scholarly journals Who could be One Health Activist at the community level?: A case for India

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Sandul Yasobant ◽  
Walter Bruchhausen ◽  
Deepak Saxena ◽  
Farjana Zakir Memon ◽  
Timo Falkenberg
Keyword(s):  
Health System ◽  
Work Experience ◽  
Financial Incentives ◽  
One Health ◽  
Health Workers ◽  
Structured Interview ◽  
Communicable Diseases ◽  
Community Level ◽  
System Level

Abstract Background Community health workers (CHWs) are the mainstay of the public health system, serving for decades in low-resource countries. Their multi-dimensional work in various health care services, including the prevention of communicable diseases and health promotion of non-communicable diseases, makes CHWs, the frontline workers in their respective communities in India. As India is heading towards the development of One Health (OH), this study attempted to provide an insight into potential OH activists (OHA) at the community level. Thus, this case study in one of India’s western cities, Ahmedabad, targeted identifying OHA by exploring the feasibility and the motivation of CHWs in a local setting. Methods This case study explores two major CHWs, i.e., female (Accredited Social Health Activists/ASHA) health workers (FHWs) and male (multipurpose) health workers (MHWs), on their experience and motivation for becoming an OHA. The data were collected between September 2018 and August 2019 through a mixed design, i.e., quantitative data (cross-sectional structured questionnaire) followed by qualitative data (focus group discussion with a semi-structured interview guide). Results The motivation of the CHWs for liaisoning as OHA was found to be low; however, the FHWs have a higher mean motivation score [40 (36–43)] as compared to MHWs [37 (35–40)] out of a maximum score of 92. Although most CHWs have received zoonoses training or contributed to zoonoses prevention campaigns, their awareness level was found to be different among male and female health workers. Comparing the female and male health workers to act as OHA, higher motivational score, multidisciplinary collaborative work experience, and way for incentive generation documented among the female health workers. Conclusion ASHAs were willing to accept the additional new liaison role of OHAs if measures like financial incentives and improved recognition are provided. Although this study documented various systemic factors at the individual, community, and health system level, which might, directly and indirectly, impact the acceptance level to act as OHA, they need to be accounted for in the policy regime.

scholarly journals Who could be One Health Activist at the community level?: A case for India

2020 ◽  
Author(s):  
Sandul Yasobant ◽  
Walter Bruchhausen ◽  
Deepak Saxena ◽  
Farjana Zakir Memon ◽  
Timo Falkenberg
Keyword(s):  
Health System ◽  
Financial Incentives ◽  
One Health ◽  
Health Workers ◽  
Structured Interview ◽  
Communicable Diseases ◽  
Community Level ◽  
System Level ◽  
Cross Sectional

Abstract Background: Community Health Workers (CHWs) are the mainstay of the public health system, serving for decades in low resource countries. Their multi-dimensional work in diverse health care services, including the prevention of communicable diseases and health promotion for non-communicable diseases, are making CHWs the frontline workers in their respective communities in India. As India is heading towards the development of One Health (OH), this study attempted to provide an insight into potential OH activists (OHA) at the community level. Thus, this case study in one of the western cities of India, Ahmedabad, targeted to identify OHA by exploring the motivation to become an OHA in a local setting.Methods: This case study explores two major CHWs i.e. female (Accredited Social Health Activists-ASHA) and male (multipurpose male health worker) on their motivation for becoming an OHA. The data was collected between September 2018 and August 2019 through a mixed design i.e. quantitative data (cross-sectional structured questionnaire) and qualitative data (focus group discussion with a semi-structured interview guide). Results: The motivation of the CHWs for OHA was found to be low. Although most CHWs have received zoonoses training or contributed to zoonoses prevention campaigns, their awareness level was found to be different among male and female health workers. ASHAs were found to be willing to accept the additional new liaison role of OHAs if measures like financial incentives and improved recognition are provided. Conclusion: The high demotivation of CHWs that has been documented on the individual, community, and health system level needs to be urgently addressed in future policies.

scholarly journals Benefits and Challenges of Policy Options in Rationing the Hospital Radiology Services: A Case Study

2020 ◽  
Author(s):  
Hasan Jafari ◽  
Mohammad Ranjbar ◽  
Hamideh Mahjoub ◽  
Hamed Ghoshoni ◽  
Mohammad Baghi ◽  
...  
Keyword(s):  
Health System ◽  
Supply And Demand ◽  
Knowledge Network ◽  
System Level ◽  
Radiology Department ◽  
Policy Options ◽  
Policy Makers ◽  
Rationing Policy ◽  
Care Costs

