Working towards universal health coverage: a qualitative study to identify strategies for improving student enrolment for the pre-service training of nurses, midwives and community health workers in Nigerian health training institutions

Abstract Background Student enrolment processes and practices can affect the quality of pre-service training programmes. These processes and practices may have serious implications for the quality and quantity of students within health training institutions, the quality of education for prospective health workers and consequently health workforce performance. This study assessed current student enrolment processes and practices for nurses, midwives and community health workers within health training institutions in two Nigerian states, so as to identify strategies for improving student enrolment for these key cadres of frontline health workers. Methods This study was carried out in Bauchi and Cross-River States, which are the two Human Resources for Health (HRH) project focal states in Nigeria. Utilizing a qualitative research design, 55 in-depth interviews and 13 focus group discussions were conducted with key stakeholders including students and tutors from pre-service health training institutions as well as policy-makers and public sector decision-makers from Ministries of Health, Government Agencies and Regulatory Bodies. Study participants were purposively sampled and the qualitative data were audio-recorded, transcribed and then thematically analysed. Results Study participants broadly described the application process to include the purchase, completion and submission of application forms by prospective students prior to participation in entrance examinations and oral interviews. The use of ‘weeding examinations’ during the student enrolment process, especially in Bauchi state, was identified as a useful quality assurance mechanism for the pre-service training programmes of frontline health workers. Other strategies identified by stakeholders to address challenges with student enrolment include sustained advocacy to counter-cultural norms and gender stereotypes vis-à-vis certain professions, provision of scholarships for trainee frontline health workers and ultimately the development as well as effective implementation of national and state-specific policy and implementation guidelines for the student enrolment of key frontline health workers. Conclusion While there are challenges which currently affect student enrolment for nurses, midwives and community health workers in Nigeria, this study has proposed key strategies which if carefully considered and implemented can substantially improve the status quo. These will probably have far-reaching implications for improving health workforce performance, population health outcomes and efforts to achieve universal health coverage.

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An innovative approach to improve the detection and treatment of risk factors in poor urban settings: a feasibility study in Argentina

BMC Public Health ◽

10.1186/s12889-021-10569-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Poggio Rosana ◽

Goodarz Danaei ◽

Laura Gutierrez ◽

Ana Cavallo ◽

María Victoria Lopez ◽

...

Keyword(s):

Public Health ◽

Risk Factors ◽

Primary Care ◽

Community Health ◽

Community Health Workers ◽

Feasibility Study ◽

Health Workers ◽

Health Coverage ◽

Cvd Risk Factors ◽

Cvd Risk

Abstract Background The effective management of cardiovascular (CVD) prevention among the population with exclusive public health coverage in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs). Methods We conducted a non-controlled feasibility study using a mixed methods approach to evaluate acceptability, adoption and fidelity of a multi-component intervention implemented in the public healthcare system. The eligibility criteria were having exclusive public health coverage, age ≥ 40 years, residence in the PCC’s catchment area and 10-year CVD risk ≥10%. The multi-component intervention addressed (1) system barriers through task shifting among the PCC’s staff, protected medical appointments slots and a new CVD form and (2) Provider barriers through training for primary care physicians and CHW and individual barriers through a home-based intervention delivered by community health workers (CHWs). Results A total of 185 participants were included in the study. Of the total number of eligible participants, 82.2% attended at least one clinical visit for risk factor control. Physicians intensified drug treatment in 77% of participants with BP ≥140/90 mmHg and 79.5% of participants with diabetes, increased the proportion of participants treated according to GCP from 21 to 32.6% in hypertensive participants, 7.4 to 33.3% in high CVD risk and 1.4 to 8.7% in very high CVD risk groups. Mean systolic and diastolic blood pressure were lower at the end of follow up (156.9 to 145.4 mmHg and 92.9 to 88.9 mmHg, respectively) and control of hypertension (BP < 140/90 mmHg) increased from 20.3 to 35.5%. Conclusion The proposed CHWs-led intervention was feasible and well accepted to improve the detection and treatment of risk factors in the poor population with exclusive public health coverage and with moderate or high CVD risk at the primary care setting in Argentina. Task sharing activities with CHWs did not only stimulate teamwork among PCC staff, but it also improved quality of care. This study showed that community health workers could have a more active role in the detection and clinical management of CVD risk factors in low-income communities.

