Effectiveness of A Community Level Maternal Health Intervention in Improving Uptake of Postnatal Care in Migori County, Kenya

Background: Provision of a continuum of care during pregnancy, delivery, and the postnatal period results in reduced maternal and neonatal morbidity and mortality. Complications and lack of skilled postnatal care has consequences for mothers and babies. We examined to what extent a community level integrated maternal health intervention contributed to improvements in uptake of skilled care after delivery by pregnant women. Methods: An Ex post quasi-experimental design was applied. Among 590 reproductive-aged women, we assessed the effectiveness of a community level integrated maternal health intervention and predictors of uptake of postnatal care. Descriptive, bivariate and multivariate analyses were conducted. Results: About three fifths (64%) of the women reported having sought postnatal care services at the health facility within six (6) weeks. Women in the intervention arm were 3.3 times more likely to take up postnatal care at a health facility (AOR= 3.31[95% CI 1.245 to 8.804] p=0.016). Women referred to the health facility for postnatal care by Community Health Workers (CHWs) were 2.72 times more likely to take up the services (AOR= 2.72[95% CI 1.05 to 7.07] p=0.039) than those not referred by CHWs. Distance to health facility (61%) was the major barrier, while some mothers did not feel the need for postnatal care (11%). Conclusion and Implications for Translation: Routine health education by trained providers at community level health facilities, coupled with enhanced CHWs' involvement can improve uptake of postnatal care. Ignorance and accessibility challenges are some barriers to the uptake of postnatal care. Key words: • Community • Maternal • Health • Intervention • Postnatal-Care • Kenya • MAISHA • Community Health Volunteers (CHVs) • Community Health Workers (CHWs) Copyright © 2019 Gitonga et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“Now You Have Become Doctors”: Lady Health Workers' Experiences Implementing an mHealth Application in Rural Pakistan

Frontiers in Global Women's Health ◽

10.3389/fgwh.2021.645705 ◽

2021 ◽

Vol 2 ◽

Author(s):

Mai-Lei Woo Kinshella ◽

Sana Sheikh ◽

Sohail Bawani ◽

Michelle La ◽

Sumedha Sharma ◽

...

Keyword(s):

Health Care ◽

Maternal Health ◽

Focus Group ◽

Qualitative Analysis ◽

Health System ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Community Level ◽

Rural Pakistan

Background: PIERS on the Move (POM) is a mobile health application developed to support community health workers identification and management of women at risk of adverse outcomes from pre-eclampsia. The objective of this study was to evaluate the impact of using POM in Pakistan on Lady Health Workers' (LHWs) knowledge and self-efficacy related to caring for women with pre-eclampsia, and their perception of usefulness of the tool.Methodology: An evaluation was designed for health care workers involved in the Community-Level Intervention for Pre-eclampsia (CLIP) cluster randomized trial from 2014 to 2016 in Sindh Province, Pakistan (NCT01911494). A semi-structured focus group guide was developed based on the Technology Acceptance Model (TAM), which theorizes that an individual's behavioral intention to use a system is determined by perceived usefulness and ease of use. Preliminary qualitative analysis was undertaken by the Pakistan and Canadian teams to create a coding framework for full qualitative analysis, which was completed using NVivo12.Results: Three key informant interviews were conducted with two Lady Health Supervisors and one Senior Medical Officer. Sixty-two LHWs were included in three focus group discussions. LHWs found the POM app easy to use and useful for their work as a helpful repository for maternal health information and guiding counseling and management of pre-eclampsia. LHWs reported increased knowledge and confidence in their work. Availability of clinical homecare, including postpartum, was felt to positively impact healthcare provided to pregnant and postpartum women. Potential community level impacts included strengthening relationships between health care providers and communities and between LHWs and the health system. LHWs shared reports of earlier care-seeking and increased awareness of maternal health issues by community members.Conclusions: LHWs carry a large burden of responsibility for community health in rural Pakistan and appreciated the investment in their skills and capacity during the CLIP trial with the POM app. Investing in communications technology for community health workers through improved referrals and follow up may strengthen cohesiveness of the health system overall.

