scholarly journals Who are CHWs? An ethnographic study of the multiple identities of community health workers in three rural Districts in Tanzania

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mohamed Yunus Rafiq ◽  
Hannah Wheatley ◽  
Hildegalda P. Mushi ◽  
Colin Baynes
Keyword(s):  
Health Care ◽  
Family Planning ◽  
Health Services ◽  
Health Care Providers ◽  
Rural Areas ◽  
Health Workers ◽  
Multiple Roles ◽  
Care Providers ◽  
Professional Identities ◽  
Community Members

Abstract Background Numerous studies have examined the role of community health workers (CHWs) in improving the delivery of health services and accelerating progress towards national and international development goals. A limited but growing body of studies have also explored the interactions between CHWs’ personal, communal and professional identities and the implications of these for their profession. CHWs possess multiple, overlapping roles and identities, which makes them effective primary health care providers when properly supported with adequate resources, but it also limits their ability to implement interventions that only target certain members of their community, follow standard business working days and hours. In some situations, it even prevents them from performing certain duties when it comes to sensitive topics such as family planning. Methods To understand the multiple identities of CHWs, a mixture of qualitative and ethnographic methods was utilized, such as participant observation, open-ended and semi-structured interviews, and focus group discussions with CHWs, their supervisors, and their clients. The observation period began in October 2013 and ended in June 2014. This study was based on implementation research conducted by the Connect Project in Rufiji, Ulanga and Kilombero Districts in Tanzania and aimed to understand the role of CHWs in the provision of maternal and child health services in rural areas. Results To our knowledge, this was the first study that employed an ethnographic approach to examine the relationship between personal, communal and professional identities, and its implications for CHWs’ work in Tanzania. Our findings suggest that it is difficult to distinguish between personal and professional identities among CHWs in rural areas. Important aspects of CHW services such as personalization, access, and equity of health services were influenced by CHWs’ position as local agents. However, the study also found that their personal identity sometimes inhibited CHWs in speaking about issues related to family planning and sexual health. Being local, CHWs were viewed according to the social norms of the area that consider the gender and age of each worker, which tended to constrain their work in family planning and other areas. Furthermore, the communities welcomed and valued CHWs when they had curative medicines; however, when medical stocks were delayed, the community viewed the CHWs with suspicion and disinterest. Community members who received curative services from CHWs also tended to become more receptive to their preventative health care work. Conclusion Although CHWs’ multiple roles constrained certain aspects of their work in line with prevalent social norms, overall, the multiple roles they fulfilled had a positive effect by keeping CHWs embedded in their community and earned them trust from community members, which enhanced their ability to provide personalized, equitable and relevant services. However, CHWs needed a support system that included functional supply chains, supervision, and community support to help them retain their role as health care providers and enabled them to provide curative, preventative, and referral services.

scholarly journals Feasibility testing of a community dialogue approach for promoting the uptake of family planning and contraceptive services in Zambia

2020 ◽  
Author(s):  
Margarate Nzala Munakampe ◽  
Theresa Nkole ◽  
Adam Silumbwe ◽  
Joseph Mumba Zulu ◽  
Joanna Paula Cordero ◽  
...  
Keyword(s):  
Health Care ◽  
Family Planning ◽  
Health Care Providers ◽  
Health Workers ◽  
Quality Care ◽  
Healthcare Providers ◽  
Care Providers ◽  
Community Members ◽  
Community Dialogue ◽  
Feasibility Testing