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Toward a geography of community health workers in Niger: a geospatial analysis

10.1101/2021.02.02.21250043 ◽

2021 ◽

Author(s):

Nicholas P Oliphant ◽

Nicolas Ray ◽

Khaled Bensaid ◽

Adama Ouedraogo ◽

Asma Yaroh Gali ◽

...

Keyword(s):

High Resolution ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Health Facilities ◽

Health Coverage ◽

Community Case Management ◽

Front Line ◽

Integrated Community Case Management ◽

Geographical Accessibility

Background Little is known about the geography of community health workers (CHWs), their contribution to geographical accessibility of primary health care (PHC) services, and strategies for optimizing efficiency of CHW deployment in the context of universal health coverage (UHC). Methods Using a complete georeferenced census of front-line health facilities and CHWs in Niger and other high resolution spatial datasets, we modelled travel times to front-line health facilities and CHWs between 2000-2013, accounting for training, essential commodities, and maximum population capacity. We estimated additional CHWs needed to maximize geographical accessibility of the population beyond the reach of existing front-line health facilities and CHWs. We assessed the efficiency of geographical targeting of the existing CHW network compared to modelled CHW networks designed to optimize geographical targeting of the estimated population, under-five deaths, and plasmodium falciparum malaria cases. Results The percent of the population within 60 minutes walking to the nearest CHW increased from 0·0% to 17·5% between 2000-2013, with 15·5% within 60 minutes walking to the nearest CHW trained on integrated community case management (iCCM) — making PHC services and iCCM, specifically, geographically accessible for an estimated 2·3 million and 2·0 million additional people, respectively. An estimated 10·4 million people (59·0%) remained beyond a 60-minute catchment of front-line health facilities and CHWs. Optimal deployment of 8064 additional CHWs could increase geographic coverage of the estimated total population from 41·5% to 73·6%. Geographical targeting of the existing CHW network was inefficient but optimized CHW networks could improve efficiency by 55·0%-81·9%, depending on targeting metric. Interpretations We provide the first high-resolution maps and estimates of geographical accessibility to CHWs at national scale, highlighting improvements between 2000-2013 in Niger, geographies where gaps remained, approaches for improving targeting, and the importance of putting CHWs on the map to inform planning in the context of UHC.

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How should community health workers in fragile contexts be supported: Qualitative evidence from Sierra Leone, Liberia and Democratic Republic of Congo

10.21203/rs.3.rs-27544/v2 ◽

2020 ◽

Author(s):

Joanna Raven ◽

Haja Wurie ◽

Ayesha Idriss ◽

Abdulai Jawo Bah ◽

Amuda Baba ◽

...

Keyword(s):

