scholarly journals An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan.

2021 ◽  
Author(s):  
George William Lutwama ◽  
Maryse Kok ◽  
Eelco Jacobs
Keyword(s):  
Community Health ◽  
Access To Health Care ◽  
Health Workers ◽  
South Sudan ◽  
Scale Up ◽  
Barriers And Facilitators ◽  
Drug Misuse ◽  
Access To Health Services ◽  
Access To Health ◽  
The Government

Abstract Background: Community health workers (CHWs) are crucial for increasing access to health services to communities. Due to decades of conflict and under-funding, access to health care in South Sudan remains severely limited. To improve equitable access to healthcare, the government has introduced “the Boma Health Initiative (BHI)”, a strategy to harmonise community health programmes across the country. In order to scale up the BHI, it is necessary to assess the recent CHW programmes and draw lessons for future implementation. This study aimed to explore the characteristics, barriers, and facilitators to the implementation of CHW interventions in South Sudan between 2011 and 2019.Methods: The study used a qualitative approach drawing from 26 key informant interviews and a scoping review of 21 Health Pooled Fund (HPF) programme reports from October 2016 to June 2018 and policy documents from 2011 to 2019. The results were thematically analysed based on a conceptual framework on factors influencing the performance of CHWs.Results: Funding of CHW programmes has come from international donors, channelled through non-governmental organisations (NGOs) that have implemented a variety of CHW programmes. Communities have been participating in the selection of voluntary CHWs, intervention areas, and occasionally in the supervision of activities performed by CHWs. The coordination mechanisms among stakeholders have been weak, leading to wastage and duplication of resources. Although training of CHWs is done, training duration was short, and refresher-trainings were rare. There were and still are disparities in the type of incentives provided to CHWs. Monitoring and supportive supervision activities have been insufficient; drug misuse and stock-outs were common. Conclusion: Despite their challenges, CHW programmes can be implemented in conflict-affected South Sudan if the local human capital is leveraged and engaged by NGOs as implementing partners. Robust coordination efforts are required to build synergies among stakeholders for the effective implementation of the BHI strategy.

scholarly journals An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
George William Lutwama ◽  
Maryse Kok ◽  
Eelco Jacobs
Keyword(s):  
Community Health ◽  
Access To Health Care ◽  
Health Workers ◽  
South Sudan ◽  
Scale Up ◽  
Barriers And Facilitators ◽  
Drug Misuse ◽  
Access To Health Services ◽  
Access To Health ◽  
The Government

Abstract Background Community health workers (CHWs) are crucial for increasing access to health services to communities. Due to decades of conflict and under-funding, access to health care in South Sudan remains severely limited. To improve equitable access to healthcare, the government has introduced “the Boma Health Initiative (BHI)”, a strategy to harmonise community health programmes across the country. In order to scale up the BHI, it is necessary to assess the recent CHW programmes and draw lessons for future implementation. This study aimed to explore the characteristics, barriers, and facilitators to the implementation of CHW interventions in South Sudan between 2011 and 2019. Methods The study used a qualitative approach drawing from 26 key informant interviews and a scoping review of 21 Health Pooled Fund (HPF) programme reports from October 2016 to June 2018 and policy documents from 2011 to 2019. The results were thematically analysed based on a conceptual framework on factors influencing the performance of CHWs. Results Funding of CHW programmes has come from international donors, channelled through non-governmental organisations (NGOs) that have implemented a variety of CHW programmes. Communities have been participating in the selection of voluntary CHWs, intervention areas, and occasionally in the supervision of activities performed by CHWs. The coordination mechanisms among stakeholders have been weak, leading to wastage and duplication of resources. Although training of CHWs is done, training duration was short, and refresher-trainings were rare. There were and still are disparities in the type of incentives provided to CHWs. Monitoring and supportive supervision activities have been insufficient; drug misuse and stock-outs were common. Conclusion Despite their challenges, CHW programmes can be implemented in conflict-affected South Sudan if the local human capital is leveraged and engaged by NGOs as implementing partners. Robust coordination efforts are required to build synergies among stakeholders for the effective implementation of the BHI strategy.

scholarly journals Community Health Workers: Challenges and Vulnerabilities of Accredited Social Health Activists Working in Conflict-affected Settings in the State of Assam, India

