scholarly journals Integrating a nationally scaled workforce of community health workers in primary care: a modelling study

2018 ◽  
Vol 111 (12) ◽  
pp. 453-461 ◽  
Author(s):  
Benedict Hayhoe ◽  
Thomas E Cowling ◽  
Virimchi Pillutla ◽  
Priya Garg ◽  
Azeem Majeed ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Community Health ◽  
Health Worker ◽  
Community Health Workers ◽  
Community Health Worker ◽  
Health Workers ◽  
Pilot Studies ◽  
Cancer Screenings ◽  
Home Based

Objective To model cost and benefit of a national community health worker workforce. Design Modelling exercise based on all general practices in England. Setting United Kingdom National Health Service Primary Care. Participants Not applicable. Data sources Publicly available data on general practice demographics, population density, household size, salary scales and screening and immunisation uptake. Main outcome measures We estimated numbers of community health workers needed, anticipated workload and likely benefits to patients. Results Conservative modelling suggests that 110,585 community health workers would be needed to cover the general practice registered population in England, costing £2.22bn annually. Assuming community health workerss could engage with and successfully refer 20% of eligible unscreened or unimmunised individuals, an additional 753,592 cervical cancer screenings, 365,166 breast cancer screenings and 482,924 bowel cancer screenings could be expected within respective review periods. A total of 16,398 additional children annually could receive their MMR1 at 12 months and 24,716 their MMR2 at five years of age. Community health workerss would also provide home-based health promotion and lifestyle support to patients with chronic disease. Conclusion A scaled community health worker workforce integrated into primary care may be a valuable policy alternative. Pilot studies are required to establish feasibility and impact in NHS primary care.

scholarly journals An analysis of the services provided by Community Health Workers within an urban district in South Africa: a key contribution towards universal access to care.

2021 ◽  
Author(s):  
Leena Susan Thomas ◽  
Eric Buch ◽  
Yogan Pillay
Keyword(s):  
South Africa ◽  
Access To Care ◽  
Community Health ◽  
Health Worker ◽  
Social Services ◽  
Community Health Workers ◽  
Community Health Worker ◽  
Health Workers ◽  
Urban Setting ◽  
Early Screening

Abstract Introduction: Community health worker teams are potential game-changers in ensuring access to care in vulnerable communities. Who are they? What do they actually do? Can they help South Africa realize universal health coverage? As the proactive arm of the health services, community health workers teams provide household and community education, early screening, tracing and referrals for a range of health and social services. There is little local or global evidence on the household services provided by such teams, beyond specific disease-oriented activities such as for HIV and TB. This paper seeks to address this gap.Methods: Descriptive secondary data analysis of community health worker team activities in the Ekurhuleni health district, South Africa covering approximately 280 000 households with one million people. Results: Study findings illustrated that community health workers in these teams provided early screening and referrals for pregnant women and children under five. They distributed condoms and chronic medication to homes. They screened and referred for hypertension, diabetes mellitus, HIV and TB. The teams also undertook defaulter and contact tracing, the majority of which was for HIV & TB clients. Psychosocial support provided was in the form of access to social grants, access to child and gender-based violence protection services, food parcels and other services.Conclusion: Community Health Workers form the core of these teams and perform several health and psychosocial services in households and poor communities in South Africa, in addition to general health education. The teams studied provided a range of activities across many health conditions (mother & child related, HIV & TB, non-communicable diseases), as well as social services. These teams provided comprehensive care in a large-scale urban setting and can improve access to care.

scholarly journals Development of a tool for assessing quality of comprehensive care provided by community health workers in a community-based care programme in South Africa

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e030677
Author(s):  
Frances Griffiths ◽  
Olukemi Babalola ◽  
Celia Brown ◽  
Julia de Kadt ◽  
Hlologelo Malatji ◽  
...  
Keyword(s):  
South Africa ◽  
Quality Of Care ◽  
Community Health ◽  
Health Worker ◽  
Community Health Workers ◽  
Community Health Worker ◽  
Health Workers ◽  
Comprehensive Care ◽  
Household Visit