Abstract Background: Community dialogues have been used in participatory approaches in various health prevention and awareness programs, including family planning interventions, to increase understanding and alignment of particular issues from different peoples’ perspectives. The main objective of this paper is to document the feasibility of a community dialogue approach, which aimed to promote dialogue between healthcare providers and community members. The feasibility testing was part of formative-phase research needed to design an intervention, with the ultimate goal of increasing the uptake of family planning and contraception. The community dialogue intervention generated discussions on key approaches to improve family planning and contraception provision and uptake. Methods: Key stages of the community dialogue were undertaken, with representation from healthcare providers and community members. Participants included frontline and managerial health care providers, community health workers, family planning and contraception users, the youth, other stakeholders from the education sector, and civil society. How the dialogue was implemented (operational feasibility) as well as the cultural feasibility of the community dialogue content was evaluated through participant observations during the dialogue, using a standardised feasibility testing tick-list, and through focus group discussions with the stakeholders who participated in the community dialogue. Results: Overall, 21 of the 30 invited participants attended the meeting- 70 per cent attendance. The approach facilitated discussions on how quality care could be achieved in family planning and contraception provision, guided by the ground rules that were agreed upon by the different stakeholders. A need for more time for the discussion was noted. Participants also noted the need for more balanced representation from adolescents as well as other family planning stakeholders, such as community members, especially in comparison to healthcare providers. Some participants were not comfortable with the language used. Young people felt older participants used complicated terminologies while community members felt the health care providers outnumbered them, in terms of representation. Conclusion: Generally, the community dialogue was well received by the community members and the healthcare providers, as was observed from the sentiments expressed by both categories. Some key considerations for refining the approach included soliciting maximum participation from otherwise marginalized groups like the youth would provide stronger representation.

scholarly journals Health Care Providers as Agents of Change: Integrating PrEP With Other Sexual and Reproductive Health Services for Adolescent Girls and Young Women

2021 ◽  
Vol 3 ◽  
Author(s):  
Gabrielle O'Malley ◽  
Kristin M. Beima-Sofie ◽  
Stephanie D. Roche ◽  
Elzette Rousseau ◽  
Danielle Travill ◽  
...  
Keyword(s):  
Health Care ◽  
Family Planning ◽  
Reproductive Health ◽  
Health Services ◽  
Adolescent Girls ◽  
Health Care Providers ◽  
Young Women ◽  
Care Providers ◽  
Reproductive Health Services ◽  
Care Worker

Background: Successful integration of pre-exposure prophylaxis (PrEP) with existing reproductive health services will require iterative learning and adaptation. The interaction between the problem-solving required to implement new interventions and health worker motivation has been well-described in the public health literature. This study describes structural and motivational challenges faced by health care providers delivering PrEP to adolescent girls and young women (AGYW) alongside other SRH services, and the strategies used to overcome them.Methods: We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) with HCWs from two demonstration projects delivering PrEP to AGYW alongside other SRH services. The Prevention Options for the Women Evaluation Research (POWER) is an open label PrEP study with a focus on learning about PrEP delivery in Kenyan and South African family planning, youth mobile services, and public clinics at six facilities. PrIYA focused on PrEP delivery to AGYW via maternal and child health (MCH) and family planning (FP) clinics in Kenya across 37 facilities. IDIs and FGDs were transcribed verbatim and analyzed using a combination of inductive and deductive methods.Results: We conducted IDIs with 36 participants and 8 FGDs with 50 participants. HCW described a dynamic process of operationalizing PrEP delivery to better respond to patient needs, including modifying patient flow, pill packaging, and counseling. HCWs believed the biggest challenge to sustained integration and scaling of PrEP for AGYW would be lack of health care worker motivation, primarily due to a misalignment of personal and professional values and expectations. HCWs frequently described concerns of PrEP provision being seen as condoning or promoting unprotected sex among young unmarried, sexually active women. Persuasive techniques used to overcome these reservations included emphasizing the social realities of HIV risk, health care worker professional identities, and vocational commitments to keeping young women healthy.Conclusion: Sustained scale-up of PrEP will require HCWs to value and prioritize its incorporation into daily practice. As with the provision of other SRH services, HCWs may have moral reservations about providing PrEP to AGYW. Strategies that strengthen alignment of HCW personal values with professional goals will be important for strengthening motivation to overcome delivery challenges.

scholarly journals Effect on Dimensions of Health Services to Inpatient Satisfaction at Primary Health Care

2021 ◽  
Vol 8 (2) ◽  
pp. 71
Author(s):  
Ayu Rahajeng Dianing Negari ◽  
Annisa Nurida ◽  
Musa Ghufron ◽  
Muhammad Anas
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Primary Health Care ◽  
Health Services ◽  
Service Quality ◽  
Health Care Providers ◽  
Health Workers ◽  
Care Providers ◽  
Five Dimensions ◽  
Primary Health