2020 ◽  
Author(s):  
Preety R Rajbangshi ◽  
Devaki Nambiar ◽  
Aradhana Srivast
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Social Relations ◽  
Health Workers ◽  
Social Health ◽  
Access To Health Services ◽  
North East ◽  
The North ◽  
East Region ◽  
Access To Health

Abstract Introduction:. It is well acknowledged that India’s Community Health workers known as Accredited Social Health Activists (ASHA) are the bedrock of its health system. Many ASHAs are currently working in fragile and conflict-affected settings. No efforts have yet been made to understand the challenges and vulnerabilities of these female workers. This paper seeks to address this gap by bringing attention to the situation of ASHAs working in the fragile and conflict settings and how conflict impacts them and their work. Methods: Qualitative fieldwork was undertaken in four conflict-affected villages in two conflict-affected districts -Kokrajhar and Karbi Anglong of Assam state situated in the North-East region of India. Detailed account of four ASHAs from the majority (Bodo or Karbi) and minority (Adivasi or Koch) communities serving roughly 4000 people is presented. Data transliterated into English were analysed by authors by developing a codebook using grounded theory and thematic organisation of codes. Results: ASHAs reported facing challenges in ensuring access to health services during and immediately after outbreaks of conflict. They experienced difficulty in arranging transport and breakdown of services at remote health facilities. Their physical safety and security were at risk during episodes of conflict. ASHAs reported hostile attitudes of the communities they served due to the breakdown of social relations, trauma due to displacement, and loss of family members, particularly their husbands. Conclusion: Conflict must be recognised as an important context within which community health workers operate, with greater policy focus and research devoted to understanding and addressing the barriers they face as workers and as persons affected by conflict.

Gambaran Epidemiologi Hipertensi di Puskesmas Gamping I

2017 ◽  
Vol 19 (1) ◽  
pp. 43-50
Author(s):  
Sekti Riyantina ◽  
Th Ninuk Sri Hartini ◽  
Idi Setiyobroto
Keyword(s):  
Population Density ◽  
Health Services ◽  
Community Health ◽  
Health Center ◽  
Access To Health Care ◽  
Community Health Center ◽  
Communicable Diseases ◽  
Access To Health Services ◽  
Access To Health ◽  
Gender Education

Background : Epidemiological transition stems from a change where a decline in the prevalence of communicable diseases and non- communicable diseases (NCDs) have increased. Report in 2011 there was one billion people worldwide suffer from hypertension and in Indonesia the figure reached 31.7%. Objective : The purpose of this study was to determine the epidemiological of hypertension Gamping I Community Health Center and determine the proportion of hypertension according to age, sex, occupation, education, socio-economic, geographic, demographic and access to health services. Method : The research design was a retrospective cohort. This research was conducted in Gamping I Community Health Center in November 2016. Population and sample in this study were all patients with hypertension in Gamping I Community Health Center in 2013, 2014 and 2015. The independent variables in this study were age, gender, education, employment, social, cultural, demographic population density, geographic and ease of access to health services. While the dependent variable is the proportion of hypertension. Data analysis was performed using Chi Square to know know the proportions of age, gender, education, employment, social, economic, population density, geography, access to health services with hypertension in 2013, 2014 and 2015. Result : Based on the analysis proves the young elderly, women, housewife, secondary education, non-poor families, low-lying area, population density and access to health care were likely to have hypertension with percentages respectively 33%, 66.7%, 44.9%, 70.1%, 76.7% , 71.9%, 37.9% and 82.9%.   Keywords: Hypertension, Epidemiology

scholarly journals Adaptation and performance of a mobile application for early detection of cutaneous leishmaniasis

2021 ◽  
Vol 15 (2) ◽  
pp. e0008989
Author(s):  
Luisa Rubiano ◽  
Neal D. E. Alexander ◽  
Ruth Mabel Castillo ◽  
Álvaro José Martínez ◽  
Jonny Alejandro García Luna ◽  
...  
Keyword(s):  
Health Services ◽  
Community Health ◽  
Cutaneous Leishmaniasis ◽  
Mobile Application ◽  
Health Workers ◽  
Prediction Rule ◽  
Case Detection ◽  
Access To Health Services ◽  
Community Health Volunteers ◽  
Access To Health

