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.

Improving use of maternal care services among married adolescent girls: an intervention study in rural India

2020 ◽  
pp. 1-20
Author(s):  
Ashok Dyalchand ◽  
Rohini Prabha Pande ◽  
Gopal Kulkarni ◽  
Manisha Khale
Keyword(s):  
Antenatal Care ◽  
Community Health ◽  
Community Health Workers ◽  
Adolescent Girls ◽  
Maternal Care ◽  
Health Workers ◽  
Care Delivery ◽  
Scale Up ◽  
Care Services ◽  
Study Sites

Abstract This study examined the effect of the Safe Adolescent Transition and Health Initiative (SATHI) programme on the use of maternal care services among rural, pregnant adolescents in India. This was an intensive community-based, multi-site intervention project conducted in Maharashtra state between 2008 and 2011. Its aims were to improve the reproductive health of married adolescent girls and avert the adverse consequences of early motherhood. It had a quasi-experimental, case-control, pre-post design to enable rigorous evaluation. This study used cross-sectional data from 644 married girls aged under 19 years at baseline and 802 at endline to assess the maternal care outcomes of antenatal care, delivery and postnatal services and nutrition during pregnancy. Difference-in-differences analysis showed that all outcomes improved significantly in the study sites between baseline and endline, and the improvement in study sites was significantly larger than in the control sites. Multivariate analysis showed a statistically significant dose–response effect of intervention participation for antenatal care, pregnancy nutrition and postnatal care. Study participation was not statistically significantly associated with higher rates of safe or institutional delivery. The analysis suggests that training and supporting community health workers to work with married adolescent girls using interpersonal communication and interacting frequently with them and their families and communities can significantly improve the use of maternal care services among this population. With almost a million community health workers and 200,000 auxiliary nurse midwives at the community level providing primary level care in India, this intervention offers a proven strategy to replicate and scale-up to reach large numbers of married adolescent girls who do not currently use maternal care services.

scholarly journals Assessment of relevance and effectiveness of community health workforce (CHW) development system in Bangladesh

2015 ◽  
Vol 5 (2) ◽  
pp. 332-335
Author(s):  
Md Humayun Kabir Talukder ◽  
BH Nazma Yasmeen ◽  
Rumana Nazneen ◽  
Md Zakir Hossain ◽  
Ishrat Jahan Chowdhury
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workforce ◽  
Rural Areas ◽  
Ethical Issues ◽  
Health Workers ◽  
Care Delivery ◽  
Cross Sectional ◽  
Development System ◽  
Audiovisual Aids

Background : Community Health Workforce (CHW) development has a rich history in South East Asian Region (SEAR). The first Community Health Unit was established in Sri Lanka in 1926 and then practiced over many of the regional countries like, Thailand, Mayanmar and India. Community Health Workers are in the fore front workforce to bring about change through community health programmes to national levels. In Bangladesh, there are also different categories of health workforce serving in the health care delivery system.Objectives : To assess relevance and effectiveness of community health workforce (CHW) development system in Bangladesh.Methods : This cross sectional study was conducted from 1st November 2010-30th April 2011 by purposive sampling technique. Study population were directors, administrators, principals, teachers of different institutes/ organizations and community health workers working in different corners of Bangladesh. Study places were different divisional towns of Bangladesh. Previously developed questionnaire & checklist were used for the collection of data from the institutes/ organizations by data collectors. These data were edited, processed and was analysed by using SPSS soft ware and a small portion by manually. No strong ethical issues were involved in this activity.Results : Study revealed that all the respondents (100%) are in favour of production of CHW in Bangladesh through formal academic institutional or pre service education (61.4%) .Most of the respondents (56.8%) viewed that there are scopes of utilisation of produced CHW in rural areas and most of the respondents (63.6%) also viewed that terminal/marginalized/underprivileged peoples of hard to reach areas at least can be served by CHW. Regarding the competency of produced CHW few of the respondents (43.2%) viewed positively. Most of the respondents (86.4%) viewed that both govt. & non govt. sectors should produce CHW with a very good coordination and co-operation. Study revealed the institutional capacities or situations about physical facilities, ongoing course, audiovisual aids, library, manpower and assessment procedure.Conclusion : Study revealed that there is strong & logical relevance present for the production of CHW in Bangladesh. So the existing Human Resource for Health (HRH) policy is to be revised & revisited as a time felt need to develop more competent CHW for Bangladesh to serve the marginalized, terminal, people of remote, rural & hard to reach areas.Northern International Medical College Journal Vol.5(2) 2014: 332-335

scholarly journals Community health workers as a sustainable health care innovation

