ◽

Vol 14 (11) ◽

pp. 271

Author(s):

Gahizi Emmanuel ◽

Andi Wahju Rahardjo Emanuel ◽

Djoko Budiyanto Setyohadi

Keyword(s):

Public Health ◽

Health Services ◽

Community Health ◽

Community Health Workers ◽

Human Service ◽

Mobile Application ◽

Health Workers ◽

User Centered Design ◽

Public Health Services ◽

Adequate Knowledge

Community health workers (CHWs) are the basis of public health services that aim to connect the gap between public health and the human service system. This gap can be completely bridged by navigating the health and human service systems and educating communities on disease prevention. Unfortunately, the way of sharing, accessing information, and delivering health services is still non-digitalized in Rwanda. Community Health workers use a manual system in their daily activities, which is prone to error and falsification. Moreover, these people selected to perform these activities often do not have adequate knowledge about diseases and health systems since they are not professional health workers. To address the above problem, we designed a prototype mobile application to enable these workers to automatically submit reports, transfer knowledge, share information, and receive training from professionals. The design process followed a User-Centered Design approach to meet the users’ requirements. The evaluation of the design showed that 91.7% of the CHWs agreed with the designed application prototype. This finding shows that CHWs has an interest in using the mobile application in their work. Using the mobile application will help CHWs to improve data collection, the reporting process, and ease of receiving training.

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

Global Health Promotion ◽

10.1177/1757975918811087 ◽

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.

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