Background Detection and management of neglected tropical diseases such as cutaneous leishmaniasis present unmet challenges stemming from their prevalence in remote, rural, resource constrained areas having limited access to health services. These challenges are frequently compounded by armed conflict or illicit extractive industries. The use of mobile health technologies has shown promise in such settings, yet data on outcomes in the field remain scarce. Methods We adapted a validated prediction rule for the presumptive diagnosis of CL to create a mobile application for use by community health volunteers. We used human-centered design practices and agile development for app iteration. We tested the application in three rural areas where cutaneous leishmaniasis is endemic and an urban setting where patients seek medical attention in the municipality of Tumaco, Colombia. The application was assessed for usability, sensitivity and inter-rater reliability (kappa) when used by community health volunteers (CHV), health workers and a general practitioner, study physician. Results The application was readily used and understood. Among 122 screened cases with cutaneous ulcers, sensitivity to detect parasitologically proven CL was >95%. The proportion of participants with parasitologically confirmed CL was high (88%), precluding evaluation of specificity, and driving a high level of crude agreement between the app and parasitological diagnosis. The chance-adjusted agreement (kappa) varied across the components of the risk score. Time to diagnosis was reduced significantly, from 8 to 4 weeks on average when CHV conducted active case detection using the application, compared to passive case detection by health facility-based personnel. Conclusions Translating a validated prediction rule to a mHealth technology has shown the potential to improve the capacity of community health workers and healthcare personnel to provide opportune care, and access to health services for underserved populations. These findings support the use of mHealth tools for NTD research and healthcare.

scholarly journals Community health workers in Lesotho: Experiences of health promotion activities

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Thato Seutloali ◽  
Lizeka Napoles ◽  
Nomonde Bam
Keyword(s):  
Health Care ◽  
Health Promotion ◽  
Community Health ◽  
Community Health Workers ◽  
Access To Health Care ◽  
Health Care Services ◽  
Health Workers ◽  
Care Services ◽  
Home Based ◽  
Access To Health

Background: Lesotho adopted primary health care in 1979, and community health workers (CHWs) were included in the programme to focus on health promotion, particularly to reach people in underserved rural areas. Although the CHW programme has been successful, the heavy burden of disease because of HIV and/or AIDS and tuberculosis shifted resources from health promotion to home-based care.Aim: The study explored the lived experience of CHWs in conducting health promotion activities in Lesotho.Setting: The study was conducted in four health centres in Berea district, Lesotho.Methods: A qualitative study was conducted using an interviewer guide translated from English into Sesotho for four CHW focus group discussions, four individual interviews of key informants and four semi-structured interviews with the health centre nurses.Results: The roles of CHWs in health promotion ranged from offering basic first aid and home-based care to increasing access to health care services by taking patients to the facilities and promoting behaviour change through health education. Their perceived successes included increased access to health care services and reduced mortality rates. CHW challenges involved their demotivation to carry out their work because of lack of or inconsistent financial incentives and supplies, work overload which compromises quality of their work and limited community involvement.Conclusion: This study concludes that CHWs are beneficial to health promotion and its various activities. They had a clear understanding of their roles and responsibilities, although they did not fully comprehend that what they were describing was, in fact, health promotion. When it came to advocacy, CHWs did not fully understand it, nor did they consider it as part of their roles, although they acknowledged its importance. Their role of increasing access to health care services by accompanying patients to the facilities has increased considerably because of changes in disease burden. This is affecting their ability to practise other health promotion activities which focus on disease prevention.

scholarly journals Community health workers: challenges and vulnerabilities of Accredited Social Health Activists working in conflict-affected settings in the state of Assam, India

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Preety R Rajbangshi ◽  
Devaki Nambiar ◽  
Aradhana Srivastava
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Social Relations ◽  
Health Workers ◽  
Social Health ◽  
Access To Health Services ◽  
North East ◽  
The North ◽  
East Region ◽  
Access To Health