Community Health ◽

Sierra Leone ◽

Community Health Workers ◽

Democratic Republic ◽

Health Workers ◽

Democratic Republic Of Congo ◽

Community Support ◽

Health Coverage ◽

Republic Of Congo ◽

And Performance

Abstract Background: Community Health Workers (CHWs) are critical players in fragile settings, where staff shortages are particularly acute, health indicators are poor and progress towards Universal Health Coverage is slow. Like other health workers, CHWs need support to contribute effectively to health programmes and promote health equity. Yet the evidence base of what kind of support works best is weak. We present evidence from three fragile settings - Sierra Leone, Liberia and Democratic Republic of Congo on managing CHWs, and synthesise recommendations for best approaches to support this critical cadre.Methods: We used a qualitative study design to explore how CHWs are managed, the challenges they face and potential solutions. We conducted interviews with decision makers and managers (n=37), life history interviews with CHWs (n=15) and reviewed policy documents. Results: Fragility disrupts education of community members so that they may not have the literacy levels required for the CHW role. This has implications for the selection, role, training and performance of CHWs. Policy preferences about selection need discussion at the community level, so that they reflect community realities. CHWs scope of work is varied and may change over time, requiring ongoing training. The modular, local, and mix of practical and classroom training approach worked well, helping to address gender and literacy challenges and developing a supportive cohort of CHWs. A package of supervision, community support, regular provision of supplies, performance rewards and regular remuneration is vital to retention and performance of CHWs. But there are challenges with supervision, scarcity of supplies, inadequate community recognition and unfulfilled promises about allowances. Clear communication about incentives with facility staff and communities is required as is their timely delivery.Conclusions: This is the first study that has explored the management of CHWs in fragile settings. CHWs interface role between communities and health systems is critical because of their embedded positionality and the trusting relationships they (often) have. Their challenges are aligned to those generally faced by CHWs but chronic fragility exacerbates them and requires innovative problem solving to ensure that countries and communities are not left behind in reforming the way that CHWs are supported.

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Global health's durable dreams: ethnography, ‘community health workers’ and health without health infrastructure

Africa ◽

10.1017/s0001972019000950 ◽

2020 ◽

Vol 90 (1) ◽

pp. 95-111

Author(s):

Ramah McKay

Keyword(s):

Public Health ◽

Global Health ◽

Community Health ◽

Community Health Workers ◽

Health Systems ◽

Social Relations ◽

Health Workers ◽

Health Coverage ◽

Global Health Policy ◽

Public Health Officials

AbstractTracing the persistence of community health workers (CHWs) as a key category in both global health policy and anthropological representation, this article asks how enduring scholarly investments in CHWs can reveal changing political stakes for both health work and ethnographic research. Amid renewed calls for a focus on health systems and universal health coverage, the article suggests that the durability of attention to CHWs is instructive. It simultaneously points to the imbrication of health with political and social relations and clinical and technological infrastructures as well as to how ethnographic investments in health systems can sometimes obscure the ambivalent politics of health. Drawing on fieldwork with CHWs, NGO staff and public health officials, and on public health literature on CHWs, it argues for greater attention to the political ambivalence of health labour. It suggests that the experiences of health workers themselves can serve as analytical examples in this regard, pointing to analyses that begin not with normative notions of health systems or the conceptual boundaries of global health ‘projects’ but with a focus on the contested relations through which health labour is realized over time. Such attention can also indicate possibilities for health beyond dreams of projects, clinics or health systems.

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A mental health training program for community health workers in India: impact on recognition of mental disorders, stigmatizing attitudes and confidence

International Journal of Culture and Mental Health ◽

10.1080/17542863.2016.1259340 ◽

2016 ◽

Vol 10 (1) ◽

pp. 62-74 ◽

Cited By ~ 7

Author(s):

Christina Hofmann-Broussard ◽

Gregory Armstrong ◽

Mark J. Boschen ◽

Konduri V. Somasundaram

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Community Health ◽

Training Program ◽

Community Health Workers ◽

Health Workers ◽

Mental Health Training ◽

Health Training ◽

Stigmatizing Attitudes

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How should community health workers in fragile contexts be supported: Qualitative evidence from Sierra Leone, Liberia and Democratic Republic of Congo

10.21203/rs.3.rs-27544/v1 ◽

2020 ◽

Author(s):

Joanna Raven ◽

Haja Wurie ◽

Ayesha Idriss ◽

Abdulai Jawo Bah ◽

Amuda Baba ◽

...

