Title: End user experience of Hayat app and dashboard: qualitative assessment of usability, community engagement and validity of data for antenatal care provision and routine immunization in rural Pakistan and Afghanistan (Preprint)

BACKGROUND An mHealth app was developed for front line health workers, to strengthen maternal, neonatal and child health services through increased transparency, accountability, and improved governance by collecting and disseminating real-time data. Key features included tracking frontline health workers through Global Positioning System during outreach visits, registration of clients; and recording data. OBJECTIVE In this paper we report the end user experiences of the captured during the qualitative end line study of the Hayat app. This includes perceptions and experience of the using the digital app with a focus on usability, validity of data, and community response. This paper aims to identify barriers and enablers to integration of mhealth and inform how digital technology can be utilized for strengthening the district health systems in LMICs. METHODS Qualitative assessment was carried out in select rural districts of Khyber Pakhtunkhwa and Gilgit-Baltistan in Pakistan and select catchments of Bamyan and in Badakshan Province in Afghanistan. Methods used for assessment included 17 focus group discussions with LHWs and 28 key informant interviews with health workers and key stakeholders. Thematic content analysis was undertaken based on an adapted framework derived from the World Health Organization guide for “Monitoring and Evaluating Digital Health Interventions” and technology acceptance model. RESULTS The study revealed high usability of the app both by the stakeholders. Overall, the app improved quality and timeliness of data, improved immunization coverage and maternal care through supportive supervision and monitoring of frontline health workers. Data validity improved and health managers were confident of the reliability of data collected through the app. However, connectivity issues, difficulty in access to remote sites, security issues, lack of incentives and increased workload were some of the perceived barriers identified by the end users. CONCLUSIONS The use of smart phone-based application has high acceptability among the HCPs, and has benefitted the existing health system functioning but providing reliable data, and better monitoring. However, successful integration of app in the health system will require inter sectorial collaboration to address the challenges identified in implementation. CLINICALTRIAL N/A

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Prevalence and factors associated with Metabolic Syndrome in elderly users of the Unified Health System

Revista Brasileira de Epidemiologia ◽

10.1590/1809-4503201400040001 ◽

2014 ◽

Vol 17 (4) ◽

pp. 805-817 ◽

Cited By ~ 10

Author(s):

Edna Cunha Vieira ◽

Maria do Rosário Gondim Peixoto ◽

Erika Aparecida da Silveira

Keyword(s):

Metabolic Syndrome ◽

Health System ◽

Health Workers ◽

The Elderly ◽

World Health ◽

Fat Percentage ◽

Cross Sectional ◽

Factors Associated ◽

Unified Health System ◽

The Metabolic Syndrome

OBJECTIVE: To evaluate the prevalence and factors associated with metabolic syndrome in the elderly. METHODS: Cross-sectional study, with 133 individuals randomly selected in the Unified Health System in Goiania, Goiás. The following variables were researched: anthropometric (BMI, waist circumference, fat percentage by Dual X-ray absorptiometry), sociodemographic (gender, age, color, income, marital status and years of schooling), lifestyle (physical activity, smoking and risk alcohol consumption) and food intake (risk and protective foods). The metabolic syndrome was assessed according to harmonized criteria proposed by the World Health Organization (WHO). The combinations were tested by Poisson regression for confounding factors. RESULTS: The prevalence of metabolic syndrome was 58.65% (95%CI 49.8 - 67.1), with 60.5% (95%CI 49.01 - 71.18) for females and 55.7% (95%CI 41.33 - 69.53) for males. Hypertension was the most prevalent component of the syndrome in both men, with 80.8% (95%CI 64.5 - 90.4), and women, with 85.2% (95%CI 75.5 - 92.1). After the multivariate analysis, only the excess of weight measured by body mass index (prevalence ratio = 1.66; p < 0.01) remained associated with the metabolic syndrome. CONCLUSIONS: The prevalence of metabolic syndrome in this sample was high, indicating the need for systematic actions by health workers in the control of risk factors through prevention strategies and comprehensive care to the elderly.

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A sustainable community based model of non-communicable disease risk factor surveillance: “SHRADDHA-JAGRITHI project” (Preprint)

10.2196/preprints.27299 ◽

2021 ◽

Author(s):

Jaideep Menon ◽

Mathews Numpeli ◽

Sajeev.P. Kunjan ◽

Beena.V. Karimbuvayilil ◽

Aswathy Sreedevi ◽

...

