scholarly journals Health system readiness for innovation scale-up: the experience of community-based distribution of injectable contraceptives in Nigeria

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Oluwaseun Akinyemi ◽  
Bronwyn Harris ◽  
Mary Kawonga
Keyword(s):  
Health System ◽  
Community Health ◽  
Health Workers ◽  
Scale Up ◽  
Task Shifting ◽  
Policy Framework ◽  
Framework Analysis ◽  
Community Based ◽  
System Readiness ◽  
Injectable Contraceptives

Abstract Background Following the successful pilot of the community-based distribution of injectable contraceptives (CBDIC) by community health extension workers (CHEWs) in Gombe, northern Nigeria in 2010, there was a policy decision to scale-up the innovation to other parts of the country. However, there is limited understanding of health system factors that may facilitate or impede the successful scale-up of this innovation beyond the pilot site. Thus, this study assessed the health system readiness to deliver CBDIC in Nigeria and how this may influence the scale-up process. Methods This study was conducted in two Local Government Areas in Gombe State in September 2016. Seven key informant interviews were held with purposively sampled senior officials of the ministries of health at the federal and state levels as well as NGO program managers. Also, 10 in-depth interviews were carried out with health workers. All transcripts were analyzed using the thematic framework analysis approach. Result The availability of a policy framework that supports task-shifting and task-sharing, as well as application of evidence from the pilot programme and capacity building programmes for health workers provided a favourable environment for scale-up. Health system challenges for the scale-up process included insufficient community health workers, resistance to the task-shifting policy from professional health groups (who should support the CHEWs), limited funding and poor logistics management which affected commodity distribution and availability. However, there were also a number of health worker innovations which kept the scale-up going. Health workers sometimes used personal resources to make up for logistics failures and poor funding. They often modify the process in order to adapt to the realities on the ground. Conclusion This study shows health system weaknesses that may undermine scale-up of CBDIC. The study also highlights what happens when scale-up is narrowly focused on the intervention without considering system context, capacity and readiness. However, agency and discretionary decision-making among frontline health workers facilitated the process of scaling up, although the sustainability of this is questionable. Benefits observed during the pilot may not be realised on a larger scale if health system challenges are not addressed.

scholarly journals “Our culture prohibits some things”: Qualitative inquiry into how sociocultural context influences the scale up of community-based injectable contraceptives in Nigeria

2019 ◽  
Author(s):  
Oluwaseun Akinyemi ◽  
Bronwyn Harris ◽  
Mary Kawonga
Keyword(s):  
Focus Group ◽  
Qualitative Study ◽  
Health Workers ◽  
Scale Up ◽  
Community Members ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Community Based ◽  
Injectable Contraceptives ◽  
Depth Interviews

AbstractObjectivesTo explore how sociocultural factors may support or impede the adoption of community-based distribution of injectable contraceptives in Nigeria.DesignA qualitative study based on a grounded theory approach was conducted through in-depth interviews and focus group discussions.SettingMost participants lived in Gombe State, North East Nigeria. Other participants were from Ibadan (South West) and Abuja (Federal capital territory).ParticipantsThrough seven key informant interviews, 15 in-depth interviews and 10 focus group discussions, 102 participants were involved in the study.MethodsThis study, conducted in 2016 was part of a larger study on scale up of community-based distribution of injectable contraceptives. Qualitative data were collected from traditional and religious leaders, health workers and community members. The data were audio recorded, transcribed and analysed using a thematic framework method.ResultsSociocultural challenges to scale up included patriarchy and men’s fear of losing control over their spouses, traditional and religious beliefs about fertility, and myths about contraceptives and family planning. As a result of deep-rooted beliefs that children are ‘divine blessings’ and that procreation should not be regulated, participants described a subtle resistance to uptake of injectable contraceptives. Since Gombe is largely a patriarchal society, male involvement emerged as important to the success of meaningful innovation uptake. Community leaders largely described their participation in the scale up process as active, although they also identified scope for further involvement and recognition.ConclusionScale up is more than setting up health sector implementing structures, training health workers and getting innovation supplies, but also requires preparedness which includes paying attention to complex contextual issues. This requires the health system and those who work in it, to move beyond a narrow health ‘comfort zone’ by actively engaging with, and learning from, those who are leading, caring for and living in, the community.Strengths and limitations of this studyThe study participants represented a range of stakeholders - users of injectable contraceptives, community members, providers and health system managers.Our results highlighted that scale up is influenced by several socio-cultural factors; thus, showing the importance of paying attention to complex contextual issues during innovation uptake.The findings of our study emphasized how health systems and communities should interact in order to ensure successful scale up of health innovations.As with any qualitative study, the findings of this study are not statistically generalizable.FundingThis research was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York (Grant No--B 8606.R02), Sida (Grant No:54100113), the DELTAS Africa Initiative (Grant No: 107768/Z/15/Z) and Deutscher Akademischer Austauschdienst (DAAD). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (UK) and the UK government. The statements made and views expressed are solely the responsibility of the authors.Declarations of interestNone.

