Using Digital Health, Financial Incentives, and Community Health Worker Support to Change Health Behavior

2019 ◽  
Author(s):  
Keyword(s):  
Health Behavior ◽  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Financial Incentives ◽  
Digital Health ◽  
Worker Support ◽  
Change Health Behavior

scholarly journals Post-Ebola Community Health Worker programme performance in Kenema District, Sierra Leone: A long way to go!

F1000Research ◽  
2020 ◽  
Vol 8 ◽  
pp. 794
Author(s):  
Harold Thomas ◽  
Katrina Hann ◽  
Mohamed Vandi ◽  
Joseph Bengalie Sesay ◽  
Koi Sylvester Alpha ◽  
...  
Keyword(s):  
Community Health ◽  
Health Worker ◽  
Sierra Leone ◽  
Community Health Worker ◽  
Financial Incentives ◽  
Recovery Period ◽  
Positive Trend ◽  
District Health ◽  
Cross Sectional ◽  
The Mean

Background: The devastating 2014-2015 Ebola outbreak in Sierra Leone could erode the gains of the health system including the Community Health Worker (CHW) programme. We conducted a study to ascertain if the positive trend in reporting cases of malaria, pneumonia and diarrhoea treated by CHWs in the post-Ebola period has been sustained 18 months post-Ebola. Methods: We conducted a retrospective cross-sectional study using aggregated CHW programme data (2013-2017) from all Primary Health Units in Kenema district. Data was extracted from the District Health Information System and analysed using STATA. Data in the pre- (June 2013-April 2014), during- (June 2014-April 2015) and post-Ebola recovery (June 2016-April 2017) periods was compared and analysed for reporting completeness; Rapid Diagnostic Tests (RDTs) performed and cases of malaria, diarrhoea and pneumonia treated per month. Differences across periods were tested using two-sample t-test with significance set at 0.05. Results: CHW reporting increased from pre-Ebola by 8% (p-value=0.29) intra-Ebola and 19% (p-value=0.012) post-Ebola. Compared to the pre-Ebola period, in the post-Ebola recovery period, there was a significant increase in the mean monthly reported RDTs of 35% (p-value=0.020); malaria treatments 66% (p-value<0.001); and pneumonia treatments increased by 80% (p-value=0.004). Conversely, the mean monthly diarrhoea cases treated decreased by 20% (p-value=0.16) in the post-Ebola period. Conclusion: The resiliency demonstrated by the CHW programme during and immediately after the Ebola outbreak has been sustained in the post-Ebola recovery period. Continued programme investments in supportive supervision and financial incentives for CHWs will be critical to ensure uninterrupted contribution towards Sustainable Development Goal 3.

scholarly journals Post-Ebola Community Health Worker programme performance in Kenema District, Sierra Leone: A long way to go!

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 794
Author(s):  
Harold Thomas ◽  
Katrina Hann ◽  
Mohamed Vandi ◽  
Joseph Bengalie Sesay ◽  
Koi Sylvester Alpha ◽  
...  
Keyword(s):  
Community Health ◽  
Health Worker ◽  
Sierra Leone ◽  
Community Health Worker ◽  
Financial Incentives ◽  
Recovery Period ◽  
Positive Trend ◽  
District Health ◽  
Cross Sectional ◽  
The Mean

Background: The devastating 2014-2015 Ebola outbreak in Sierra Leone could erode the gains of the health system including the Community Health Worker (CHW) programme. We conducted a study to ascertain if the positive trend in reporting cases of malaria, pneumonia and diarrhoea treated by CHWs in the post-Ebola period has been sustained 18 months post-Ebola. Methods: We conducted a retrospective cross-sectional study using aggregated CHW programme data (2013-2017) from all Primary Health Units in Kenema district. Data was extracted from the District Health Information System and analysed using STATA. Data in the pre- (June 2013-April 2014), during- (June 2014-April 2015) and post-Ebola recovery (June 2016-April 2017) periods was compared and analysed for reporting completeness; Rapid Diagnostic Tests (RDTs) performed and cases of malaria, diarrhoea and pneumonia treated per month. Differences across periods were tested using two-sample t-test with significance set at 0.05. Results: CHW reporting increased from pre-Ebola by 8% (p-value=0.29) intra-Ebola and 19% (p-value=0.012) post-Ebola. Compared to the pre-Ebola period, in the post-Ebola recovery period, there was a significant increase in the mean monthly reported RDTs of 35% (p-value=0.020); malaria treatments 66% (p-value<0.001); and pneumonia treatments increased by 80% (p-value=0.004). Conversely, the mean monthly diarrhoea cases treated decreased by 20% (p-value=0.16) in the post-Ebola period. Conclusion: The resiliency demonstrated by the CHW programme during and immediately after the Ebola outbreak has been sustained in the post-Ebola recovery period. Continued programme investments in supportive supervision and financial incentives for CHWs will be critical to ensure uninterrupted contribution towards Sustainable Development Goal 3.

