Implementing Community-based Health Planning and Services in impoverished urban communities: health workers’ perspective

IntroductionWith rapid urbanisation in low-income and middle-income countries, health systems are struggling to meet the needs of their growing populations. Community-based Health Planning and Services (CHPS) in Ghana have been effective in improving maternal and child health in rural areas; however, implementation in urban areas has proven challenging. This study aims to engage key stakeholders in urban communities to understand how the CHPS model can be adapted to reach poor urban communities.Methods and analysisA Participatory Action Research (PAR) will be used to develop an urban CHPS model with stakeholders in three selected CHPS zones: (a) Old Fadama (Yam and Onion Market community), (b) Adedenkpo and (c) Adotrom 2, representing three categories of poor urban neighbourhoods in Accra, Ghana. Two phases will be implemented: phase 1 (‘reconnaissance phase) will engage and establish PAR research groups in the selected zones, conduct focus groups and individual interviews with urban residents, households vulnerable to ill-health and CHPS staff and key stakeholders. A desk review of preceding efforts to implement CHPS will be conducted to understand what worked (or not), how and why. Findings from phase 1 will be used to inform and co-create an urban CHPS model in phase 2, where PAR groups will be involved in multiple recurrent stages (cycles) of community-based planning, observation, action and reflection to develop and refine the urban CHPS model. Data will be managed using NVivo software and coded using the domains of community engagement as a framework to understand community assets and potential for engagement.Ethics and disseminationThis study has been approved by the University of York’s Health Sciences Research Governance Committee and the Ghana Health Service Ethics Review Committee. The results of this study will guide the scale-up of CHPS across urban areas in Ghana, which will be disseminated through journal publications, community and government stakeholder workshops, policy briefs and social media content. This study is also funded by the Medical Research Council, UK.

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Challenges to the Utilization of Community-based Health Planning and Services: the views of stakeholders in Yendi Municipality, Ghana

10.21203/rs.3.rs-408667/v1 ◽

2021 ◽

Author(s):

Bougangue Bassoumah ◽

Mohammed Adam Andani ◽

Martin Nyaaba Adokiya

Keyword(s):

Communication Networks ◽

Postnatal Care ◽

Health Workers ◽

Health Planning ◽

Cultural Beliefs ◽

Northern Region ◽

Coding System ◽

Community Based ◽

The Sustainable Development ◽

Antenatal And Postnatal Care

Abstract Background The Community-based Health Planning and Services (CHPS) is a national health reform programme that provides healthcare at the doorsteps of rural community members, particularly, women and children. It seeks to reduce health inequalities and promote equity of health outcomes. The study explored challenges of the CHPS utilization following reports by the Ghana Statistical Service of poor clinic attendance and high maternal and child morbidities and mortalities in the Northern Region of Ghana. Methods This observational study employed qualitative methods to interview key informants covering relevant stakeholders. The study was guided by the systems theory. In all, 30 in-depth interviews were conducted involving 8 community health officers, 8 community volunteers, and 14 women receiving postnatal care in four (4) CHPS zones in the Yendi Municipality. The data were thematically analysed using Atlas.ti.v.7 software and manual coding system. 2 Results The study found poor clinical attendance in the form of delays in seeking health care, low antenatal and postnatal care visits, barriers affecting the utilization of the CHPS compounds to include lack of transportation and poor road network, cultural beliefs such as taboos of certain foods and proof for women's faithfulness to their husbands as challenges of health facility utilization. Besides, the absence of health workers at the CHPS compounds such as the CHOs, poor communication networks during emergencies when the ambulance service becomes inaccessible and lack of capacity by CHPS compound to sterilize some equipment. Furthermore, lack of incentives and adequate infrastructures like potable water and electricity, poor coordination of healthcare interventions and practices, lack of specialists and equipment as well as poor community engagement are major setbacks to the progress of the CHPS policy. Conclusions On clinical attendance, timing and number of antenatal and postnatal care visits, remain major concerns for the CHPS programme in the study setting. The barriers accounting for the low utilization of CHPS compounds are cost of referrals and cultural beliefs. There is an urgent need to address these challenges to improve the utilization of CHPS compounds and to contribute to achieving the sustainable development goals.

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Engaging Parents in Mental Health Services: A Qualitative Study of Community Health Workers’ Strategies in High Poverty Urban Communities

Administration and Policy in Mental Health and Mental Health Services Research ◽

10.1007/s10488-021-01124-8 ◽

2021 ◽

Author(s):

Erika L. Gustafson ◽

Davielle Lakind ◽

Angela L. Walden ◽

Dana Rusch ◽

Marc S. Atkins

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Qualitative Study ◽

Health Services ◽

Community Health ◽

Urban Communities ◽

Community Health Workers ◽

Health Workers ◽

High Poverty

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Can public sector community health workers deliver a nurturing care intervention in South Africa? The Amagugu Asakhula feasibility study

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00802-6 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Sonja Klingberg ◽

Esther M. F. van Sluijs ◽

Stephanie T. Jong ◽

Catherine E. Draper

Keyword(s):