Background: Satisfaction is a feeling that the consumers feel when the service they receive meets or surpass their expectations. Public satisfaction with health care services is still a significant issue for health institutions in improving the service quality. Despite various efforts that health care providers have made, some residents in an area were unsatisfied with the health services in their environment.Objective: To determine the effect of the dimensions of health service quality on patient satisfaction at the Primary Health Care 1 Melaya, Jembrana, BaliMethod: Analytical observational study, a cross-sectional design. The total sample was 70 respondents. Data collection was performed using questionnaires. Multiple linear regression was used to analyze the average value of patient satisfaction based on the five dimensions of quality of health care.Result: The dimensions of tangibility, responsiveness, assurance, and empathy have a significance value (p<0.05), while the reliability dimension has no significance value (p>0.05). So the formula used to predict patient satisfaction with health services received is as follows:y = 0,352+0,295*X1–0,104*X2–0,201*X3+0,334*X4+0,180*X5The dimension of health services that has the largest influence on the satisfaction of inpatients is assurance. Patients feel assured and satisfied when the health workers communicate their expertise and competencies before doing their work.Conclusion: Tangibility, reliability, responsiveness, and assurance were four of five dimensions of health services that have significantly influenced the satisfaction of inpatients.

scholarly journals Feasibility testing of a community dialogue approach for promoting the uptake of family planning and contraceptive services in Zambia

2020 ◽  
Author(s):  
Margarate Nzala Munakampe ◽  
Theresa Nkole ◽  
Adam Silumbwe ◽  
Joseph Mumba Zulu ◽  
Joanna Paula Cordero ◽  
...  
Keyword(s):  
Family Planning ◽  
Health Care Providers ◽  
Health Workers ◽  
Quality Care ◽  
Healthcare Providers ◽  
Care Providers ◽  
Community Members ◽  
Community Dialogue ◽  
Awareness Programs ◽  
Feasibility Testing

Abstract Background: Community dialogues have been used in participatory approaches in various health prevention and awareness programs, including family planning interventions to increase understanding and alignment of particular issues from different peoples’ perspectives. The main aim of this paper is to document the feasibility testing of a community dialogue approach, which aimed to promote dialogue between healthcare providers and community members. The feasibility testing was part of formative-phase research needed to design an intervention, with the ultimate goal of increasing the uptake of family planning and contraception. The community dialogue intervention generated discussions on key approaches to improve family planning and contraception provision and uptake.Methods: Key stages of the community dialogue were undertaken, with representation from healthcare providers and community members. Participants included frontline and managerial health care providers, community health workers, family planning and contraception users, the youth, other stakeholders from the education sector, and civil society. How the dialogue was implemented (operational feasibility) as well as the cultural feasibility of the community dialogue content was evaluated through participant observations during the dialogue, using a standardised feasibility testing tick-list, and through focus group discussions with the stakeholders who participated in the community dialogue.Results: Overall, 21 of the 30 invited participants attended the meeting- 70 per cent attendance. The approach facilitated discussions on how quality care could be achieved in family planning and contraception provision, guided by the ground rules that were agreed upon by the different stakeholders. A need for more time for the discussion was noted. Also, more balanced representation from the adolescents, other stakeholders in family planning such as the community members was noted, especially in comparison to the healthcare providers. Some participants were not comfortable with the language used. And the young people felt older participants used complicated terminologies.Conclusion: Generally, the community dialogue was well received by the community members and the healthcare providers, as was observed from the sentiments expressed by both categories. Some key considerations for refining the approach included soliciting maximum participation from otherwise marginalized groups like the youth would provide stronger representation.

scholarly journals The effectiveness of classic lecture and workshop as interventions to improve primary health care providers knowledge and skill on the management of pediatric emergencies: a case study