ObjectiveTo develop a tool for use by non-clinical fieldworkers for assessing the quality of care delivered by community health workers providing comprehensive care in households in low- and middle-income countries.DesignWe determined the content of the tool using multiple sources of information, including interactions with district managers, national training manuals and an exploratory study that included observations of 70 community health workers undertaking 518 household visits collected as part of a wider study. We also reviewed relevant literature, selecting relevant domains and quality markers. To refine the tool and manual we worked with the fieldworkers who had undertaken the observations. We constructed two scores summarising key aspects of care: (1) delivering messages and actions during household visit, and (2) communicating with the household; we also collected contextual data. The fieldworkers used the tool with community health workers in a different area to test feasibility.SettingSouth Africa, where community health workers have been brought into the public health system to address the shortage of healthcare workers and limited access to healthcare. It was embedded in an intervention study to improve quality of community health worker supervision.Primary and secondary outcomesOur primary outcome was the completion of a tool and user manual.ResultsThe tool consists of four sections, completed at different stages during community health worker household visits: before setting out, at entry to a household, during the household visit and after leaving the household. Following tool refinement, we found no problems on field-testing the tool.ConclusionsWe have developed a tool for assessing quality of care delivered by community health workers at home visits, often an unobserved part of their role. The tool was developed for evaluating an intervention but could also be used to support training and management of community health workers.

scholarly journals An analysis of the services provided by community health workers within an urban district in South Africa: a key contribution towards universal access to care

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
L. S. Thomas ◽  
E. Buch ◽  
Y. Pillay
Keyword(s):  
South Africa ◽  
Access To Care ◽  
Community Health ◽  
Health Worker ◽  
Social Services ◽  
Community Health Workers ◽  
Community Health Worker ◽  
Health Workers ◽  
Urban Setting ◽  
Early Screening

Abstract Introduction Community health worker teams are potential game-changers in ensuring access to care in vulnerable communities. Who are they? What do they actually do? Can they help South Africa realize universal health coverage? As the proactive arm of the health services, community health workers teams provide household and community education, early screening, tracing and referrals for a range of health and social services. There is little local or global evidence on the household services provided by such teams, beyond specific disease-oriented activities such as for HIV and TB. This paper seeks to address this gap. Methods Descriptive secondary data analysis of community health worker team activities in the Ekurhuleni health district, South Africa covering approximately 280,000 households with 1 million people. Results Study findings illustrated that community health workers in these teams provided early screening and referrals for pregnant women and children under five. They distributed condoms and chronic medication to homes. They screened and referred for hypertension, diabetes mellitus, HIV and TB. The teams also undertook defaulter and contact tracing, the majority of which was for HIV and TB clients. Psychosocial support provided was in the form of access to social grants, access to child and gender-based violence protection services, food parcels and other services. Conclusion Community health workers form the core of these teams and perform several health and psychosocial services in households and poor communities in South Africa, in addition to general health education. The teams studied provided a range of activities across many health conditions (mother and child related, HIV and TB, non-communicable diseases), as well as social services. These teams provided comprehensive care in a large-scale urban setting and can improve access to care.

scholarly journals KEBUTUHAN DAN KENDALA KADER KESEHATAN DALAM MEMBANTU KEBERHASILAN IBU MENYUSUI

2020 ◽  
Vol 7 (2) ◽  
pp. 89-97
Author(s):  
Nova Fajri ◽  
Sri Intan Rahayuningsih ◽  
Nevi Hasrati Nizami ◽  
Mira Rizkia
Keyword(s):  
Community Health ◽  
Health Worker ◽  
Community Health Workers ◽  
Community Health Worker ◽  
Health Workers ◽  
Peer Group ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Adequate Knowledge