scholarly journals Multiple pathways to scaling up and sustainability: an exploration of digital health solutions in South Africa

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Alison Swartz ◽  
Amnesty E. LeFevre ◽  
Shehani Perera ◽  
Mary V. Kinney ◽  
Asha S. George
Keyword(s):  
South Africa ◽  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Digital Health ◽  
National Level ◽  
Scaling Up ◽  
Value Proposition ◽  
Problem Identification ◽  
Organisational Context

Abstract Background With the aim to support further understanding of scaling up and sustaining digital health, we explore digital health solutions that have or are anticipated to reach national scale in South Africa: the Perinatal Problem Identification Programme (PPIP) and Child Healthcare Problem Identification Programme (Child PIP) (mortality audit reporting and visualisation tools), MomConnect (a direct to consumer maternal messaging and feedback service) and CommCare (a community health worker data capture and decision-support application). Results A framework integrating complexity and scaling up processes was used to conceptually orient the study. Findings are presented by case in four domains: value proposition, actors, technology and organisational context. The scale and use of PPIP and Child PIP were driven by ‘champions’; clinicians who developed technically simple tools to digitise clinical audit data. Top-down political will at the national level drove the scaling of MomConnect, supported by ongoing financial and technical support from donors and technical partners. Donor preferences played a significant role in the selection of CommCare as the platform to digitise community health worker service information, with a focus on HIV and TB. A key driver of scale across cases is leadership that recognises and advocates for the value of the digital health solution. The technology need not be complex but must navigate the complexity of operating within an overburdened and fragmented South African health system. Inadequate and unsustained investment from donors and government, particularly in human resource capacity and robust monitioring and evaluation, continue to threaten the sustainability of digital health solutions. Conclusions There is no single pathway to achieving scale up or sustainability, and there will be successes and challenges regardless of the configuration of the domains of value proposition, technology, actors and organisational context. While scaling and sustaining digital solutions has its technological challenges, perhaps more complex are the idiosyncratic factors and nature of the relationships between actors involved. Scaling up and sustaining digital solutions need to account for the interplay of the various technical and social dimensions involved in supporting digital solutions to succeed, particularly in health systems that are themselves social and political dynamic systems.

scholarly journals Strengthening the community health worker programme for health improvement through enhancing training, supervision and motivation in Wakiso district, Uganda

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
David Musoke ◽  
Charles Ssemugabo ◽  
Rawlance Ndejjo ◽  
Edwinah Atusingwize ◽  
Trasias Mukama ◽  
...  
Keyword(s):  
Health Education ◽  
Qualitative Methods ◽  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Financial Incentives ◽  
Health Improvement ◽  
Community Members ◽  
Quantitative And Qualitative Methods ◽  
Children Under 5

Abstract Objective The objective of the project was to strengthen the community health worker (CHW) programme in Ssisa sub-county, Wakiso district, Uganda by providing a coherent, structured and standardized training, supervision and motivation package so as to enhance their performance. Results The project trained all 301 CHWs who received non-financial incentives of t-shirts, gumboots and umbrellas, and 75 of them received solar equipment to support lighting their houses and charging phones. Twenty-four of the CHWs who had coordination roles received additional training. Three motorcycles were also provided to enhance transportation of CHW coordinators during their work including supervision. By end of the project, the CHWs had conducted 40,213 household visits, carried out health education sessions with 127,011 community members, and treated 19,387 children under 5 years of age. From the project evaluation, which used both quantitative and qualitative methods, 98% of the CHWs reported having improved competence in performance of their roles. In addition, the CHWs were highly motivated to do their work. The motorcycles were instrumental in supporting the work of CHW coordinators including monthly collection of reports and distribution of medicines. The project demonstrated that by improving training, supervision and motivation, performance of CHW programmes can be enhanced.

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