Objective: In many countries, limiting the financial and budgetary resources is a challenge in the health system. One of the most costly parts of the health system is undoubtedly the radiology department of hospitals. Therefore, this study aimed to determine the benefits and challenges of the policies proposed for rationing hospital radiology services. Information sources and selected methods for study: In this narrative or literature review study, Persian (SID, Magiran, Barkat Knowledge network system, Irandoc), and Latin (Google Scholar, PubMed, Scopus, ISI web of sciences) databases were searched. The applied keywords were radiology, rationing, distribution, priority setting, resource allocation, and policy brief. In the initial search, 145 articles were studied. Subsequently, after reviewing the titles and abstracts, 65 studies were selected and investigated. Finally, 44 related studies were thoroughly investigated. The inclusion criteria covered the studies in Persian or English. The exclusion criteria included the studies that did not have full texts. Our search included the studies conducted from 1/1/2000 to 1/1/ 2017. Results: The present study examined the benefits and challenges of radiology services rationing. Policy options were presented at 3 levels of provider, organizational, and system. The provider level consisted of training clinical and non-clinical personnel to use and maintain the medical equipment and requiring the physicians to use clinical guidelines. The organization level included reviewing imaging tariffs, entering insurance in controlling supply and demand for radiology services, and assessing equipment by the Institute for Health Technology Assessment. The system level contained assignment of radiological services to the private sector. Conclusion: As health care costs are rising and resources are increasingly constrained by ever-increasing demands, policy makers and officials can use the proposed solutions with regard to contextual conditions to design a rationing model. Services at the macro level of the health system and operationalization of the rationing process reduce the gap between supply and demand of the health services.  

scholarly journals Policy and Linkages in the Application of a One Health System for Reporting and Controlling African Trypanosomiasis and Other Zoonotic Diseases in Zambia

Pathogens ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 30
Author(s):  
Gloria M. Mulenga ◽  
Boniface Namangala ◽  
Kalinga Chilongo ◽  
Lars Henning ◽  
Bruce Gummow
Keyword(s):  
Health System ◽  
One Health ◽  
Zoonotic Diseases ◽  
African Trypanosomiasis ◽  
Disease Reporting ◽  
Support Programmes ◽  
The Impact ◽  
Local Levels ◽  
Optimal Implementation

The capacity to detect, control and manage emerging and re-emerging zoonotic diseases in Africa has been limited by a lack of utilisation of available reporting structures and policies to support programmes at national and local levels. This study explored the impact of the Zambian government policies on animal and human disease reporting and management and on One Health opportunities. An in-depth review and analysis of strengths, weaknesses, opportunities, and threats in the existing policies and reporting structures in the departments responsible for Veterinary Services, Health, and Wildlife, was conducted. According to our findings, sub-optimal implementation of existing policies related to the control of zoonotic diseases was impacting disease reporting, and reporting structures play an important role in effective and sustainable reporting of zoonotic diseases. Further, the study explored capacities and strategies in trypanosomiasis control as a case study that could prompt effective adoption of a One Health approach, and as such, the study suggests measures that could help to assess the performance of a One Health system in the control of African trypanosomiasis and other zoonotic diseases.

scholarly journals Community Health Workers as Influential Health System Actors and not "Just Another Pair Of Hands"

2020 ◽  
Author(s):  
Sumit Kane ◽  
Anjali Radkar ◽  
Mukta Gadgil ◽  
Barbara McPake
Keyword(s):  
Health System ◽  
Community Health ◽  
Community Health Workers ◽  
Health Systems ◽  
Work Experience ◽  
Health Workers ◽  
Human Resources For Health ◽  
Research Question ◽  
Large Body ◽  
Optimal Strategies