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Maternal health training priorities for nursing and allied professions in Haiti

Revista Panamericana de Salud Pública ◽

10.26633/rpsp.2020.67 ◽

2020 ◽

Vol 44 ◽

pp. 1

Author(s):

Amelia J. Brandt ◽

Julio Pedroza ◽

Silvia H. de Bortoli Cassiani ◽

Samantha Brown ◽

Fernando A. Menezes da Silva

Keyword(s):

Maternal Health ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Training Needs ◽

Traditional Birth Attendants ◽

Community Level ◽

Birth Attendants ◽

Health Organization ◽

Auxiliary Nurses

Objectives. This study summarizes the findings of a training needs and priority assessment completed in Haiti. Its objective is to describe the characteristics of nursing and allied professions providing first level maternal health care and identify training needs and priorities to inform planning of Human Resources for Health interventions. Methods. A cross-sectional survey was completed between October 2016 and March 2017 by the Pan American Health Organization/World Health Organization Haiti office in collaboration with national health authorities. Participants reached consensus to submit one finalized version of the survey. Data were collected on composition, capacities, and training needs and priorities of traditional birth attendants, community health workers, registered nurses, professional midwives, and auxiliary nurses. Results. Haiti relies heavily on community level workers including community health workers, auxiliary nurses, and traditional birth attendants. Traditional birth attendants attend the majority of Haiti’s births, despite having low education levels and not being regulated by the Ministry of Public Health and Population. All professional categories prioritize preventive capacities such as timely identification of complications, while none are trained to manage postpartum hemorrhage, preeclampsia, or eclampsia. Management of obstetric emergencies is a training priority for Haiti but is not part of the scope of work of the nursing and allied health professions included in this study. Conclusions. Community level health workers are key in providing preventive care and referral of complicated pregnancies, but lack of access to providers qualified to treat obstetric complications remains a challenge to reducing maternal mortality.

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Facilitating equitable community-level access to maternal health services: exploring the experiences of Rwanda’s community health workers

International Journal for Equity in Health ◽

10.1186/s12939-019-1065-4 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 2

Author(s):

Germaine Tuyisenge ◽

Valorie A. Crooks ◽

Nicole S. Berry

Keyword(s):

Health Care ◽

Maternal Health ◽

Health Services ◽

Community Health ◽

Community Health Workers ◽

Maternal Care ◽

Health Workers ◽

Maternal Health Services ◽

Community Level ◽

Equitable Access

Abstract Background In Rwanda, community health workers (CHWs) are an integral part of the health system. For maternal health, CHWs are involved in linking members of the communities in which they live to the formal health care system to address preventative, routine, and acute maternal care needs. Drawing on the findings from in-depth interviews with maternal health CHWs and observational insights in ten Rwandan districts, we identify specific strategies CHWs employ to provide equitable maternal care while operating in a low resource setting. Methods Using case study methodology approach, we conducted interviews with 22 maternal health CHWs to understand the nature of their roles in facilitating equitable access to maternal care in Rwanda at the community level. Interviews were conducted in five Rwandan districts. Participants shared their experiences of and perceptions on promoting equitable access to maternal health service in their communities. Results Four key themes emerged during the analytic process that characterize the contexts and strategic ways in which maternal health CHWs facilitate equitable access to maternal care in an environment of resource scarcity. They are: 1) community building; 2) physical landscapes, which serve as barriers or facilitators both to women’s care access and CHWs’ equitable service provision; 3) the post-crisis socio-political environment in Rwanda, which highlights resilience and the need to promote maternal health subsequent to the genocide of 1994; and, 4) the strategies used by CHWs to circumvent the constraints of a resource-poor setting and provide equitable maternal health services at the community level. Conclusion Rwanda’s maternal CHWs are heavily responsible for promoting equitable access to maternal health services. Consequently, they may be required to use their own resources for their practice, which could jeopardize their own socio-economic welfare and capacity to meet the demands of their families. Considering the unpaid and untrained nature of this position, we highlight the factors that threaten the sustainability of CHWs’ role to facilitate equitable access to maternal care. These threats introduce turbulence into what is a relatively successful community-level health care initiative.

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Baby Steps: Using Intervention Mapping to Develop a Sustainable Perinatal Physical Activity Healthcare Intervention

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115869 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5869

Author(s):

Anna M. Dieberger ◽

Mireille N. M. van Poppel ◽

Estelle D. Watson

Keyword(s):

Physical Activity ◽

Behavior Change ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Intervention Mapping ◽