Elem Sci Anth ◽  
2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Katie Cueva ◽  
Christine Ingemann ◽  
Larisa Zaitseva ◽  
Gwen Healey Akearok ◽  
Josée G. Lavoie
Keyword(s):  
Health Care ◽  
Community Health ◽  
Community Health Workers ◽  
Culturally Relevant ◽  
Health Workers ◽  
Care Delivery ◽  
Health Care Systems ◽  
Health And Wellness ◽  
Care Systems ◽  
Circumpolar North

Health care delivery in the Circumpolar North is challenged by a scarcity of culturally relevant health care services, few medical providers trained in cross-cultural care, and high costs of transportation. Community health workers (CHWs) are primarily Indigenous individuals who provide on-the-ground health care and health promotion services in their own communities. The CHWs’ scope of work varies from health education to clinical care and often focuses on upstream factors that impact the public’s health. Although often overlooked and underutilized, the CHW role is an innovative approach to promoting more sustainable and culturally relevant care within health systems. Investigating and understanding the potential ways that CHW-integrated health care systems support health and wellness could allow for a clearer understanding of how to translate this approach to other regions seeking a transition to sustainability in health and wellness. Drawing on experiences with CHWs in the Circumpolar North, this article introduces a conceptual model summarizing pathways that describe how integrating CHWs supports wellness in their communities. The proposed model includes five pathways for how CHWs could support wellness: (1) the recruitment of CHWs from within a community promotes community capacity and control; (2) the CHW role allows them to advocate to address structural and systemic inequalities that contribute to ill health, if CHWs are supported to organize their communities around wellness; (3) CHWs have the potential to support and empower community members;  (4) CHWs have the potential to develop culturally relevant, feasible, and effective health promotion strategies; and (5) CHWs have the potential to build on community strengths. This model allows for CHW-integrated health care systems to be critically examined to both test and refine this proposed model, and support and empower community health workers as a transition to a more sustainable health care delivery system that reduces inequities and promotes health.

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 Timely Access to Maternal, Neonatal and Child Healthcare for rural communities in Rwanda: Job satisfaction of Community Health Workers delivering Community Based Maternal, Newborn and Child Healthcare

2020 ◽  
Author(s):  
Jean Bosco BIGIRIMANA ◽  
Isaac Luginaah
Keyword(s):  
Job Satisfaction ◽  
Rural Communities ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Care Delivery ◽  
Access To Health Services ◽  
Community Based ◽  
Cross Sectional ◽  
Child Healthcare

Abstract Background In Rwanda, although there has been progressing in health care delivery as expressed in the reduction in maternal and child mortality, rates are still high and geographically variable. For the improvement of equitable access to health services for maternal, newborn and child healthcare (MNCH), community-based maternal, newborn and child healthcare (CBMNCH) depends on the use of “community health workers” (CHWs). However, the CHW program faces challenges that disrupt the quality delivery of a full package of services. Yet little is known about the satisfaction of CHWs in delivering CBMNCH. Methods This quantitative cross-sectional study involved a survey of 500 sampled CHWs delivered CBMNCH in three selected rural districts of the southern province, Rwanda. Ordinal regression was used to examine the determinants of CHWs` job satisfaction. Results Multivariate analysis shows that the determinants of job satisfaction were motivation (OR = 8.59, p < 0.001), formal training in CBMNCH (OR = 2.24, p < 0.05), individual supervision (OR = 6.19, p < 0.001), and peer support (OR = 2.66, p < 0.01), knowledge about CBMNCH (OR = 0.51, p < 0.05), access to essential materials (OR = 0.32, p < 0.05), and incentives (OR = 0.53 (p < 0.01). Conclusion The findings indicated that the managers of CHW programs and other stakeholders need to improve the working conditions of CHWs to enhance their job satisfaction, to enable the effective provision of CBMNCH.

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