scholarly journals Bottlenecks to Intervention Scale Up: Supply and Demand Side Perspectives From a Large, Community-based Trial of Malaria Testing

2021 ◽  
Author(s):  
Joseph Kirui ◽  
Josephine Malinga ◽  
Edna Sang ◽  
George Ambani ◽  
Lucy Abel ◽  
...  
Keyword(s):  
Community Health ◽  
Large Scale ◽  
Health Workers ◽  
Supply And Demand ◽  
Scale Up ◽  
Demand Side ◽  
Endemic Region ◽  
Community Based ◽  
The Impact ◽  
Malaria Test

Abstract Background: Maximizing the impact of community-based programs requires understanding how the supply of and demand for the intervention interact at the point of delivery. We present results from a large-scale community health worker study designed to increase the availability of and demand for malaria diagnostic testing in a rural, malaria-endemic region in western Kenya between 2015 and 2017. Methods: Community Health Workers (CHWs) provided free malaria Rapid Diagnostic Test(mRDT) in the community. Those with a positive malaria test were provided with a discounted first-line antimalarial over-the-counter. We conducted a community-based survey to collect individual study outcomes at 12- and 18-months post-implementation. In addition, we collected monthly testing data from the 244 participating CHWs and also conducted in-depth interviews with a random sample of 70 CHWs. Results: From the survey, 55% (n=948/1738) reported having a malaria test for their recent illness with 38% having been tested by a CHW. Being aware of a local CHW (95% CI:1.10-2.04) and belonging to a wealthy household (95% CI:1.14-2.06) were associated with higher malaria testing uptake from any source. Poorer households were more likely to receive a test from a CHW. School-aged children between 5-17 years were more than twice as likely to be tested by a CHW (95% CI:1.47-4.14). Both confidence in AL treatment (95% CI:1.54-4.92) and perceived accuracy of an RDT performed by a CHW (95% CI:1.12-5.27) were strongly and positively associated with testing by a CHW. In adjusted analyses, specific CHWs attributes were significantly associated with higher testing rates including formal employment (95% CI:0.05-2.70), those serving more than 50 households (95% CI:0.70-2.74) and those serving areas with a higher proportion of positive tests (95% CI:1.05, 3.22). On both the supply side and the demand side, confidence in a test performed by a CHW was strongly correlated with the success of the intervention.Conclusion: Scale-up of community-based malaria testing intervention through CHWs is feasible and effective at reaching the poorest households. In order to maximize the impact of such interventions, it is important to recognize factors that may restrict both delivery and demand for such services.

scholarly journals ‘Our culture prohibits some things’: qualitative inquiry into how sociocultural context influences the scale-up of community-based injectable contraceptives in Nigeria

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e035311 ◽  
Author(s):  
Oluwaseun Oladapo Akinyemi ◽  
Bronwyn Harris ◽  
Mary Kawonga
Keyword(s):  
Focus Group ◽  
Health Workers ◽  
Scale Up ◽  
Qualitative Inquiry ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Community Based ◽  
North East ◽  
Injectable Contraceptives ◽  
Depth Interviews

ObjectivesTo explore how sociocultural factors may support or impede the adoption of community-based distribution of injectable contraceptives in Nigeria.DesignA qualitative study based on inductive thematic analysis was conducted through in-depth interviews and focus group discussions.SettingMost participants lived in Gombe State, North-East Nigeria. Other participants were from Ibadan (South-West) and Abuja (Federal Capital Territory).ParticipantsThrough seven key informant interviews, 15 in-depth interviews and 10 focus group discussions, 102 participants were involved in the study.MethodsThis study conducted in 2016 was part of a larger study on scale-up of community-based distribution of injectable contraceptives. Qualitative data were collected from traditional and religious leaders, health workers and community members. The data were audio recorded, transcribed and analysed using a thematic framework method.ResultsSociocultural challenges to scale-up included patriarchy and men’s fear of losing control over their spouses, traditional and religious beliefs about fertility, and myths about contraceptives and family planning. As a result of deep-rooted beliefs that children are ‘divine blessings’ and that procreation should not be regulated, participants described a subtle resistance to uptake of injectable contraceptives. Since Gombe is largely a patriarchal society, male involvement emerged as important to the success of meaningful innovation uptake. Community leaders largely described their participation in the scale-up process as active, although they also identified the scope for further involvement and recognition.ConclusionScale-up is more than setting up health sector implementing structures, training health workers and getting innovation supplies, but also requires preparedness which includes paying attention to complex contextual issues. Policy implementers should also see scale-up as a learning process and be willing to move at the speed of the community.

