Case study of a method of development of a selection process for community health workers in sub-Saharan Africa

Abstract Background Choosing who should be recruited as a community health worker (CHW) is an important task, for their future performance partly depends on their ability to learn the required knowledge and skills, and their personal attributes. Developing a fair and effective selection process for CHWs is a challenging task, and reports of attempts to do so are rare. This paper describes a five-stage process of development and initial testing of a CHW selection process in two CHW programmes, one in Malawi and one in Ghana, highlighting the lessons learned at each stage and offering recommendations to other CHW programme providers seeking to develop their own selection processes. Case presentation The five stages of selection process development were as follows: (1) review an existing selection process, (2) conduct a job analysis, (3) elicit stakeholder opinions, (4) co-design the selection process and (5) test the selection process. Good practice in selection process development from the human resource literature and the principles of co-design were considered throughout. Validity, reliability, fairness, acceptability and feasibility—the determinants of selection process utility—were considered as appropriate during stages 1 to 4 and used to guide the testing in stage 5. The selection methods used by each local team were a written test and a short interview. Conclusions Working with stakeholders, including CHWs, helped to ensure the acceptability of the selection processes developed. Expectations of intensiveness—in particular the number of interviewers—needed to be managed as resources for selection are limited, and CHWs reported that any form of interview may be stressful. Testing highlighted the importance of piloting with CHWs to ensure clarity of wording of questions, interviewer training to maximise inter-rater reliability and the provision of guidance to applicants in advance of any selection events. Trade-offs between the different components of selection process utility are also likely to be required. Further refinements and evaluation of predictive validity (i.e. a sixth stage of development) would be recommended before roll-out.

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The use of low-cost ruggedized Android tablets to augment in-service training of community health workers in Mukono, Uganda: perspectives and lessons learned from the field

African Health Sciences ◽

10.4314/ahs.v21i3.60 ◽

2021 ◽

Vol 21 (3) ◽

pp. 1482-1490

Author(s):

Christina E Stiles ◽

Edward O’Neil Jr ◽

Kenneth Kabali ◽

James O’Donovan

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Low Cost ◽

Local Level ◽

Scale Up ◽

Lessons Learned ◽

Sub Saharan Africa ◽

Refresher Training ◽

Service Training

Background: Despite potential for community health workers (CHWs) to effectively reduce morbidity and mortality in sub-Saharan Africa, they still face multiple barriers including access to on-going and refresher training. Digital technology offers a potential solution to improve the provision of ongoing training for CHWs. Objectives: This report shares participant insights and experiences following the implementation of a mobile health (mHealth) assisted Integrated Community Case Management (iCCM) refresher training programme for CHWs in Mukono, Uganda. We seek to document benefits and challenges of such an approach. Methods: CHWs were trained to recognize, treat and prevent childhood pneumonia via locally made videos preloaded onto low cost, ruggedized Android tablets. Subsequent interviews were compiled with key stakeholders including CHWs, CHW leaders and programme supervisors to better understand the strengths, barriers and lessons learned following the interven- tion. Results: Success factors included the establishment of CHW leadership structures, the ability to use the tablets to learn on an “any pace, any place” basis and using the tablets to conduct community teaching and outreach. Barriers included appro- priate consideration of the implementation timeline and avoiding a “one size fits all” approach to digital literacy training. Conclusions: The strength of the program stemmed from a grassroots approach that prioritized stakeholder input at all stages. Leadership at a local level, a history of local engagement and trust built up over a period time were also integral. As organizations aim to scale up digitally enhanced training initiatives, it is paramount that attention is paid to these human factors which are key for program success. Keywords: Low-cost ruggedized Android tablets; in-service training; community health workers; Mukono.

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Winning the Argument and Moving the Fight: The Legacy of a Grassroots Humanitarian

Public Voices ◽

10.22140/pv.24 ◽

2016 ◽

Vol 14 (1) ◽

pp. 115

Author(s):

Mary Coleman

Keyword(s):