Kader kesehatan masyarakat adalah pihak dari masyarakat desa yang merupakan lini terdepan dalam membantu masyarakat di desa mengatasi permasalahan kesehatan termasuk membantu keberhasilan ibu menyusui memberikan ASI ekslusif selama enam bulan dan melanjutkan sampai dua tahun, namun belum banyak penelitian yang menggali bagaimana kebutuhan serta kendala yang dihadapi kader dalam membantu keberhasilan ibu menyusui. Tujuan penelitian ini yaitu untuk mengetahui kebutuhan kader kesehatan desa dalam menyukseskan menyusui eksklusif dan menyusui sampai dua tahun serta kendala yang dihadapi. Penelitian ini menggunakan pendekatan cross sectional study dengan metode deskriptif eksploratif terhadap 47 orang kader kesehatan dari 6 desa di kecamatan Darussalam Aceh Besar yang diambil secara acak. Hasil penelitian menunjukkan bahwa 63,8% kader sangat setuju bahwa mereka berperan dalam keberhasilan ibu menyusui. Selain itu, 66% kader membutuhkan kelompok diskusi dengan pertugas kesehatan tentang menyusui secara tatap muka. Dalam melaksanakan perannya, juga terdapat kendala yang dihadapi kader kesehatan dalam membantu ibu menyusui yaitu merasa gagal dalam berkomunikasi dan meyakinkan ibu untuk menyusui bayinya (21,3%), belum memiliki pengetahuan yang memadai ketika ibu menyusui mengeluhkan ASI nya sedikit, puting kecil, dan bayi tidak mau menyusu (17%). Oleh karena itu, dibutuhkan pengetahuan yang mumpuni dari kader serta forum diskusi yang dapat memotivasi kader serta berkonsultasi terhadap permasalahan yang belum diketahuinya untuk membantu keberhasilan ibu menyusui.   Community health workers are village structures that are at the frontline of helping communities overcome health problems including helping successful mothers to breastfeed exclusively for six months and continue for up to two years. However, very little research has discussed the needs and constraints faced by the community health worker in helping breastfeeding mothers succeed. The purpose of this study was to determine the needs of village community health workers in the success of exclusive breastfeeding and breastfeeding for up to two years and the obstacles faced. This study used a cross-sectional study approach with a descriptive exploratory method on 47 community health workers from 6 villages in the Darussalam Aceh Besar sub-district who were taken randomly. The results showed that 63.8% of the community health worker strongly agreed that they played a role in the success of breastfeeding mothers. Besides, 66% of community health workers need a face-to-face discussion group with health workers about breastfeeding. In carrying out their role, there are also obstacles faced by the community health worker in helping breastfeeding mothers, namely feeling that they fail to communicate and convince mothers to breastfeed their babies (21.3%), do not have adequate knowledge when breastfeeding mothers complain about their low milk, small nipples, and babies do not want to breastfeed (17%). Therefore, it requires qualified knowledge from community health workers as well as discussion peer group with the breastfeeding counselor that can motivate them and consult on unknown problems to help the success of breastfeeding mothers.

scholarly journals Development of a Framework to Describe Roles and Responsibilities for Sickle Cell Community Health Workers

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5831-5831
Author(s):  
Joan Corder-Mabe ◽  
Shirley Johnson ◽  
Wally R. Smith ◽  
Daniel Sop Mouaffo ◽  
Thokozeni Lipato
Keyword(s):  
Community Health ◽  
Health Worker ◽  
Community Health Workers ◽  
Sickle Cell ◽  
Community Health Worker ◽  
Strong Evidence ◽  
Health Workers ◽  
Conflicts Of Interest ◽  
Roles And Responsibilities ◽  
Common Framework