Background: Over the last 20 years, community health workers (CHWs) have become a mainstay of human resources for health in many low- and middle-income countries (LMICs). A large body of research chronicles CHWs’ experience of their work. In this study we focus on 2 narratives that stand out in the literature. The first is the idea that social, economic and health system contexts intersect to undermine CHWs’ experience of their work, and that a key factor underpinning this experience is that LMIC health systems tend to view CHWs as just an ‘extra pair of hands’ to be called upon to provide ‘technical fixes.’ In this study we show the dynamic and evolving nature of CHW programmes and CHW identities and the need, therefore, for new understandings. Methods: A qualitative case study was carried out of the Indian CHW program (CHWs are called accredited social health activists: ASHAs). It aimed to answer the research question: How do ASHAs experience being CHWs, and what shapes their experience and performance? In depth interviews were conducted with 32 purposively selected ASHAs and key informants. Analysis was focused on interpreting and on developing analytical accounts of ASHAs’ experiences of being CHWs; it was iterative and occurred throughout the research. Interviews were transcribed verbatim and transcripts were analysed using a framework approach (with Nvivo 11). Results: CHWs resent being treated as just another pair of hands at the beck and call of formal health workers. The experience of being a CHW is evolving, and many are accumulating substantial social capital over time – emerging as influential social actors in the communities they serve. CHWs are covertly and overtly acting to subvert the structural forces that undermine their performance and work experience. Conclusion: CHWs have the potential to be influential actors in the communities they serve and in frontline health services. Health systems and health researchers need to be cognizant of and consciously engage with this emerging global social dynamic around CHWs. Such an approach can help guide the development of optimal strategies to support CHWs to fulfil their role in achieving health and social development goals.

scholarly journals Non-communicable diseases in the Western Area District, Sierra Leone, following the Ebola outbreak

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 795 ◽  
Author(s):  
Ibrahim Baimba Koroma ◽  
Dena Javadi ◽  
Katrina Hann ◽  
Anthony D Harries ◽  
Francis Smart ◽  
...  
Keyword(s):  
Health System ◽  
Sierra Leone ◽  
Ebola Virus ◽  
Health Workers ◽  
Virus Disease ◽  
Secondary Data ◽  
Communicable Diseases ◽  
Cross Sectional ◽  
Non Communicable Diseases ◽  
Western Area

Background: Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality in the world. During infectious disease outbreaks, such as the Ebola virus disease outbreak in West Africa from 2014-2015, the health system is often strained, and diagnosis, management and care of NCDs may be compromised. This study assessed numbers and distribution of NCDs in all health facilities in the Western-Area District, Sierra Leone, in the post-Ebola period (June–December 2015) comparing findings with the pre-Ebola (June–December 2013) and Ebola outbreak (June–December 2014) periods. Methods: This was a cross-sectional study using secondary data from routine records of aggregate monthly NCD reports. Data were analysed using Open EPI and comparisons were made between the post-Ebola and pre-Ebola/Ebola periods using the chi-square test. Results: There were 10,011 people reported with NCDs during the three six-month periods, with 6194 (62%) presenting at peripheral health units (PHU). Reported NCDs decreased during Ebola and increased post-Ebola, but did not recover to pre-Ebola levels. Hypertension cases remained fairly constant throughout being mainly managed at PHU. Numbers with diabetes mellitus generally stayed the same except for a significant post-Ebola increase in tertiary hospitals. Small numbers were reported with mental health disorders across all facilities in all time periods. Conclusion: NCD reporting is recovering in the immediate post-Ebola period. Decentralization of NCD care is welcome and is an effective strategy for management as evidenced by hypertension. To be successful, this must be supported by strengthening other elements of the health system such as training of health workers, robust information and referral systems and reliable medicine supply chains.

scholarly journals Non-communicable diseases in the Western Area District, Sierra Leone, following the Ebola outbreak

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 795
Author(s):  
Ibrahim Baimba Koroma ◽  
Dena Javadi ◽  
Katrina Hann ◽  
Anthony D Harries ◽  
Francis Smart ◽  
...  
Keyword(s):  
Health System ◽  
Sierra Leone ◽  
Ebola Virus ◽  
Health Workers ◽  
Virus Disease ◽  
Secondary Data ◽  
Communicable Diseases ◽  
Cross Sectional ◽  
Non Communicable Diseases ◽  
Western Area

Background: Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality in the world. During infectious disease outbreaks, such as the Ebola virus disease outbreak in West Africa from 2014-2015, the health system is often strained, and diagnosis, management and care of NCDs may be compromised. This study assessed numbers and distribution of NCDs in all health facilities in the Western-Area District, Sierra Leone, in the post-Ebola period (June–December 2015) comparing findings with the pre-Ebola (June–December 2013) and Ebola outbreak (June–December 2014) periods. Methods: This was a cross-sectional study using secondary data from routine records of aggregate monthly NCD reports. Data were analysed using Open EPI and comparisons were made between the post-Ebola and pre-Ebola/Ebola periods using the chi square test. Results: There were 10,011 people reported with NCDs during the three six-month periods, with 6194 (62%) presenting at peripheral health units (PHU). Reported NCDs decreased during Ebola and increased post-Ebola, but did not recover to pre-Ebola levels. Hypertension cases remained fairly constant throughout being mainly managed at PHU. Numbers with diabetes mellitus generally stayed the same except for a significant post-Ebola increase in tertiary hospitals. Small numbers were reported with mental health disorders across all facilities in all time periods. Conclusion: NCD reporting is recovering in the immediate post-Ebola period. Decentralization of NCD care is welcome and is an effective strategy for management as evidenced by hypertension. To be successful, this must be supported by strengthening other elements of the health system such as training of health workers, robust information and referral systems and reliable medicine supply chains.