2021 ◽  
Vol 5 (1) ◽  
pp. 133
Author(s):  
Ricky Indra Alfaray ◽  
Rahmat Sayyid Zharfan ◽  
Yudhistira Pradnyan Kloping ◽  
Yudith Annisa Ayu Rezkitha ◽  
Rafiqy Sa’adiy Faizun ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Rural Areas ◽  
Health Workers ◽  
Test Results ◽  
Care Providers ◽  
Primary Health ◽  
Significant Difference ◽  
Post Test

Abstract A preliminary study showed that most health workers in primary health care (PHC) claimed that they need a refreshing course because of their lack of updated knowledge and skill. This study enrolled 27 primary healthcare workers recruited from the PHC. The intervention used were classic lectures and workshops. The knowledge was evaluated using a paper-based test and practice, while the skill was evaluated using a practice test. Multiple questions (pre-test and post-test) based on current emergency management for pediatric were used for paper-based evaluation. Semi-structured interviews were conducted to confirm the subject's perspective on the intervention. A paired t-test was used for evaluating the pre- and post-test results, which was confirmed by a triangulation approach. There was a significant difference between the pre- and post-test results (p<0.001), and 8 of 10 subjects can demonstrate the procedure learned correctly after the intervention. A total of 14 interviewed subjects stated great effectiveness of the intervention, with several limitations on applicability in daily clinical practice. Classic lecture and workshop as an intervention in health education effectively increase health workers' knowledge and skill in PHC. This study might help other rural areas PHC apply the same method so the professionalism and quality of health workers in PHC providers can be maintained.Keywords                : primary health care, classic lecture; workshop; knowledge; skillCorrespondence     : [email protected]

scholarly journals Health care providers’ perspectives on delivering gender equity focused family planning program for young married couples in a cluster randomized controlled trial in rural Maharashtra, India

2019 ◽  
Vol 3 ◽  
pp. 1508 ◽  
Author(s):  
Saritha Nair ◽  
Anvita Dixit ◽  
Mohan Ghule ◽  
Madhusudana Battala ◽  
Velhal Gajanan ◽  
...  
Keyword(s):  
Health Care ◽  
Family Planning ◽  
Gender Equity ◽  
Health Care Providers ◽  
Rural Areas ◽  
Controlled Trial ◽  
Married Couples ◽  
High Fertility ◽  
Health Providers ◽  
Care Providers

Background: There is increasing programming and research on male engagement and gender-equity (GE) counselling in family planning (FP) services. However, there is a lack of data on healthcare provider’s perspectives on delivering these interventions. The objective of the paper is to present providers’ perspectives on delivering a GE-focused FP intervention, CHARM, to married couples in rural India. Methods:  In-depth interviews were carried out with 22 male village health care providers who were delivering a GE-focused FP intervention, CHARM, to 428 husbands (247 couples) rural Maharashtra, India. Providers were interviewed on their experiences and perspectives during delivery of CHARM. Major domains were identified during a thematic analysis. Results: Local male health providers are interested and can be engaged in delivering a GE-focused FP intervention. Providers believed that the CHARM intervention improves couples’ communication, contraceptive use and strengthened their own capacity to provide FP services in accordance with national FP programmatic efforts. Providers found the low-tech flipchart including pictures and information helpful in supporting their service provision. Providers reported some challenges including lack of privacy and space for counselling, limited access to contraceptive options beyond pill and condom, numerous myths and misconceptions about contraceptives. Providers also reported persistent social norms related to expectancy of pregnancy early in marriage, and son preference. Conclusions: Providers in rural areas with high fertility and related maternal health complications are interested in and can successfully implement a GE-focused FP intervention. Future efforts using this approach may benefit from greater focus to support broader array of spacing contraceptives particularly among first time parents, none or one child parents. There is a need to better support engagement of wives possibly through female provider led sessions parallel to male programs, i.e. gender synchronized rather than couples’ sessions. Trial registration: ClinicalTrials.gov NCT01593943, May 8, 2012.

scholarly journals Comparing the current status with desired situation of the quality ofeducation and improvement for rural health workers in Iran