Keyword(s):

Public Health ◽

Health System ◽

Public Health System ◽

Health Workers ◽

Communicable Disease ◽

Community Based ◽

Frontline Health Workers ◽

The Individual ◽

Non Communicable Disease

UNSTRUCTURED Abstract: India has a massive non-communicable disease (NCD) burden at an enormous cost to the individual, family, society and health system at large, in spite of which prevention and surveillance is relatively neglected. Risk factors for atherosclerotic cardiovascular disease if diagnosed early and treated adequately would help decrease the mortality and morbidity burden. India is in a stage of rapid epidemiological transition with the state of Kerala being at the forefront, pointing us towards likely disease burden and outcomes for the rest of the country, in the future. A previous study done by the same investigators, in a population of >100,000, revealed poor awareness and treatment of NCDs and also poor adherence to medicines in individuals with CVD. The investigators are looking at a sustainable, community based model of surveillance for NCDs with corporate support wherein frontline health workers check all individuals in the target group ( > age 30 years) with further follow up and treatment planned in a “spoke and hub” model using the public health system of primary health centres (PHCs) as spokes to the hubs of Taluk or District hospitals. All data entry done by frontline health workers would be on a Tab PC ensuring rapid acquisition and transfer of participant health details to PHCs for further follow up and treatment. The model will be evaluated based on the utilisation rate of various services offered at all tier levels. The proportions of the target population screened, eligible individuals who reached the spoke or hub centres for risk stratification and care and community level control for hypertension and diabetes in annual surveys will be used as indicator variables. The model ensures diagnosis and follow up treatment at no cost to the individual entirely through the tiered public health system of the state and country.

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Digital health for real-time monitoring of a national immunisation campaign in Indonesia: a large-scale effectiveness evaluation

BMJ Open ◽

10.1136/bmjopen-2020-038282 ◽

2020 ◽

Vol 10 (12) ◽

pp. e038282

Author(s):

Hafizah Jusril ◽

Iwan Ariawan ◽

Rita Damayanti ◽

Lutfan Lazuardi ◽

Miriam Musa ◽

...

Keyword(s):

Real Time ◽

Large Scale ◽

Health Workers ◽

Digital Health ◽

Ease Of Use ◽

Qualitative Assessment ◽

Vaccine Hesitancy ◽

Real Time Monitoring ◽

Risk Profiles ◽

National Immunisation

ObjectiveTo assess the contribution of a digital health real-time monitoring platform towards the achievement of coverage targets during a national immunisation campaign in Indonesia.InterventionsA digital health platform was introduced to facilitate real-time reporting and data visualisation. Health workers submitted reports of children immunised each day by geolocation using mobile phones. Automated reports were generated for programme managers at all levels to enable early responses to coverage gaps.MethodsRisk profiles were generated for each district to assess precampaign immunisation programme performance. Digital health platform use and progress towards targets were monitored continuously throughout the campaign. Study outcomes were total coverage and time to achieve full (100%) coverage. Kaplan-Meier, Cox and linear regression analyses were used to estimate the associations and outcomes after adjusting for district risk profiles. A complementary qualitative assessment explored user experiences and acceptance through interviews with vaccinators and programme managers in provinces and districts selected through multistage random sampling.ResultsBetween August and December 2018, 6462 health facilities registered to use the digital health platform across 28 provinces and 395 districts. After adjusting for precampaign district risk profile and intracampaign delays due to vaccine hesitancy, districts with greater platform utilisation demonstrated higher coverage overall (R2=0.28, p<0.0001) and a shorter interval to achieving full coverage (>75% reporting compliance; Risk Ratio 15.4, 95% CI 5.8 to 40.6). Stronger effects were observed among districts experiencing implementation delays due to vaccine hesitancy. Results from 106 key informant interviews conducted in 6 provinces and 18 districts suggest high degrees of acceptability, ease of use and satisfaction.ConclusionA digital health platform introduced for real-time monitoring of a national immunisation campaign in Indonesia was feasible, well liked and associated with improved problem solving and programme performance, particularly among districts affected by vaccine hesitancy.Trial registration numberISRCTN10850448.

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Chronic Disease Stigma, Skepticism of the Health System, and Socio-economic Fragility: Qualitative Assessment of Factors Impacting Receptiveness to Group Medical Visits and Microfinance for Non-Communicable Disease Care in Rural Kenya

10.21203/rs.3.rs-47902/v1 ◽

2020 ◽

Author(s):

Rae Dong ◽

Claudia Leung ◽

Mackenzie N. Naert ◽

Violet Naanyu ◽

Peninah Kiptoo ◽

...