scholarly journals District health managers perspectives of introducing a new service: a qualitative study of the community-based newborn care programme in Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Della Berhanu ◽  
Iram Hashmi ◽  
Joanna Schellenberg ◽  
Bilal Avan
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Community Health ◽  
Health Workers ◽  
Newborn Care ◽  
District Level ◽  
District Health ◽  
Community Based ◽  
Care Programme

Abstract Background The planning, resourcing, implementation and monitoring of new programmes by district health managers is integral for success and sustainability. Ethiopia introduced the Community-Based Newborn Care programme in 2014 to improve newborn survival: an innovative component allowed community health workers to provide antibiotics for young infants with possible serious bacterial infection when referral was not possible. Informed by the World Health Organization health system building block framework, we aimed to study the capacity and operational challenges of introducing this new health service from the perspective of programme implementers and managers at the district level 20 months after programme initiation. Methods This qualitative study was part of a programme evaluation. From November to December of 2015, we conducted 28 semi-structured interviews with staff at district health offices, health centres and implementing Non-Governmental Organisations in 15 districts of four regions of Ethiopia. Verbatim transcripts were analysed using a priori and emerging themes. Results In line with the government's commitment to treat sick newborns close to their homes, participants reported that community health workers had been successfully trained to provide injectable antibiotics. However, the Community-Based Newborn Care programme was scaled up without allowing the health system to adapt to programme needs. There were inadequate processes and standards to ensure consistent availability of (1) trained staff for technical supervision, (2) antibiotics and (3) monitoring data specific to the programme. Furthermore, Non-Governmental Organizations played a central implementing role, which had implications for the long-term district level ownership and thus for the sustainability of the programme. Conclusion In settings where sustainable local implementation depends on district-level health teams, new programmes should assess health system preparedness to absorb the service, and plan accordingly. Our findings can inform policy makers and implementers about the pre-conditions for a health system to introduce similar services and maximize long-term success.

A Community-Based Participatory Diabetes Prevention and Management Intervention in Rural India Using Community Health Workers

2012 ◽  
Vol 38 (6) ◽  
pp. 822-834 ◽  
Author(s):  
Padmini Balagopal ◽  
N. Kamalamma ◽  
Thakor G. Patel ◽  
Ranjita Misra ◽  
Ranjita Misra ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Diabetes Prevention ◽  
Health Workers ◽  
Rural India ◽  
Community Based ◽  
Management Intervention

scholarly journals Capacitação de agentes comunitários de saúde: integração entre universidade e atenção básica

2020 ◽  
Vol 11 (3) ◽  
pp. 349-359
Author(s):  
Amanda Brait Zerbeto ◽  
Leonardo De Carvalho ◽  
Thaís Amanda Rossa ◽  
Daniel De Paula
Keyword(s):  
Health System ◽  
Continuing Education ◽  
Community Health ◽  
Engineering Students ◽  
Health Workers ◽  
Unified Health System ◽  
Local Problems ◽  
Health Concept ◽  
Institutional Relations ◽  
Training Community