2021 ◽  
Vol 10 (1) ◽  
pp. 1-1
Author(s):  
Beheshteh Shamsaee ◽  
Mehdi Bagheri ◽  
Nader Gholi Ghourchian ◽  
Parivash Jafari
Keyword(s):  
Health Care ◽  
Health System ◽  
Rural Health ◽  
Health Care Providers ◽  
Rural Areas ◽  
Health Workers ◽  
Current Status ◽  
Care Providers ◽  
Fuzzy Delphi ◽  
The Impact

Background: Rural health workers (Behvarz) are considered health- care pioneers standing at the forefront of providing services for rural areas. Those health providers need to be optimally educated throughout the country. What can serve this purpose is an integrated high quality "education". Methods: The current descriptive research compared two situations of education quality. To this end 300, rural health workers completed researcher-made questionnaires, including 2 dimensions,7 components and, 80 questions obtained from the analysis of the qualitative process through the fuzzy Delphi method. Results: The results indicated a gap between the current status and desirable situations of qualitative improvement components of rural health workers’ education. The findings also showed that the highest standardized coefficient in the area of education was related to the variable of learning and transfer of education with a coefficient of 0.971. In the area of optimization, the highest standard coefficient for the desirable situation belonged to the interpersonal and functional relationship variable, with the value of 0.978, while the lowest standardized coefficient was related to the variable of information and communication technology (ICT) development as 0.956. Conclusion: In brief, optimal education for the health- care providers is considered an integral part of the health system; therefore, the impact of education on the general health of the people should be taken into consideration. Therefore, there is a need for theoretical and practical exploration of qualitative education towards health system improvement and promotion.

scholarly journals Brazil’s Community Health Workers Practicing Narrative Medicine: Patients’ Perspectives

2021 ◽  
Author(s):  
Rogério Meireles Pinto ◽  
Rahbel Rahman ◽  
Margareth Santos Zanchetta ◽  
W. Galhego-Garcia
Keyword(s):  
Health Care ◽  
Community Health ◽  
Community Health Workers ◽  
Health Care Providers ◽  
Health Workers ◽  
Hybrid Approach ◽  
Narrative Medicine ◽  
Structured Interview ◽  
Patient Perspectives ◽  
Care Providers

Abstract Background Narrative medicine (NM) encourages health care providers to draw on their personal experiences to establish therapeutic alliances with patients of prevention and care services. NM medicine practiced by nurses and physicians has been well documented, yet there is little understanding of how community health workers (CHWs) apply NM concepts in their day-to-day practices from patient perspectives. Objective To document how CHWs apply specific NM concepts in Brazil’s Family Health Strategy (FHS), the key component of Brazil’s Unified Health System. Design We used a semi-structured interview, grounded in Charon’s (2001) framework, including four types of NM relationships: provider–patient, provider–colleague, provider–society, and provider–self. A hybrid approach of thematic analysis was used to analyze data from 27 patients. Key Results Sample: 18 females; 13 White, 12 “Pardo” (mixed races), 12 Black. We found: (1) provider–patient relationship—CHWs offered health education through compassion, empathy, trustworthiness, patience, attentiveness, jargon-free communication, and altruism; (2) provider–colleague relationship—CHWs lacked credibility as perceived by physicians, impacting their effectiveness negatively; (3) provider–society relationship—CHWs mobilized patients civically and politically to advocate for and address emerging health care and prevention needs; (4) provider–self relationship—patients identified possible low self-esteem among CHWs and a need to engage in self-care practices to abate exhaustion from intense labor and lack of resources. Conclusion This study adds to patient perspectives on how CHWs apply NM concepts to build and sustain four types of relationships. Findings suggest the need to improve provider–colleague relationships by ongoing training to foster cooperation among FHS team members. More generous organizational supports (wellness initiatives and supervision) may facilitate the provider–self relationship. Public education on CHWs’ roles is needed to enhance the professional and societal credibility of their roles and responsibilities. Future research should investigate how CHWs’ personality traits may influence their ability to apply NM.

scholarly journals Reopening Oral Health Services during the COVID-19 Pandemic through a Knowledge Exchange Coalition