Higher Education ◽

United States ◽

Winning Strategy ◽

Supreme Court Decision ◽

The United States ◽

Colleges And Universities ◽

Lessons Learned ◽

The Political ◽

Political Actors ◽

Trade Offs

The author of this article argues that the two-decades-long litigation struggle was necessary to push the political actors in Mississippi into a more virtuous than vicious legal/political negotiation. The second and related argument, however, is that neither the 1992 United States Supreme Court decision in Fordice nor the negotiation provided an adequate riposte to plaintiffs’ claims. The author shows that their chief counsel for the first phase of the litigation wanted equality of opportunity for historically black colleges and universities (HBCUs), as did the plaintiffs. In the course of explicating the role of a legal grass-roots humanitarian, Coleman suggests lessons learned and trade-offs from that case/negotiation, describing the tradeoffs as part of the political vestiges of legal racism in black public higher education and the need to move HBCUs to a higher level of opportunity at a critical juncture in the life of tuition-dependent colleges and universities in the United States. Throughout the essay the following questions pose themselves: In thinking about the Road to Fordice and to political settlement, would the Justice Department lawyers and the plaintiffs’ lawyers connect at the point of their shared strength? Would the timing of the settlement benefit the plaintiffs and/or the State? Could plaintiffs’ lawyers hold together for the length of the case and move each piece of the case forward in a winning strategy? Who were plaintiffs’ opponents and what was their strategy? With these questions in mind, the author offers an analysis of how the campaign— political/legal arguments and political/legal remedies to remove the vestiges of de jure segregation in higher education—unfolded in Mississippi, with special emphasis on the initiating lawyer in Ayers v. Waller and Fordice, Isaiah Madison

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Costing interventions in the field: preliminary cost estimates and lessons learned from an evaluation of community-wide mass drug administration for elimination of soil-transmitted helminths in the DeWorm3 trial

BMJ Open ◽

10.1136/bmjopen-2021-049734 ◽

2021 ◽

Vol 11 (7) ◽

pp. e049734

Author(s):

Katya Galactionova ◽

Maitreyi Sahu ◽

Samuel Paul Gideon ◽

Saravanakumar Puthupalayam Kaliappan ◽

Chloe Morozoff ◽

...

Keyword(s):

Data Collection ◽

Drug Administration ◽

Financial Reporting ◽

Mass Drug Administration ◽

Lessons Learned ◽

Secondary Outcome ◽

Data Quality Control ◽

Soil Transmitted Helminths ◽

Trade Offs ◽

Rich Data

ObjectiveTo present a costing study integrated within the DeWorm3 multi-country field trial of community-wide mass drug administration (cMDA) for elimination of soil-transmitted helminths.DesignTailored data collection instruments covering resource use, expenditure and operational details were developed for each site. These were populated alongside field activities by on-site staff. Data quality control and validation processes were established. Programmed routines were used to clean, standardise and analyse data to derive costs of cMDA and supportive activities.SettingField site and collaborating research institutions.Primary and secondary outcome measuresA strategy for costing interventions in parallel with field activities was discussed. Interim estimates of cMDA costs obtained with the strategy were presented for one of the trial sites.ResultsThe study demonstrated that it was both feasible and advantageous to collect data alongside field activities. Practical decisions on implementing the strategy and the trade-offs involved varied by site; trialists and local partners were key to tailoring data collection to the technical and operational realities in the field. The strategy capitalised on the established processes for routine financial reporting at sites, benefitted from high recall and gathered operational insight that facilitated interpretation of the estimates derived. The methodology produced granular costs that aligned with the literature and allowed exploration of relevant scenarios. In the first year of the trial, net of drugs, the incremental financial cost of extending deworming of school-aged children to the whole community in India site averaged US$1.14 (USD, 2018) per person per round. A hypothesised at-scale routine implementation scenario yielded a much lower estimate of US$0.11 per person treated per round.ConclusionsWe showed that costing interventions alongside field activities offers unique opportunities for collecting rich data to inform policy toward optimising health interventions and for facilitating transfer of economic evidence from the field to the programme.Trial registration numberNCT03014167; Pre-results.

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Predicting Rates of Inbreeding in Populations Undergoing Selection

Genetics ◽

10.1093/genetics/154.4.1851 ◽

2000 ◽

Vol 154 (4) ◽

pp. 1851-1864 ◽

Cited By ~ 5

Author(s):

John A Woolliams ◽

Piter Bijma

Keyword(s):