O Projeto Rondon tem criado oportunidades, especialmente na saúde, para que universitários interajam com comunidades vulneráveis, socializando saberes e discutindo soluções coletivamente. O Agente Comunitário de Saúde (ACS) é um personagem fundamental na implementação do Sistema Único de Saúde (SUS), fortalecendo a integração entre os serviços de saúde e a comunidade. Mesmo com muitos avanços, a formação dos ACS permanece um desafio. Este estudo relata a experiência de um projeto de extensão na elaboração, desenvolvimento e realização de uma capacitação para ACS no município de Lindoeste, Paraná. As oficinas foram elaboradas multidisciplinarmente por acadêmicos de enfermagem, nutrição, psicologia e engenharia ambiental. Adotou-se o conceito ampliado de saúde, abordando conceitos do SUS, promoção e prevenção, educação ambiental, nutrição, humanização, além de demandas locais. A utilização de metodologias ativas e de temas relacionados à comunidade permitiram a troca de saberes, criando um espaço em que todos puderam expor suas opiniões e assim buscar soluções para os problemas locais. O desconhecimento dos ACS sobre os conceitos do SUS foi um desafio para o aprofundamento da discussão, moldando o debate muitas vezes num modelo pedagógico clássico. Um ponto positivo foi a integração e colaboração entre os ACS a partir do entendimento dos impactos que o processo de trabalho pode trazer ao município. A partir da capacitação dos ACS, ficou evidente a importância de os projetos de extensão estarem em consonância com as necessidades do território que, no presente trabalho, revelou a necessidade de elaboração e realização da educação continuada dos ACS. Palavras-chave: Sistema Único de Saúde; Atenção Primária à Saúde; Educação Continuada; Relações Comunidade-Instituição Training community health workers: integration between university and primary healthcare   Abstract: The Rondon Project has provided opportunities, especially in the health area, for university students to interact with vulnerable communities, share knowledge, and discuss solutions collectively. The Community Health Worker (CHW) plays a key role in implementing the Brazilian Unified Health System (Sistema Único de Saúde - SUS), strengthening the integration between health services and the community. Even with many advances, the education of CHWs remains a challenge. This study reports an extension project's experience in elaborating, developing, and accomplishing training for CHW in Lindoeste, Paraná state, Brazil. The workshops were developed in a multidisciplinary manner by nursing, nutrition, psychology, and environmental engineering students. The expanded health concept was adopted, addressing SUS concepts, health promotion, prevention, environmental education, nutrition, humanization, and local demands. The use of active learning methods and community-related themes allowed for knowledge sharing, creating an environment where everyone could express their opinions and seek solutions to local problems. CHW's lack of knowledge about SUS concepts was a challenge to deepen the discussion, often shaping the debate in a traditional way. A positive point was the integration and collaboration among CHW, which were carried out in understanding the value of the collaborative workflow for their community. This experience highlighted the importance of the extension project being in tune with the demand of the territory, which in the present work revealed the need to elaborate and carry out continuing education of the CHW. Keywords: : Unified Health System; Primary Health Care; Continuing Education; Community Institutional Relations

A sustainable community based model of non-communicable disease risk factor surveillance: “SHRADDHA-JAGRITHI project” (Preprint)

2021 ◽  
Author(s):  
Jaideep Menon ◽  
Mathews Numpeli ◽  
Sajeev.P. Kunjan ◽  
Beena.V. Karimbuvayilil ◽  
Aswathy Sreedevi ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Public Health System ◽  
Health Workers ◽  
Communicable Disease ◽  
Community Based ◽  
Frontline Health Workers ◽  
The Individual ◽  
Non Communicable Disease

UNSTRUCTURED Abstract: India has a massive non-communicable disease (NCD) burden at an enormous cost to the individual, family, society and health system at large, in spite of which prevention and surveillance is relatively neglected. Risk factors for atherosclerotic cardiovascular disease if diagnosed early and treated adequately would help decrease the mortality and morbidity burden. India is in a stage of rapid epidemiological transition with the state of Kerala being at the forefront, pointing us towards likely disease burden and outcomes for the rest of the country, in the future. A previous study done by the same investigators, in a population of >100,000, revealed poor awareness and treatment of NCDs and also poor adherence to medicines in individuals with CVD. The investigators are looking at a sustainable, community based model of surveillance for NCDs with corporate support wherein frontline health workers check all individuals in the target group ( > age 30 years) with further follow up and treatment planned in a “spoke and hub” model using the public health system of primary health centres (PHCs) as spokes to the hubs of Taluk or District hospitals. All data entry done by frontline health workers would be on a Tab PC ensuring rapid acquisition and transfer of participant health details to PHCs for further follow up and treatment. The model will be evaluated based on the utilisation rate of various services offered at all tier levels. The proportions of the target population screened, eligible individuals who reached the spoke or hub centres for risk stratification and care and community level control for hypertension and diabetes in annual surveys will be used as indicator variables. The model ensures diagnosis and follow up treatment at no cost to the individual entirely through the tiered public health system of the state and country.

scholarly journals Community-Based Interventions for Stroke Provided by Nurses and Community Health Workers: A Review of the Literature

2020 ◽  
Vol 52 (4) ◽  
pp. 152-159 ◽  
Author(s):  
Gayenell S. Magwood ◽  
Michelle Nichols ◽  
Carolyn Jenkins ◽  
Ayaba Logan ◽  
Suparna Qanungo ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Review Of The Literature ◽  
Community Based Interventions ◽  
Community Based
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