Healthcare Intervention ◽

Activity Levels ◽

Major Barrier ◽

Practical Applications

While the benefits of physical activity (PA) during and after pregnancy have been established, many women do not reach the recommended PA levels during this time. A major barrier found in the literature is a lack of counselling by healthcare providers (HCPs), which is partly caused by the limited knowledge on the topic. The aim of this study was to develop an intervention to improve the promotion of PA by HCPs. We used Intervention Mapping (IM), a theory-based framework to develop an intervention, called “Baby steps”, in a high-income (Austria) and a low-to-middle-income country (South Africa). We applied the following IM steps: (1) A needs assessment to determine the barriers and enablers of PA promotion by HCPs, including a scoping literature review and community needs assessments (qualitative interviews, questionnaires, and focus groups with midwives, obstetricians, and community health workers) to determine the desired outcomes of the intervention. (2) Performance and change objectives were formulated, describing the behaviors that need to change for the intervention to succeed. (3) Based on these objectives, theory-based behavior change techniques were selected, and practical applications were developed. (4) The applications were combined into two evidence-based interventions tailored to each country’s needs. Step (5) and (6) consist of an implementation and evaluation plan, respectively. The intervention is aimed at HCPs, such as midwives and community health workers, consisting of a two-day training course, including practical resources. Combining didactic and interactive education, it addresses both PA knowledge and the skills needed to transfer knowledge and facilitate behavior change. In the future, the intervention’s effect on women’s activity levels during and after pregnancy needs to be studied.

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Stock-Outs of Essential Medicines Among Community Health Workers (CHWs) In Low- And Middle-Income Countries (LMICs): A Systematic Literature Review of The Extent, Reasons, And Consequences

10.21203/rs.3.rs-692874/v1 ◽

2021 ◽

Author(s):

Abimbola Olaniran ◽

Jane Briggs ◽

Ami Pradhan ◽

Erin Bogue ◽

Benjamin Schreiber ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Grey Literature ◽

Community Level ◽

Health Centers ◽

Essential Medicines ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Abstract Background: This paper explores the extent of community-level stock-out of essential medicines among Community Health Workers (CHWs) in Low- and Middle-Income Countries (LMICs) and identifies the reasons for and consequences of essential medicine stock-outs. Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Five electronic databases were searched with a prespecified strategy and the grey literature examined, January 2006 - March 2021. Papers containing information on (i) the percentage of CHWs stocked out or (ii) reasons for stock-outs along the supply chain and consequences of stock-out were included and appraised for risk of bias. Outcomes were quantitative data on the extent of stock-out, summarized using descriptive statistics, and qualitative data regarding reasons for and consequences of stock-outs, analyzed using thematic content analysis and narrative synthesis. Results: Two reviewers screened 1083 records; 78 evaluations were included. Over the last fifteen years, CHWs experienced stock-outs of essential medicines nearly one third of the time and at a significantly (p < 0.01) higher rate than the health centers to which they are affiliated (28.93% [CI 95%: 28.79 - 29.07] vs 9.17 % [CI 95%: 8.64 - 9.70], respectively). A comparison of the period 2006-2015 and 2016-2021 showed a significant (p < 0.01) increase in CHW stock-out level from 26.36% [CI 95%: 26.22 -26.50] to 48.65% [CI 95%: 48.02- 49.28] while that of health centers increased from 7.79% [95% CI: 7.16 - 8.42] to 14.28% [95% CI: 11.22- 17.34]. Distribution barriers were the most cited reasons for stock-outs. Ultimately, patients were the most affected: stock-outs resulted in out-of-pocket expenses to buy unavailable medicines, poor adherence to medicine regimes, dissatisfaction, and low service utilization. Conclusion: Community-level stock-out of essential medicines constitutes a serious threat to achieving universal health coverage and equitable improvement of health outcomes. This paper suggests stock-outs are getting worse, and that there are particular barriers at the last mile. There is an urgent need to address the health and non-health system constraints that prevent the essential medicines procured for LMICs by international and national stakeholders from reaching the people who need them the most.

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Helping communities to manage disaster risk

Setting up Community Health Programmes in Low and Middle Income Settings ◽

10.1093/med/9780198806653.003.0025 ◽

2019 ◽

pp. 432-443

Author(s):

Joel Hafvenstein ◽

Jonathan Stone

Keyword(s):

Community Health ◽

Community Health Workers ◽

Emergency Response ◽

Disaster Response ◽

Health Workers ◽

Disaster Risk ◽

Community Level ◽

Response Team ◽

Health Programmes

This chapter describes how to manage disaster risk and how community-level action is essential when organizing any emergency response action. It outlines the types of hazards that communities face, how they can be reduced and how we can increase the effectiveness and resilience of community health programmes (CHPs) to meet those hazards. It explains how we can train a disaster response team (DRT) and use them and community health workers (CHWs) both to deliver and to help to implement disaster safety messages. It describes in some detail both the types of disaster and ways in which the community can respond and work with others, including government and external providers.

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