scholarly journals “Even when people live just across the road…they won’t go”: Community health worker perspectives on incentivized delays to under-five care-seeking in urban slums of Kampala, Uganda

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0244891
Author(s):  
Amy W. Blasini ◽  
Peter Waiswa ◽  
Phillip Wanduru ◽  
Lucky Amutuhaire ◽  
Cheryl A. Moyer
Keyword(s):  
Health System ◽  
Community Health ◽  
Health Workers ◽  
Quality Care ◽  
Urban Slum ◽  
System Level ◽  
Care Seeking ◽  
Positive Health ◽  
Autopsy Study ◽  
Under Five

Background Although under-five (U5) mortality in Uganda has dropped over the past two decades, rates in urban slum neighborhoods remain high. As part of a broader verbal and social autopsy study of U5 deaths, this study explored the perspectives of volunteer community health workers, called Village Health Teams (VHTs), on why children under five in Kampala’s informal settlements are still dying despite living in close proximity to nearby health facilities. Methods This exploratory, qualitative study took place between January and March 2020 in the Rubaga division of Kampala, Uganda. VHTs from the slums of Kawaala and Nankulabye parishes, both located near a large government health center, were interviewed by a trained local interviewer to determine their perceptions of barriers to care-seeking and attribution for U5 childhood deaths. All interviews were audiotaped, transcribed into English, imported into NVivo V 12.0 and thematically analyzed using the Attride-Stirling framework. Results 20 VHTs were interviewed, yielding two global themes, the first focusing on VHTs perceptions of their role in the community to promote positive health outcomes, and the second focusing on VHTs’ perceptions of how prompt care-seeking is disincentivized. Within the latter theme, three inter-related sub-themes emerged: disincentives for care-seeking at the health system level, which can drive negative beliefs held by families about the health system, and in turn, drive incentives for alternative health behaviors, which manifest as “incentivized delays” to care-seeking. Discussion This study illustrates VHT perspectives on the complex interactions between health system disincentives and the attitudes and behaviors of families with a sick child, as well as the reinforcing nature of these factors. Findings suggest a need for multi-pronged approaches that sensitize community members, engage community and health system leadership, and hold providers accountable for providing high-quality care. VHTs have enormous potential to foster improvement if given adequate resources, training, and support.

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 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

Quality

2020 ◽  
pp. 166-183
Author(s):  
Julie Sin
Keyword(s):  
Health Services ◽  
Health System ◽  
Services Quality ◽  
Quality Care ◽  
System Level ◽  
Quality Of Services ◽  
Provider Perspective ◽  
Multidimensional Concept

This chapter looks at the topic of health services quality from a commissioning and whole population perspective. Quality is noted to be a multidimensional concept and dimensions of quality are considered. The role of the commissioner in maintaining and improving quality of services is explored, and this is seen within a wider backdrop of a health system with commissioner and provider functions (if there are such distinctions in the system). Commissioners need to know whether they are securing quality care for their population for the money spent. They also need an understanding of how this dovetails with the provider perspective on this topic. Commissioners also need to be able to articulate what they wish to assess in practice under the guise of quality. Finally, at a system level there are also bearings on how to compile and interpret a picture of a population’s health if needed.

What are the roles of community health workers? Looking back at the philosophies of primary health care

2019 ◽  
Vol 27 (2) ◽  
pp. 117-120
Author(s):  
Marietou Niang
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Community Development ◽  
Health System ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Primary Health ◽  
Looking Back

This commentary discusses the different roles of community health workers (CHWs), their challenges and limitations in a historical perspective of primary health care (PHC). We first try to show that the comprehensive philosophy of PHC promulgated in Alma-Ata proposed the role of CHWs as actors who work in community development. On the other hand, in the 1980s, with the emergence of the selective philosophy of PHC, CHWs’ role was more affiliated with the health system. We conclude our pitch about the balance that can exist between these different roles by suggesting that CHWs can work in continuity with the health system, but they should not be considered as affordable labor. Also, they must be supported in their activities to develop their communities, allowing them to participate effectively in programs and policies that concern them and their community.