2021 ◽  
pp. 238008442110119
Author(s):  
M. McNally ◽  
L. Rock ◽  
M. Gillis ◽  
S. Bryan ◽  
C. Boyd ◽  
...  
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Health Services ◽  
Return To Work ◽  
Health Care Providers ◽  
Online Survey ◽  
Knowledge Exchange ◽  
Oral Health Care ◽  
Care Providers ◽  
Oral Health Services

Background: The COVID-19 novel coronavirus closed oral health care in Nova Scotia (NS) Canada in March 2020. Preparing for a phased reopening, a knowledge exchange coalition (representing government, academia, hospitals, oral health professions, and regulators) developed return-to-work (RTW) guidelines detailing the augmentation of standard practices to ensure safety for patients, oral health care providers (OHPs), and the community. Using online surveys, this study explored the influence of the RTW guidelines and related education on registered NS OHPs during a phased return to work. Methods: Dissemination of R2W guidelines included website or email communiques and interdisciplinary education webinars that coincided with 2 RTW phases approved by the government. Aligned with each phase, all registered dentists, dental hygienists, and dental assistants were invited to complete an online survey to gauge the influence of the coalition-sponsored education and RTW guidelines, confidence, preparedness, and personal protective equipment use before and after the pandemic. Results: Three coalition-sponsored multidisciplinary webinars hosted 3541 attendees prior to RTW. The response to survey 1 was 41% (881/2156) and to survey 2 was 26% (571/2177) of registrants. Survey 1 (82%) and survey 2 (89%) respondents “agreed/strongly agreed” that R2W guidelines were a primary source for guiding return to practice, and most were confident with education received and had the skills needed to effectively treat patients during the COVID-19 pandemic. Confidence and preparedness improved in survey 2. Gowns/lab coat use for aerosol-generating procedures increased from 26% to 93%, and the use of full face shields rose from 6% to 93% during the pandemic. Conclusions: A multistakeholder coalition was effective in establishing and communicating comprehensive guidelines and web-based education to ensure unified reintegration of oral health services in NS during a pandemic. This multiorganizational cooperation lay the foundation for responses to subsequent waves of COVID-19 and may serve as an example for collaboratively responding to future public health threats in other settings. Knowledge Transfer Statement: The return-to-work strategy that was developed, disseminated, and assessed through this COVID-19 knowledge exchange coalition will benefit oral health practitioners, professional regulators, government policy makers, and researchers in future pandemic planning.

Needs assessment for gender sensitive reproductive health services for adolescents

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Fatemeh Rahmanian ◽  
Soheila Nazarpour ◽  
Masoumeh Simbar ◽  
Ali Ramezankhani ◽  
Farid Zayeri
Keyword(s):  
Health Care ◽  
Reproductive Health ◽  
Health Services ◽  
Health Care Providers ◽  
Health Care Services ◽  
Care Providers ◽  
Reproductive Health Services ◽  
Care Needs ◽  
Reproductive Health Care ◽  
Care Services

AbstractBackgroundA dimension of reproductive health services that should be gender sensitive is reproductive health services for adolescents.ObjectiveThis study aims to assess needs for gender sensitive reproductive health care services for adolescents.MethodsThis was a descriptive cross-sectional study on 341 of health care providers for adolescents in health centers and hospitals affiliated to Shiraz University of Medical Sciences in Iran in 2016. The subjects of the study were recruited using a convenience sampling method. The tools for data collection were: (1) a demographic information questionnaire and; (2) a valid and reliable questionnaire to Assess the Needs of Gender-Sensitive Adolescents Reproductive Health Care Services (ANQ-GSARHS) including three sections; process, structure and policy making for the services. Data were analyzed using SPSS 21.ResultsThree hundred and forty-one health providers with an average working experience of 8.77 ± 5.39 [mean ± standard deviation (SD)] years participated in the study. The results demonstrated the highest scores for educational needs (92.96% ± 11.49%), supportive policies (92.71% ± 11.70%) and then care needs (92.37% ± 14.34%) of the services.ConclusionsProviding gender sensitive reproductive health care services for adolescents needs to be reformed as regards processes, structure and policies of the services. However, the gender appropriate educational and care needs as well as supportive policies are the priorities for reform of the services.

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