Keyword(s):

Chronic Disease ◽

Health System ◽

Health Workers ◽

Care Delivery ◽

Communicable Disease ◽

Qualitative Assessment ◽

East African Community ◽

Group Medical Visits ◽

Medical Visits ◽

The Impact

Abstract Background: Non-communicable diseases (NCDs) are the leading cause of mortality in the world, and innovative approaches to NCD care delivery are being actively developed and evaluated. Combining the group-based experience of microfinance and group medical visits is a novel approach to NCD care delivery that has demonstrated beneficial impact in previous pilot studies. However, the contextual factors, facilitators, and barriers impacting wide-scale implementation of these approaches within a low- and middle-income country setting are not well known.Methods: Two types of qualitative group discussion were conducted: 1) mabaraza (singular, baraza), a traditional East African community gathering used to discuss and exchange information in large group settings; and 2) focus group discussions (FGDs) among rural clinicians, community health workers, microfinance group members, and patients with NCDs. Trained research staff members led the discussions using structured question guides. Content analysis was performed with NVivo using deductive and inductive codes that were then grouped into themes.Results: We conducted 5 mabaraza and 16 FGDs. A total of 205 individuals (113 men and 92 women) participated in the mabaraza, while 162 individuals (57 men and 105 women) participated in the FGDs. Participants expressed interest in participating in microfinance and group medical visits, but cited several key challenges: 1) stigma of chronic disease, 2) earned skepticism of the health system, and 3) socio-economic fragility.Conclusions: Our qualitative study revealed and illuminated actionable factors that could impact the success of implementation of group medical visits and microfinance initiatives for NCD care. While several challenges were highlighted, participants also felt that planned interventions could address and mitigate the impact of these dynamic factors. We anticipate that our approach and analysis provides new insights and methodological techniques that will be relevant to other low-resource settings worldwide.Trial Registration: Clinicaltrials.gov, NCT02501746, registration date: July 17, 2015

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Implementation of the new WHO recommendations on HIV and infant feeding: Challenges and the way forward

African Journal of Food, Agriculture, Nutrition and Development ◽

10.18697/ajfand.52.who-3 ◽

2012 ◽

Vol 12 (52) ◽

pp. 6274-6290

Author(s):

C Sagoe-Moses ◽

◽

K Mwinga ◽

P Habimana ◽

ID Toure ◽

...

Keyword(s):

Infant Feeding ◽

Health Workers ◽

National Level ◽

Scale Up ◽

World Health ◽

Child Health Services ◽

Feeding Practice ◽

Policy Makers ◽

Hiv Exposed ◽

The Way

Breast milk provides all the nutrient needs of the infant especially in the first six months of life and also protects the growing infant from pneumonia, diarrhoea, and malnutrition, which are the major causes of morbidity and mortality in the African Region. However breastfeeding is also known to transmit the Human Immunodeficiency Virus (HIV) from mother to the child. Several guidelines have been developed to guide policy makers, health workers and mothers on the most appropriate methods to feed HIV exposed infants. Previous HIV and infant feeding guidelines emphasized on preventing infants from becoming infected with HIV by counseling HIV-infected mothers to avoid all breastfeeding. Over the period, programme implementers and researchers have reported difficulties in implementing earlier recommendations and guidelines on HIV and infant feeding within health-care systems. New evidence now shows that giving Anti-Retroviral therapy (ARVs) to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of transmitting HIV through breastfeeding. Thus, in 2010 World Health Organization (WHO) issued the latest guidelines on HIV and infant feeding entitled Principles and recommendations for infant feeding in the context of HIV and a summary of evidence. The 2010 WHO guidelines have changed the recommendations on how HIV infected mothers should feed their infants, and how health workers should support them. National authorities in each country can decide which infant feeding practice will be primarily promoted and supported by Maternal and Child Health services, i.e. breastfeeding with an antiretroviral intervention to reduce transmission or avoidance of all breastfeeding. Previous guidelines and recommendations on infant feeding in the context of HIV have undergone frequent changes over the past decade. The adaptation and implementation of previous and current guidelines at national level have met challenges. These include lack of consensus among key stakeholders, inadequate funding for the additional cost of providing ARVs to the mother or the child and difficulties in communicating the recommendations in the new guidelines clearly to mothers, health workers and policy makers. To address these challenges a number of proposals have been suggested such as coordinated consensus building process, costing of interventions and a phased implementation approach to ensure successful scale up over time. This paper describes the process of adapting global HIV and infant feeding recommendations and guidelines at national level. It also reviews the challenges encountered in implementation and proposes the way forward in addressing them.