Overlapping Generations ◽

Linear Models ◽

Selection Process ◽

Correction Term ◽

Random Mating ◽

Nonrandom Mating ◽

Selection Processes ◽

Genetic Contributions ◽

The Relationship

AbstractTractable forms of predicting rates of inbreeding (ΔF) in selected populations with general indices, nonrandom mating, and overlapping generations were developed, with the principal results assuming a period of equilibrium in the selection process. An existing theorem concerning the relationship between squared long-term genetic contributions and rates of inbreeding was extended to nonrandom mating and to overlapping generations. ΔF was shown to be ~¼(1 − ω) times the expected sum of squared lifetime contributions, where ω is the deviation from Hardy-Weinberg proportions. This relationship cannot be used for prediction since it is based upon observed quantities. Therefore, the relationship was further developed to express ΔF in terms of expected long-term contributions that are conditional on a set of selective advantages that relate the selection processes in two consecutive generations and are predictable quantities. With random mating, if selected family sizes are assumed to be independent Poisson variables then the expected long-term contribution could be substituted for the observed, providing ¼ (since ω = 0) was increased to ½. Established theory was used to provide a correction term to account for deviations from the Poisson assumptions. The equations were successfully applied, using simple linear models, to the problem of predicting ΔF with sib indices in discrete generations since previously published solutions had proved complex.

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Why Protect Ancient Woodland in the UK? Rethinking the Ecosystem Approach

Transnational Environmental Law ◽

10.1017/s2047102520000333 ◽

2020 ◽

pp. 1-24

Author(s):

Jona Razzaque ◽

Claire Lester

Keyword(s):

High Speed ◽

Biodiversity Loss ◽

Ecosystem Approach ◽

Lessons Learned ◽

Value Systems ◽

Ancient Woodland ◽

Forestry Practices ◽

Regulatory Frameworks ◽

Trade Offs ◽

The Uk

Abstract Sites of ancient woodland in the United Kingdom (UK) are diminishing rapidly and the multifunctional forest management system with its fragmented approach fails effectively to protect such woodland. In the face of reports on the destruction of ancient woodland, the HS2 High-Speed train project in the UK signifies the extent of trade-offs among the key stakeholders. Such large infrastructure projects typically come with high environmental and social costs, including deforestation, habitat fragmentation, biodiversity loss, and social disruption. This article examines the protection of ancient woodland in the UK and assesses the challenges in applying the ecosystem approach, an internationally recognized sustainability strategy, in the context of such protection. A better understanding of the ecosystem approach to manage ancient woodland is critical for promoting sustainable forestry practices in the UK and informs the discussion in this article of the importance of conserving ancient woodland globally. Lessons learned from UK woodland policies and certification schemes include the need to have in place strong regulatory frameworks, introduce clear indicators, and recognize pluralistic value systems alongside economic considerations. The article concludes that the protection of ancient woodland in the UK requires distinct and strong laws that reflect multiple values of this resource, acknowledge the trade-offs among stakeholders, and adopt an inclusive approach to reduce power asymmetries.

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Community-driven citizen science approach to explore cardiovascular disease risk perception, and develop prevention advocacy strategies in sub-Saharan Africa: a programme protocol

Research Involvement and Engagement ◽

10.1186/s40900-020-00246-x ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Kufre Joseph Okop ◽

Kathy Murphy ◽

Estelle Victoria Lambert ◽

Kiya Kedir ◽

Hailemichael Getachew ◽

...

Keyword(s):

Cardiovascular Disease ◽

Citizen Science ◽

Risk Perceptions ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Data Gathering ◽

Lessons Learned ◽

Sub Saharan Africa ◽

Rural And Urban ◽

Sub Saharan

Abstract Background In sub-Saharan Africa (SSA), which experiences a disproportionately high cardiovascular disease (CVD) burden, population-based screening and prevention measures are hampered by low levels of knowledge about CVD and associated risk factors, and inaccurate perceptions of severity of risk. Methods This protocol describes the planned processes for implementing community-driven participatory research, using a citizen science method to explore CVD risk perceptions and to develop community-specific advocacy and prevention strategies in the rural and urban SSA settings. Multi-disciplinary research teams in four selected African countries will engage with and train community members living in rural and urban communities as citizen scientists to facilitate conceptualization, co-designing of research, data gathering, and co-creation of knowledge that can lead to a shared agenda to support collaborative participation in community-engaged science. The emphasis is on robust community engagement, using mobile technology to support data gathering, participatory learning, and co-creation of knowledge and disease prevention advocacy. Discussion Contextual processes applied and lessons learned in specific settings will support redefining or disassembling boundaries in participatory science to foster effective implementation of sustainable prevention intervention programmes in Low- and Middle-income countries.

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