scholarly journals A Community Health Worker “logic model”: towards a theory of enhanced performance in low- and middle-income countries

2014 ◽  
Vol 12 (1) ◽  
Author(s):  
Joseph F Naimoli ◽  
Diana E Frymus ◽  
Tana Wuliji ◽  
Lynne M Franco ◽  
Martha H Newsome
Keyword(s):  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Logic Model ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Conclusion

2021 ◽  
pp. 195-202
Author(s):  
Laura Hakimi ◽  
Anne Geniets ◽  
James O’Donovan ◽  
Niall Winters
Keyword(s):  
Community Health ◽  
Case Studies ◽  
Health Worker ◽  
Community Health Worker ◽  
Middle Income ◽  
Middle Income Countries ◽  
Methodological Research ◽  
Training And Supervision ◽  
Low And Middle Income

Training and supervision are paramount to well-functioning, adaptable Community Health Worker (CHW) programmes. Balancing theoretical and methodological research, lessons from health worker practice, and case studies, this volume has sought to provide a resource to practitioners, policymakers and academics striving to design equitable, participatory CHW programmes. Weaving together interdisciplinary and multiregional perspectives, this book has focussed on the design, implementation and evaluation of technology-based programmes for training and supervision of CHWs, particularly in low- and middle income countries. In doing so, it has set out a roadmap for future equitable, pedagogy-driven CHW programmes.

scholarly journals The Governance of National Community Health Worker Programmes in Low- and Middle-Income Countries: An Empirically Based Framework of Governance Principles, Purposes and Tasks

2018 ◽  
Vol 8 (1) ◽  
pp. 18-27 ◽  
Author(s):  
Helen Schneider
Keyword(s):  
Health System ◽  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Political Support ◽  
Community Based ◽  
Middle Income ◽  
National Community ◽  
Middle Income Countries ◽  
Low And Middle Income

Background: National community health worker (CHW) programmes are increasingly regarded as an integral component of primary healthcare (PHC) in low- and middle-income countries (LMICs). At the interface of the formal health system and communities, CHW programmes evolve in context specific ways, with unique cadres and a variety of vertical and horizontal relationships. These programmes need to be appropriately governed if they are to succeed, yet there is little evidence or guidance on what this entails in practice. Based on empirical observations of South Africa’s community-based health sector and informed by theoretical insights on governance, this paper proposes a practical framework for the design and strengthening of CHW programme governance at scale. Methods: Conceptually, the framework is based on multi-level governance thinking, that is, the distributed, negotiated and iterative nature of decision-making, and the rules, processes and relationships that support this in health systems. The specific purposes and tasks of CHW programme governance outlined in the framework draw from observations and published case study research on the formulation and early implementation of the Ward Based Outreach Team strategy in South Africa. Results: The framework is presented as a set of principles and a matrix of 5 key governance purposes (or outputs). These purposes are: a negotiated fit between policy mandates and evidence, histories and strategies of community-based services; local organisational and accountability relationships that provide community-based actors with sufficient autonomy and power to act; aligned and integrated programme management systems; processes that enable system learning, adaptation and change; and sustained political support. These purposes are further elaborated into 17 specific tasks, distributed across levels of the health system (national, regional, and local). Conclusion: In systematising the governance functions in CHW programmes, the paper seeks to shed light on how best to support and strengthen these functions at scale.

Design & Development of a digital assistant to support teleconsultations between remote doctors and frontline health workers in low and middle-income countries (Preprint)

2020 ◽  
Author(s):  
Neha Verma ◽  
Harold Lehmann ◽  
Amal Afroz Alam ◽  
Youseph Yazdi ◽  
Soumyadipta Acharya
Keyword(s):  
Community Health ◽  
Health Worker ◽  
Community Health Workers ◽  
Unmet Needs ◽  
Health Workers ◽  
User Needs ◽  
Middle Income ◽  
Middle Income Countries ◽  
Frontline Health Workers ◽  
Low And Middle Income