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Female clients’ gender preferences for frontline health workers who provide maternal, newborn and child health (MNCH) services at primary health care level in Nigeria

10.21203/rs.2.12552/v2 ◽

2020 ◽

Author(s):

Ekechi Okereke ◽

Godwin Unumeri ◽

Akinwumi Akinola ◽

George Eluwa ◽

Sylvia Adebajo

Keyword(s):

Child Health ◽

Primary Healthcare ◽

Health Workers ◽

Healthcare Services ◽

Child Health Services ◽

Gender Preferences ◽

Newborn And Child Health ◽

Frontline Health Workers ◽

Female Clients ◽

And Child Health

Abstract Background In Nigeria, anecdotes abound that female clients, particularly within northern Nigeria, have gender-based preferences for frontline health workers (FLHWs) who provide healthcare services. This may adversely affect uptake of maternal newborn and child health services, especially at primary healthcare level in Nigeria, where a huge proportion of the Nigerian population and rural community members in particular, access healthcare services. This study explored female clients’ gender preferences for frontline health workers who provide maternal, newborn and child healthcare (MNCH) services at primary healthcare level in Nigeria. Methods The study adopted a cross-sectional quantitative design with 256 female clients’ exit interviews from 66 randomly selected primary health facilities within two States - Bauchi (northern Nigeria) and Cross-River (southern Nigeria). Data was collected using Personal Digital Assistants and data analysis was done using SPSS software. Descriptive analysis was carried out using percentage frequency distribution tables. Bivariate analysis was also carried out to examine possible relationships between key characteristic variables and the gender preferences of female clients involved in the study. Results Out of 256 women who accessed maternal, newborn and child health services within the sampled health facilities, 44.1% stated preference for female FLHWs, 2.3% preferred male FLHWs while 53.5% were indifferent about the gender of the health worker. However only 26.6% of female clients were attended to by male FLHWs. Bivariate analyses suggest a relationship between a female client’s health worker gender preference and her pregnancy status, the specific reason for which a female client visits a primary healthcare facility, a female client’s location in Nigeria as well as the gender of the health worker(s) working within the primary healthcare facility which she visits to access maternal, newborn and child health services. Conclusions The study findings suggest that female clients at primary healthcare level in Nigeria possibly have gender preferences for the frontline health workers who provide services to them. There should be sustained advocacy and increased efforts at community engagement to promote the acceptability of healthcare services from male frontline health workers in order to have a significant impact on the uptake of MNCH services, particularly within northern Nigeria.

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Ten Years of Universal Testing: How the Rapid Diagnostic Test Became a Game Changer for Malaria Case Management and Improved Disease Reporting

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0643 ◽

2021 ◽

Author(s):

Michael Aidoo ◽

Sandra Incardona

Keyword(s):

Case Management ◽

Health System ◽

Malaria Control ◽

Malaria Case ◽

Health Workers ◽

Malaria Diagnosis ◽

World Health ◽

Smear Microscopy ◽

Malaria Case Management ◽

Laboratory Staff

In 2010, the World Health Organization changed its guidance on malaria case management, recommending parasitological confirmation of all suspected cases before treatment with an antimalarial. This recommendation was in large part as a result of the availability of quality assured malaria rapid diagnostic tests (RDTs) that made it possible for malaria diagnosis to be performed by laboratory staff in all health facilities irrespective of the facility’s place in the tiered health system. Community health workers and other non-laboratory health workers who traditionally did not perform malaria testing due to the technical and logistic demands of smear microscopy were now able to test for malaria. The use of RDTs has led to substantial increases in testing rates, improved quality of case management, as well as more accurate reporting of malaria cases. Although current RDTs have limitations, they remain one of the most important tools in contemporary malaria control. Further improvements to existing products, such as increased sensitivity for non-falciparum tests, diversification of Plasmodium falciparum antigen targets, along with strengthened health system support for current RDTs will further enhance their utility in malaria control and prevention.

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Digital Health Interventions for Community Health Worker Training, Ongoing Education, and Supportive Supervision

10.1093/oso/9780198866244.003.0005 ◽

2021 ◽

pp. 67-86

Author(s):

Beatrice Wasunna ◽

Isaac Holeman

Keyword(s):