Abstract Introduction It is well acknowledged that India’s community health workers known as Accredited Social Health Activists (ASHA) are the bedrock of its health system. Many ASHAs are currently working in fragile and conflict-affected settings. No efforts have yet been made to understand the challenges and vulnerabilities of these female workers. This paper seeks to address this gap by bringing attention to the situation of ASHAs working in the fragile and conflict settings and how conflict impacts them and their work. Methods Qualitative fieldwork was undertaken in four conflict-affected villages in two conflict-affected districts -Kokrajhar and Karbi Anglong of Assam state situated in the North-East region of India. Detailed account of four ASHAs serving roughly 4000 people is presented. Data transliterated into English were analysed by authors by developing a codebook using grounded theory and thematic organisation of codes. Results ASHAs reported facing challenges in ensuring access to health services during and immediately after outbreaks of conflict. They experienced difficulty in arranging transport and breakdown of services at remote health facilities. Their physical safety and security were at risk during episodes of conflict. ASHAs reported hostile attitudes of the communities they served due to the breakdown of social relations, trauma due to displacement, and loss of family members, particularly their husbands. Conclusions Conflict must be recognised as an important context within which community health workers operate, with greater policy focus and research devoted to understanding and addressing the barriers they face as workers and as persons affected by conflict.

scholarly journals Training experience with community health agents: Focus on prevention and identification of stroke

2021 ◽  
Vol 11 (7) ◽  
pp. 63
Author(s):  
Ludimila Santos Muniz ◽  
Claudenice Ferreira dos Santos ◽  
Mariana de Almeida Moraes ◽  
Elieusa e Silva Sampaio ◽  
Cláudia Geovana da Silva Pires ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Warning Signs ◽  
Access To Health Services ◽  
Training Experience ◽  
Preventive Actions ◽  
Access To Health ◽  
Training Community ◽  
The Impact

Objective: To describe the experience of nurses in the process of training community health workers for the prevention and early identification of risk factors and warning signs of Stroke and for community actions before the cerebrovascular event.Methods: This is a report of an educational intervention with 1,302 community health workers from 12 Health Districts of Salvador. Thirty-four four-hour meetings were developed. The strategies and resources used included reflection dynamics on the impact of Stroke, exhibition classes, use of videos and informative pamphlets.Results: The educational activities allowed reflections on the repercussions of Stroke on the daily life of victims and their families, as well as on access to health services and the role of community health workers in those contexts.Conclusions: The experience contributed to the qualification of the work of the community health workers in preventive actions for identification and early intervention in the Stroke.

Grief, Tragic Death, and Multiple Loss in the Lives of Irish Traveller Community Health Workers

2018 ◽  
Vol 81 (1) ◽  
pp. 130-154 ◽  
Author(s):  
Mary Tobin ◽  
Sharon Lambert ◽  
John McCarthy
Keyword(s):  
Community Health ◽  
Interpretative Phenomenological Analysis ◽  
Health Workers ◽  
Minority Group ◽  
Phenomenological Analysis ◽  
Differential Mortality ◽  
Access To Health Services ◽  
Access To Health ◽  
Group Interviews ◽  
Multiple Loss

Recent data on the inequities in mortality, health, and access to health services experienced by the Traveller community in Ireland show higher rates of death by suicide and other sudden causes among members of this marginalized minority group than in the general population. Psychological literature on bereavement suggests that traumatic deaths and multiple deaths within a close network may be more likely to lead to complicated grief reactions. The aim of this study is to add to our understanding of the effects of the differential mortality rate by exploring how grief is experienced within the Traveller community in the context of bereavement from multiple deaths or sudden deaths (including suicide). Data from three semistructured focus group interviews with a total of 10 Traveller Community Health Worker participants (nine female and one male) were analyzed using Interpretative Phenomenological Analysis. Two master themes organized the salient phenomenological aspects of the grief experience: Living with Tragic Loss and Communicating Tragic Loss. A picture emerged of individual and community-level loss that is extensive, profound, and enduring. The sequelae of deaths by suicide include difficulties in coping, a search for meaning, and a pervasive sense of fear. Silence, the embodied act of giving voice to tragic loss, and strategies for managing disclosure of tragic deaths with children were all strong themes which emerged from the analysis. This study uses interpretative phenomenological analysis to generate a vivid picture of the lived psychological experience of grief as it is experienced by members of a minority group with above average rates of sudden and early deaths. This contributes to understanding the burden of health inequality in an underresearched population. Findings in relation to challenges in communicating with children about tragic deaths can be integrated into bereavement support resources.

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