scholarly journals The Structure, Process, and Outcome of Mentorship on Survivor with Schizophrenia: A Case Study

2021 ◽  
Vol 9 (1) ◽  
pp. 71
Author(s):  
Rozali Arsyad Kurniawan ◽  
Suryani Suryani ◽  
Taty Hernawaty ◽  
Lilibeth Al-Kofahy
Keyword(s):  
Health Workers ◽  
Recovery Process ◽  
Structured Interview ◽  
Nursing Interventions ◽  
Personal Recovery ◽  
Research Themes ◽  
Depth Analysis ◽  
Process And Outcome ◽  
Document Review

The personal recovery paradigm in schizophrenia patients require a change of service. One of the changes that can be made to support the schizophrenia recovery process is a change in the concept of the relationship between patients and nurses. Nurse mentorship for schizophrenia patients is a new terminology of innovation in a supportive relationship between health workers and patients. At present, it is not known how the structure, process, and outcome of mentorship to schizophrenia survivors. This study aimed to explain how the structure, process, and outcome of mentoring nurses to schizophrenia survivors. This research is qualitative research using the case study method involving three cases of mentorship conducted in Banyumas Regional Hospital. A total of nine participants were involved in this study which consisted of three nurses as mentors, three schizophrenia survivors, and three caregivers. Data were collected by semi-structured interview techniques, observation, and document review. After in-depth analysis    seven research themes were found. Participants' perception about the structure of mentorship include the theme mentorship requires a variety of abilities of nurses and conditions of survivors who can participate in mentorship. While the mentorship process includes the theme requires patience in mentorship, giving guidance for the recovery of survivors, and facing the recurrence of survivors due to treatment factors. Participants revealed the outcome of mentorship in the theme mentors feel inner satisfaction, and survivors feel more enthusiastic about life. The results of this study provide the view that mentorship has the potential to be developed into quality nursing interventions to support the recovery process of schizophrenia survivors.

scholarly journals Scaling Up Tobacco Cessation within TB Programmes: Findings from a Multi-Country, Mixed-Methods, Implementation Study.

2021 ◽  
Author(s):  
Helen Elsey ◽  
Zunayed Al Azdi ◽  
Shophika Regmi ◽  
Sushil Baral ◽  
Razia Fatima ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Health System ◽  
Tobacco Cessation ◽  
Health Workers ◽  
Scale Up ◽  
Deep Understanding ◽  
Routine Data ◽  
System Level ◽  
Horizontal Scale ◽  
Vertical Scale

Abstract Background: Brief behavioural support can effectively help TB patients to quit smoking and improve their outcomes. In collaboration with TB programmes in Bangladesh, Nepal and Pakistan, we evaluated implementation and scale-up of cessation support using four strategies: i) brief tobacco cessation intervention ii) integration of tobacco cessation within routine training iii) inclusion of tobacco indicators in routine records and iv) embedding research within TB programmes.Methods: We used mixed methods of observation, interviews and routine data within WHO’s ExpandNet framework for scale-up. We aimed to understand the extent of, and strategies which facilitated vertical scale-up (institutionalisation) within 59 health facility learning sites in Pakistan, 18 in Nepal and 15 in Bangladesh and horizontal scale-up (increased coverage beyond learning sites). We observed training and surveyed 169 TB health workers to measure changes in their confidence to deliver cessation. Routine TB data from the learning sites was analysed to assess delivery of the intervention and use of TB forms revised to report smoking status and cessation support provided. A purposive sample of TB health workers, managers and policymakers were interviewed (Bangladesh: n=12; Nepal n=13; Pakistan n=19;). Costs of scale-up were estimated using activity-based cost-analysis. Results: Routine data indicated health workers in learning sites asked all TB patients about tobacco use and offered them cessation support. Qualitative data showed use of intervention materials, often with adaptation and partial implementation in busy clinics. Short (1-2 hours) training integrated within existing programmes increased mean confidence to deliver cessation by 17% (95% CI: 14% to 20%). A focus on health system changes (reporting, training, supervision) facilitated vertical scale-up. Dissemination of materials beyond learning sites and changes to national reporting forms and training indicated horizontal scale-up. Embedding research within TB health systems was crucial for horizontal scale-up and required dynamic use of tactics e.g. alliance-building, engagement in wider policy process, use of insider-researchers, and deep understanding of health system actors and processes. Conclusions: System-level changes within TB programmes may enable routine delivery of cessation support to TB patients. These strategies are inexpensive and, with concerted efforts from TB programmes and donors, tobacco cessation can be institutionalised at-scale.