South Africa ◽

Health Care ◽

Public Sector ◽

Health Workers ◽

Care Facility ◽

Health Care Facility ◽

Preschool Age ◽

Primary Health Care Facility ◽

Community Based ◽

Primary Health

Abstract Background Nurturing care interventions have the potential to promote health and development in early childhood. Amagugu Asakhula was designed to promote developmentally important dietary and movement behaviours among children of preschool age (3–5 years) in South Africa. An initial formative study in Cape Town found the intervention to be feasible and acceptable when delivered by community health workers (CHWs) linked to a community-based organisation. This study evaluated the delivery of the Amagugu Asakhula intervention by CHWs linked to a public sector primary health care facility in Soweto, as this mode of delivery could have more potential for sustainability and scalability. Methods A qualitative design was utilised to assess feasibility, acceptability, adoption, appropriateness, implementation, fidelity and context. CHWs (n = 14) delivered the intervention to caregivers (n = 23) of preschool-age children in Soweto over 6 weeks. Following the completion of the intervention, focus group discussions were held with CHWs and caregivers. Further data were obtained through observations, study records and key informant interviews (n = 5). Data were analysed using deductive thematic analysis guided by a process evaluation framework. Results The delivery of the Amagugu Asakhula intervention through CHWs linked to a primary health care facility in Soweto was not found to be feasible due to contextual challenges such as late payment of salaries influencing CHW performance and willingness to deliver the intervention. CHWs expressed dissatisfaction with their general working conditions and were thus reluctant to take on new tasks. Despite barriers to successful delivery, the intervention was well received by both CHWs and caregivers and was considered a good fit with the CHWs’ scope of work. Conclusions Based on these findings, delivery of the Amagugu Asakhula intervention is not recommended through public sector CHWs in South Africa. This feasibility study informs the optimisation of implementation and supports further testing of the intervention’s effectiveness when delivered by CHWs linked to community-based organisations. The present study further demonstrates how implementation challenges can be identified through qualitative feasibility studies and subsequently addressed prior to large-scale trials, avoiding the wasting of research and resources.

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The implementation of a mobile application to support community-based health workers

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.051 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A C F Martins ◽

P L Pereira ◽

A C C N Mafra ◽

J L Miraglia ◽

C N Monteiro ◽

...

Keyword(s):

Health Care ◽

Mobile Application ◽

Total Population ◽

Health Workers ◽

Data Entry ◽

Population Data ◽

Administrative Staff ◽

Economic Data ◽

Process Change ◽

Community Based

Abstract Issue Real-time access to up-to-date population information is essential to the strategic planning of primary health care (PHC). In the Brazilian public health system community-based health workers (CHWs), working as part of PHC teams, collect health, demographic and socio-economic data from individuals mainly through paper-based forms that are later entered manually into electronic information systems. Mobile applications could help to improve the quality and speed of this process facilitating the CHWs day-to-day work while improving the access to the collected information. Description of the Problem During September of 2019, a mobile application installed in tablets for the collection of health, demographic and socio-economic data was deployed for 432 CHWs of 87 PHC teams in the southern region of São Paulo, Brazil, serving a total population of 283,324 individuals. During implementation, the acceptability and challenges faced by CHWs were evaluated and the time taken to complete data entry. Results Seventy-two hours of training were offered to CHWs and other 139 professionals including managers, nurses and administrative staff (AS). Some CHWs reported concerns about the process change and fear of not being able to operate the application, especially those unfamiliar to the technology. With training and team support, fear was transformed into satisfaction with the realization of the benefits of the system. The main infrastructure challenge was the need for installation of Wi-Fi routers in some health care units, in addition to the replacement 4.4% of damaged tablets. In four months 97.6% of the total population was registered in the application. Lessons A WhatsApp group was created to clarify AS doubts, receive suggestions and disseminate guidelines. AS remained as the reference point at healthcare units and data completeness still needs to be reinforced. Key messages A mobile application was well-accepted by CHWs and could facilitate the collection of population data. A tablet app proved to be a useful tool to generate information for the PHC teams.

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Umbilical cord care through community-based distribution of chlorhexidine in rural Sindh, Pakistan

European Journal of Public Health ◽

10.1093/eurpub/ckz186.162 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

M Shah ◽

Q Jamali ◽

F Aisha

Keyword(s):

Rural Communities ◽

Data Collection ◽

Umbilical Cord ◽

Rural Areas ◽

Health Workers ◽

High Rate ◽

Cord Care ◽

Community Based ◽

Sindh Province ◽

At Home

Abstract Background Unsafe practices such as cutting umbilical cord with unsterilized instruments and application of harmful substances, are in practice in many rural areas of Pakistan, and associated with high risk of neonatal sepsis and mortality. Methods We conducted an implementation research in 2015 in Tharparkar district, in Sindh province of Pakistan to understand the feasibility and acceptability of community-based distribution of chlorhexidine (CHX) in rural Pakistan. For this cohort group-only study, 225 lady health workers (LHWs) enrolled 495 pregnant women. Enrolled women received 4% CHX gel and user’s instructions for newborn cord care. The LHWs also counseled women on the benefits and correct use of CHX. Study enumerators collected data from CHX receiving women 3 times: at around 2 weeks before delivery, within 24 hours after delivery, and on the 8th day after delivery. We implemented this study jointly in collaboration with Ministry of Health in Sindh province, Pakistan. Results Among enrolled participants, 399 women (81%) received only the first visit, 295 women (60%) received first two visits and 261 women (53%) received all three visits by enumerators. Among 399 women, who received CHX gel, counseling on its use and were respondent to the first round data collection, 78% remembered that the CHX gel to be applied to cord stump and surrounding areas immediately after birth; but less than a third (29%) forgot the need to keep the cord clean and dry. Among 295 respondents in the first two rounds of data collection, who delivered at home, 97% applied CHX to cord stump on the first day. Conclusions Community-based CHX distribution by LHWs, along with counseling to recipient women, resulted in a high rate of cord care with CHX among newborn delivered at home. Results from this study may help program implementers to consider expanding this intervention for improving newborn cord care on the first day of life in Pakistan. Key messages Community-based distribution of chlorhexidine for newborn cord care appears as highly acceptable and feasible in rural communities in Pakistan. Relevant program policy supporting community-based CHX distribution along with counseling by LHW may help expanding coverage of newborn cord care in rural communities in Pakistan.

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