Keyword(s):

Community Health ◽

Sierra Leone ◽

Community Health Workers ◽

Democratic Republic ◽

Health Workers ◽

Democratic Republic Of Congo ◽

Community Support ◽

Health Coverage ◽

Republic Of Congo ◽

And Performance

Abstract Background Community Health Workers (CHWs) are critical players in fragile settings, where staff shortages are particularly acute, health indicators are poor and progress towards Universal Health Coverage is slow. Like other health workers, CHWs need support to contribute effectively to health programmes and promote health equity. Yet the evidence base of what kind of support works best is weak. We present evidence from three fragile settings - Sierra Leone, Liberia and Democratic Republic of Congo on managing CHWs, and synthesise recommendations for best approaches to support this critical cadre.Methods We used a qualitative study design to explore how CHWs are managed, the challenges they face and potential solutions. We conducted interviews with decision makers and managers (n = 37), life history interviews with CHWs (n = 15) and reviewed policy documents.Results Fragility disrupts education of community members so that they may not have the literacy levels required for the CHW role. This has implications for selection, role, training and performance of CHWs. Policy preferences about selection need discussion at the community level, so that they reflect community realities. CHWs scope of work is varied and may change over time, requiring ongoing training. The modular, local, and mix of practical and classroom training approach worked well, helping to address gender and literacy challenges and develop a supportive cohort of CHWs. A package of supervision, community support, regular provision of supplies, performance rewards and regular remuneration is vital to retention and performance of CHWs. But there are challenges with supervision, scarcity of supplies, inadequate community recognition and unfulfilled promises about allowances. Clear communication about incentives with facility staff and communities is required as is their timely delivery.Conclusions This is the first study that has explored the management of CHWs in fragile settings. CHWs interface role between communities and health systems is critical because of their embedded positionality and the trust they (often) have. Their challenges are aligned to those generally faced by CHWs but chronic fragility exacerbates them and requires innovative problem solving to ensure that countries and communities are not left behind in reforming the way that CHWs are supported.

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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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Feasibility and acceptability of computer based online certifcation program for frontline community health workers of Wardha district, India

Asian Journal of Medical Sciences ◽

10.3126/ajms.v8i2.16411 ◽

2017 ◽

Vol 8 (2) ◽

pp. 82-85

Author(s):

Manoj S Patil ◽

Abhay M Gaidhane ◽

Shital Telrandhe ◽

Quazi Syed Zahiruddin ◽

Navnita Jadhav

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Community Outreach ◽

Medical Sciences ◽

Frontline Workers ◽

Frontline Health Workers ◽

Computer Based ◽

Health Experts ◽

Strong Agreement

Background: In India, different types of Frontline Community Health Workers are recruited under different departments and health programmes. These include Anganwadi Workers (AWW) under ICDS, ASHA and ANMs under NRHM and health services. Training and recruitment of this staff cadre is an ongoing process. Most of the trainings are aimed at improving the knowledge and skills. A set of test is needed to assess the post training knowledge of trainees which should be feasible, acceptable and easy to administer. Team of Health Experts from DMIMSU, Wardha has developed such specifc Computer based online certifcation tests which were administered to selected Frontline Community Health Workers engaged with DMIMSU. This study was conducted to assess the feasibility and acceptability of these tests.Aims and Objectives: Team of Health Experts from DMIMSU,Wardha has developed specifc Computer based online certifcation tests which were administered to selected Frontline Community Health Workers engaged with DMIMSU. This study was conducted -1] To assess the feasibility and acceptability of Computer based online certifcation tests for frontline workers. 2] To assess the scope for generalization of these tests to entire frontline health cadre of the district.Materials and Methods: Data was collected from 30 randomly selected Frontline Health Workers who were engaged in Community Outreach Activities/Projects of DMIMS and had undergone trainings and Online Certifcation tests. Questionnaire with Likert type scoring scale was administered. Data was compiled in MS Excel and Weighted Means and proportions of responses towards agreement and disagreement were calculated.Results: Average Weighted Mean was 4.07 showing Strong Agreement towards the feasibility and acceptability. Only 10.3% participants showed disagreement towards the feasibility and acceptability of this test whereas 89.7% participants showed agreement and among them, 47.67% showed strong agreement towards the feasibility and acceptability of this test.Conclusion: These tests were found quite feasible and well accepted by Frontline Health Workers. Similar tests should be made compulsory for all Frontline Health Workers Cadre and their performance in tests should be linked to provisions of incentives and seniority benefits.Asian Journal of Medical Sciences Vol.8(2) 2017 82-85

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