Abstract Background: Evidence is mounting for the effectiveness of community health workers (CHWs) at improving processes and outcomes of care in sickle cell disease (SCD) and other chronic diseases. But recognition is stymied by over 60 titles currently used for CHWs, by variable CHW roles and responsibilities in SCD and other disease entities, and by variations in populations and communities served by CHWs. Herein, we use an evidence review and consensus to advance a common framework and uniform definition of the functions of CHWs, that differentiates CHW roles and responsibilities. We offer the justification for this differentiation, and for certification, credentialing, education, licensure, and payment for CHW service in the US. Methods: To standardize the CHW intervention in the NHLBI-funded Start Healing in Patients with Hydroxyurea (SHIP-HU,R18HL112737) randomized controlled trial, we reviewed existing publications related to CHW efficacy. In order to synthesize and codify this efficacy evidence according to CHW occupational activities, we performed a rapid, narrative and tabular review of the clinical trials, meta-analyses and policy consensus reports summarizing over 200 CHW interventions to improve patient health status or care delivery. We built frequency tables to total how many mentions occurred of each of the specific roles, responsibilities, competencies, and behaviors utilized in these interventions, using a predetermined list built from a review of all the included interventions. Results: (Evidence table too large to show) Findings of our review and consensus: 1) the more frequently mentioned intervention behaviors might be more important or generally required of all CHWs, whereas the rarer behaviors might either be more specialized or might be less often required of all CHWs; 2) there is strong evidence that CHWs are effective in providing culturally competent health education to individuals and groups, as well as health system navigation and care coordination; 3) there is not strong evidence for the efficacy of CHWs in the provision of direct services; 4) Coaching and social support were less commonly mentioned than the above services; 5)Neither outreach, case finding, nor advocacy were often mentioned in interventions, and; 6) Participation and evaluation in research was mentioned least in interventions. Our consensus recommendation based on these data is for a common framework or taxonomy consisting of four levels of CHW function: Peer Community Health Worker (PCHW), General Community Health Worker (GCHW), Clinical Community Health Worker (CCHW), and Health Navigator (HN). Conclusions: Our proposed evidence-based CHW taxonomy standardizes definitions, provides categories into which to place workers, and delineates levels of service that, if tested, validated, and adopted, could allow national standards for CHW scope of practice, licensure, certification, and registration to practice. Disclosures No relevant conflicts of interest to declare.

scholarly journals A Pilot Study of the ¡Vivir Mi Vida! Lifestyle Intervention for Rural-Dwelling, Late-Midlife Latinos: Study Design and Protocol

2018 ◽  
Vol 39 (1) ◽  
pp. 5-13
Author(s):  
Stacey L. Schepens Niemiec ◽  
Jeanine Blanchard ◽  
Cheryl L. P. Vigen ◽  
Jenny Martínez ◽  
Laura Guzmán ◽  
...  
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Community Health ◽  
Health Worker ◽  
Lifestyle Intervention ◽  
Community Health Worker ◽  
Health Workers ◽  
Occupational Therapist ◽  
Post Intervention ◽  
Late Midlife

Older, rural-dwelling Latinos face multiple health disparities. We describe the protocol of a pilot study of a community health worker–occupational therapist-led lifestyle program, ¡Vivir Mi Vida! ( ¡VMV!), designed for delivery in primary care and adapted for late-midlife, Latino rural-living patients. Using mixed methods, we collected feasibility, acceptability, and preliminary efficacy data on ¡VMV!. Forty 50- to 64-year-old Latinos participated in a 16-week lifestyle intervention led by a community health worker–occupational therapist team. We conducted pre- and post-intervention assessments to evaluate the efficacy of ¡VMV! in improving psychosocial and clinical health outcomes. Focus groups and interviews were held post-intervention with participants and key stakeholders to assess feasibility and acceptability. This is the first trial designed to evaluate a lifestyle intervention that includes collaboration between occupational therapists and community health workers within primary care. The detailed description of methodology promotes research transparency and reproducibility of a community health worker–occupational therapist-led lifestyle intervention.

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