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 Counseling at all contacts for postpartum contraceptive use: can paper-based tools help community health workers improve continuity of care? A qualitative study from Ethiopia

2019 ◽  
Vol 3 ◽  
pp. 1652 ◽  
Author(s):  
Muluneh Yigzaw Mossie ◽  
Anne Pfitzer ◽  
Yousra Yusuf ◽  
China Wondimu ◽  
Eva Bazant ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Community Health ◽  
Low Income ◽  
Health Workers ◽  
Continuum Of Care ◽  
Low Income Countries ◽  
Health Extension Workers ◽  
Pregnancy Risk ◽  
The Continuum

Background: Globally, there has been a resurgence of interest in postpartum family planning (PPFP) to advance reproductive health outcomes. Few programs have systematically utilized all contacts a woman and her baby have with the health system, from pregnancy through the first year postpartum, to promote PPFP. Nested into a larger study covering two districts, this study assessed the use, acceptability, and feasibility of tools for tracking women’s decision-making and use of PPFP in the community health system in Oromia region, Ethiopia. Community-level tracking tools included a modified Integrated Maternal and Child Health (IMCH) card with new PPFP content, and a newly developed tool for pregnant and postpartum women for use by Women Development Armies (WDAs). Proper completion of the tools was monitored during supervision visits. Methods: In-depth interviews and focus group discussions were conducted with health officials, health extension workers, and volunteers. A total of 34 audio-files were transcribed and translated into English, double-coded using MAXQDA, and analyzed using a thematic approach. Results: The results describe how HEWs used the modified IMCH card to track women’s decision making through the continuum of care, to assess pregnancy risk and to strengthen client-provider interaction. Supervision data demonstrated how well HEWs completed the modified IMCH card. The WDA tool was intended to promote PPFP and encourage multiple contacts with facilities from pregnancy to extended postpartum period. HEWs have reservations about the engagement of WDAs and their use of the WDA tool. Conclusions: To conclude, the IMCH card improves counseling practices through the continuum of care and is acceptable and feasible to apply. Some elements have been incorporated into a revised national tool and can serve as example for other low-income countries with similar community health systems. Further study is warranted to determine how to engage WDAs in promoting PPFP.

scholarly journals Contribution of Community Health Workers to the treatment of common illnesses among under 5-year-olds in rural Uganda.

2021 ◽  
Author(s):  
Fred Bagenda ◽  
Andrew Christopher Wesuta ◽  
Geren Stone ◽  
Moses Ntaro ◽  
Palka Patel ◽  
...  
Keyword(s):  
Case Management ◽  
Community Health ◽  
Community Health Workers ◽  
Management Strategy ◽  
Health Workers ◽  
Community Case Management ◽  
Integrated Community Case Management ◽  
Children Under Five ◽  
Under Five ◽  
Common Illnesses

Abstract Introduction The control of malaria, pneumonia, and diarrhea is important for the reduction in morbidity and mortality among children under five years. Uganda has adopted the Integrated Community Case Management strategy using Community Health Workers to address this challenge. The extent and trend of these three conditions managed by the Community Health Workers are not well documented. This study was done to document Community Health Workers’ contribution towards treatment and the trends of the three common illnesses in Bugoye Sub-County in rural Uganda.

scholarly journals Community health workers at the dawn of a new era: 9. CHWs’ relationships with the health system and communities

2021 ◽  
Vol 19 (S3) ◽  
Author(s):  
Karen LeBan ◽  
Maryse Kok ◽  
Henry B. Perry
Keyword(s):  
Health System ◽  
Community Health ◽  
Community Health Workers ◽  
Large Scale ◽  
Health Workers ◽  
Local Level ◽  
Grey Literature ◽  
Community Context ◽  
New Era

Abstract Background This is the ninth paper in our series, “Community Health Workers at the Dawn of a New Era”. Community health workers (CHWs) are in an intermediary position between the health system and the community. While this position provides CHWs with a good platform to improve community health, a major challenge in large-scale CHW programmes is the need for CHWs to establish and maintain beneficial relationships with both sets of actors, who may have different expectations and needs. This paper focuses on the quality of CHW relationships with actors at the local level of the national health system and with communities. Methods The authors conducted a selective review of journal articles and the grey literature, including case study findings in the 2020 book Health for the People: National CHW Programs from Afghanistan to Zimbabwe. They also drew upon their experience working with CHW programmes. Results The space where CHWs form relationships with the health system and the community has various inherent strengths and tensions that can enable or constrain the quality of these relationships. Important elements are role clarity for all actors, working referral systems, and functioning supply chains. CHWs need good interpersonal communication skills, good community engagement skills, and the opportunity to participate in community-based organizations. Communities need to have a realistic understanding of the CHW programme, to be involved in a transparent process for selecting CHWs, and to have the opportunity to participate in the CHW programme. Support and interaction between CHWs and other health workers are essential, as is positive engagement with community members, groups, and leaders. Conclusion To be successful, large-scale CHW programmes need well-designed, effective support from the health system, productive interactions between CHWs and health system staff, and support and engagement of the community. This requires health sector leadership from national to local levels, support from local government, and partnerships with community organizations. Large-scale CHW programmes should be designed to enable local flexibility in adjusting to the local community context.

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