BACKGROUND Many low and middle-income countries (LMICs) have adopted telemedicine programs that connect frontline health workers (FHWs) such as nurses, midwives, or community health workers in rural and remote areas with doctors in urban areas to deliver care to patients. By leveraging technology to reduce temporal, financial, and geographic barriers, these health worker-to-doctor telemedicine programs have the potential to increase quality, to expand the specialties available to patients, and to reduce the time and cost required to deliver care. OBJECTIVE We aimed to identify, validate, prioritize unmet needs in this healthcare space of health worker-to-doctor telemedicine programs, and develop and refine a solution that addresses those needs. METHODS We collected information regarding user needs through ethnographic research, direct observation, and semi-structured interviews with 37 stakeholders (5 doctors, 1 public health program manager, 12 community health workers, and 19 patients) at two telemedicine clinics in rural West Bengal, India. We used the Spiral-Innovative Iteration model to design and develop a prototype solution to meet these needs. RESULTS We identified 74 unmet needs through our immersion in health worker-to-doctor telemedicine programs. We identified a critical unmet need that achieving optimal teleconsultations in LMICs often requires shifting tasks such as history taking and physical examination, from high-skilled remote doctors to the frontline health worker (FHW). To solve this need, we developed a prototype digital assistant that would allow frontline health workers to assume some of the tasks carried out by remote clinicians. The user needs of multiple stakeholder groups (patients, FHWs, doctors, and health organizations) informed this task-shifting tool. CONCLUSIONS The final prototype developed was released as an open source digital public good and may improve the quality and efficiency of care delivery in health worker-to-doctor telemedicine programs.

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

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.

scholarly journals A Practical Measure of Health Facility Efficiency: an Innovation in the Application of Routine Health Information to Determine Health Worker Productivity in Ethiopia

2021 ◽  
Author(s):  
Md Zabir Hasan ◽  
Girmaye D. Dinsa ◽  
Peter Berman
Keyword(s):  
Health Worker ◽  
Health Facility ◽  
Health Workers ◽  
Principal Component ◽  
Practical Application ◽  
Summary Measure ◽  
Worker Productivity ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract BackgroundA simple indicator of technical efficiency, such as productivity of health workers, measured using routine health facility data, can be a practical approach that can inform initiatives to improve efficiency in low and middle-income countries. This paper presents a proof of concept of using routine information from primary healthcare (PHC) facilities to measure health workers’ productivity and its application in three regions of Ethiopia.MethodsIn four steps, we constructed a productivity measure of the health workforce of Health Centers (HCs) and demonstrated its practical application: (1) developing an analytical dataset using secondary data from health management information systems (HMIS) and human resource information system (HRIS); (2) principal component analysis and factor analysis to estimate a summary measure of output from five indicators (annual service volume of outpatient visits, family planning, first antenatal care visits, facility-based deliveries by skilled birth attendance, and children [<1 year] with three pentavalent vaccines); (3) calculating a productivity score by combining the summary measure and the total number of health workers (input); and (4) implementing regression models to identify the determinant of productivity and ranking HCs based on their adjusted productivity score. ResultsWe developed an analytical dataset of 1,128 HCs; however, significant missing values and outliers were reported in the data. The principal component and factor scores developed from the five output measures were highly consistent (correlation coefficient = 0.98). We considered the factor score as the summary measure of outputs for estimating productivity. A very weak association was observed between the summary measure of output and the total number of staff. The result also highlighted a large variability in productivity across similar health facilities in Ethiopia, represented by the significant dispersion in summary measure of output occurring at similar levels of the health workers. ConclusionsWe successfully demonstrated the analytical steps to estimate health worker productivity and its practical application using HMIS and HRIS. The methodology presented in this study can be readily applied in low and middle-income countries using widely available data – such as DHIS2 – that will allow further explorations to understand the causes of technical inefficiencies in the health system.

scholarly journals Designing a Logic Model for Mobile Maternal Health e-Voucher Programs in Low- and Middle-Income Countries: An Interpretive Review

2021 ◽  
Vol 19 (1) ◽  
pp. 295
Author(s):  
Seohyun Lee ◽  
Abdul-jabiru Adam
Keyword(s):  
Maternal Health ◽  
Program Planning ◽  
Data Entry ◽  
Logic Model ◽  
Middle Income ◽  
Mobile Money ◽  
Middle Income Countries ◽  
Planning Implementation ◽  
Voucher Programs ◽  
Low And Middle Income

Despite the increasing transition from paper vouchers to mobile e-vouchers for maternal health in low- and middle-income countries, few studies have reviewed key elements for program planning, implementation, and evaluation. To bridge this gap, this study conducted an interpretive review and developed a logic model for mobile maternal health e-voucher programs. Pubmed, EMBASE, and Cochrane databases were searched to retrieve relevant studies; 27 maternal health voucher programs from 84 studies were identified, and key elements for the logic model were retrieved and organized systematically. Some of the elements identified have the potential to be improved greatly by shifting to mobile e-vouchers, such as payment via mobile money or electronic claims processing and data entry for registration. The advantages of transitioning to mobile e-voucher identified from the logic model can be summarized as scalability, transparency, and flexibility. The present study contributes to the literature by providing insights into program planning, implementation, and evaluation for mobile maternal health e-voucher programs.

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