Community Health ◽

Health Workers ◽

Digital Health ◽

Health Interventions ◽

World Health ◽

Supportive Supervision ◽

Governmental Organization ◽

Implementation Challenges ◽

Worker Training ◽

The Right

According to the World Health Organization’s No Health Without a Workforce report, the global shortage of community health workers (CHWs) is expected to reach 12.9 million by 2035. This shortfall raises pressing questions about how CHWs are recruited, trained, and supported as front-line care providers. Lay people become CHWs in a variety of ways; they might be chosen by a non-governmental organization or a government programme, elected by community members, or simply volunteer themselves at the right time and place. After recruitment, CHWs typically undergo training, and the scope and quality of this training can vary enormously. Often, limited funds are stretched to conduct trainings in person at facilities that may or may not be readily accessible for health workers, and refresher trainings are often cut in times of budget shortfall. While there may be no simple solution to these challenges, many now look to the use of digital technologies as a promising opportunity. Digital health interventions have come to play a growing role in healthcare in the last decade, yet the uses of technology for training, ongoing education, and supportive supervision remain understudied in lower-income settings. In this chapter, we examine a case study of digital health interventions in Nepal. We examine matters of baseline literacy and access to technology, the interweaving of technology and health system design issues, and prospects for integrating digital and face-to-face education and support. While the role of technology is easily overstated, we nonetheless argue that new digital workflows can address real implementation challenges if designed in a human-centred manner.

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Health workforce in India: opportunities and challenges

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20194534 ◽

2019 ◽

Vol 6 (10) ◽

pp. 4596

Author(s):

Kesavan Sreekantan Nair

Keyword(s):

Nursing Education ◽

Health System ◽

Health Workforce ◽

Health Workers ◽

World Health ◽

Public And Private ◽

Better Regulation ◽

Political Commitments ◽

Health Organization ◽

Workforce Density

Health system reforms in India during the past decade yielded an impressive growth of medical, dental and nursing education opportunities, but health workforce density remains low in comparison to the World Health Organization (WHO) norms. Apart from shortage, retaining qualified health workforce in the rural and underserved areas remains a huge challenge. This crisis is likely to persist until and unless health system addresses the fundamental requirements of health workers as envisaged in health policies. Concerted attention and long term political commitments are required to overcome health system barriers to achieve rural recruitment and retention across various cadres in states. As the major share of health workforce belongs to the private sector, their resources need to be harnessed to meet health system goals through partnerships and collaborations. There is an urgent need for better regulation and enforcement of standards in medical education and delivery of health services across the public and private sectors.

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Feasibility of Virtual Reality based Training for Optimising COVID-19 Case Handling in Uganda

10.21203/rs.3.rs-882147/v1 ◽

2021 ◽

Author(s):

Paul Buyego ◽

Elizabeth Katwesigye ◽

Grace Kebirungi ◽

Mike Nsubuga ◽

Shirley Nakyejwe ◽

...

Keyword(s):

Virtual Reality ◽

Graphics Processing Units ◽

Medical Training ◽

Health Workers ◽

Qualitative Assessment ◽

Infection Prevention And Control ◽

P Value ◽

High Morbidity ◽

Information Retention ◽

Frontline Health Workers

Abstract BackgroundEpidemics and pandemics are causing high morbidity and mortality on a still-evolving scale exemplified by the COVID-19 pandemic. Infection prevention and control (IPC) training for frontline health workers is thus essential. However, classroom or hospital ward based training portends an infection risk due to the in-person interaction of participants. We explored the use of Virtual Reality (VR) simulations for frontline health worker training since it trains participants without exposing them to infections that would arise from in-person training. It does away with the requirement for expensive Personal Protective Equipment (PPE) that has been in acute shortage and improves learning, retention and recall. This represents the first attempt in deploying VR-based pedagogy in a Ugandan medical education context.MethodsWe used animated VR-based simulations of bedside and ward-based training scenarios for frontline health workers. The training covered the wearing and stripping of PPE, case management of COVID-19 infected individuals and hand hygiene. It used VR headsets and Graphics Processing Units (GPUs) to actualize an immersive experience, via a hybrid of VR renditions and 360degrees videos. We then compared the level of knowledge acquisition between individuals trained using this method to comparable cohorts previously trained in a classroom setting. That evaluation was supplemented by a qualitative assessment based on feedback from participants about their experience.ResultsThe effort resulted into a well-designed COVID-19 IPC VR curriculum, equivalent VR content and a pioneer cohort of trained frontline health workers. The formalized comparison with classroom-trained cohorts showed relatively better outcomes by way of skills acquired, speed of learning and rates of information retention (P-value =4.0e-09) - suggesting the effectiveness and feasibility of VR as a medium of medical training. Additionally, in the qualitative assessment 90% of the participants rated the method as very good, 58.1% strongly agreed that the activities met the course objectives, and 97.7 % strongly indicated willingness to refer the course to colleagues. ConclusionVR-based COVID-19 IPC training is feasible, effective and achieves enhanced learning while protecting participants from infections within a pandemic context in Uganda. It is a delivery medium transferable to the contexts of other highly infectious diseases.

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