scholarly journals Integrating community health workers into the formal health system to improve performance: a qualitative study on the role of on-site supervision in the South African programme

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e022186 ◽  
Author(s):  
Yu-hwei Tseng ◽  
Frances Griffiths ◽  
Julia de Kadt ◽  
Nonhlanhla Nxumalo ◽  
Teurai Rwafa ◽  
...  
Keyword(s):  
Health System ◽  
Community Health ◽  
South African ◽  
Health Workers ◽  
Group Discussions ◽  
Skill Levels ◽  
Clinic Staff ◽  
Study Approach

ObjectivesTo explore the role of on-site supervision in community health worker (CHW) programmes and CHW integration into the health system. We compared the functioning of CHW teams reporting to a clinic-based nurse with teams supervised by a community-based nurse. We also consider whether a junior nurse can provide adequate supervision, given the shortage of senior nurses.DesignA case study approach to study six CHW teams with different configurations of supervision and location. We used a range of qualitative methods: observation of CHW and their supervisors (126 days), focus group discussions (12) and interviews (117).SettingSouth Africa where a national CHW programme is being implemented with on-site supervision.ParticipantsCHWs, their supervisors, clinic managers and staff, district managers, key informants from the community and CHW clients.ResultsEffective supervisors supported CHWs through household visits, on-the-job training, debriefing, reviewing CHWs’ daily logs and assistance with compiling reports. CHWs led by senior nurses were motivated and performed a greater range of tasks; junior nurses in these teams could better fulfil their role. Clinic-based teams with senior supervisors were better integrated and more able to ensure continuity of care. In contrast, teams with only junior supervisors, or based in the community, had less engagement with clinic staff, and were less able to ensure necessary care for patients, resulting in lower levels of trust from clients.ConclusionSenior supervisors raised CHW skills, and successfully negotiated a place for CHWs in the health system. Collaboration with clinic staff reduced CHWs’ marginalisation and increased motivation. Despite being clinic-based, teams without senior supervisors had lower skill levels and were less integrated into the health system.

A Multisite Case Study of Caregiver Advise, Record, Enable Act Implementation

2019 ◽  
Vol 60 (4) ◽  
pp. 776-786 ◽  
Author(s):  
Cassandra Leighton ◽  
Beth Fields ◽  
Juleen L Rodakowski ◽  
Connie Feiler ◽  
Mary Hawk ◽  
...  
Keyword(s):  
Organizational Context ◽  
Care Delivery ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Structured Interview ◽  
Routine Care ◽  
System Level ◽  
Financing System ◽  
Implementation Team

Abstract Background and Objectives The Commonwealth of Pennsylvania passed the Caregiver Advise, Record, Enable (CARE) Act on April 20, 2016. We designed a study to explore early implementation at a large, integrated delivery financing system. Our goal was to assess the effects of system-level decisions on unit implementation and the incorporation of the CARE Act’s three components into routine care delivery. Research Design and Methods We conducted a multisite, ethnographic case study at three different hospitals’ medical–surgical units. We conducted observations and semi-structured interview to understand the implementation process and the approach to caregiver identification, notification, and education. We used thematic analysis to code interviews and observations and linked findings to the Promoting Action on Research Implementation in Health Services framework. Results Organizational context and electronic health record capability were instrumental to the CARE Act implementation and integration into workflow. The implementation team used a decentralized strategy and a variety of communication modes, relying on local hospital units to train staff and make the changes. We found that the system facilitated the CARE Act implementation by placing emphasis on the documentation and charting to demonstrate compliance with the legal requirements. Discussion and Implications General acute hospitals will be making or have made similar decisions on how to operationalize the regulatory components and demonstrate compliance with the CARE Act. This study can help to inform others as they design and improve their compliance and implementation strategies.

Sign in / Sign up

Export Citation Format

Share Document