scholarly journals A Checklist for Implementing Rural Pathways to Train, Develop and Support Health Workers in Low and Middle-Income Countries

2020 ◽  
Vol 7 ◽  
Author(s):  
Belinda O'Sullivan ◽  
Bruce Chater ◽  
Amie Bingham ◽  
John Wynn-Jones ◽  
Ian Couper ◽  
...  
Keyword(s):  
Health Worker ◽  
Health Workers ◽  
Scale Up ◽  
Field Testing ◽  
Workforce Training ◽  
Practical Implementation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Rural Workforce ◽  
Low And Middle Income

Background: There is an urgent need to scale up global action on rural workforce development. This World Health Organization-sponsored research aimed to develop a Rural Pathways Checklist. Its purpose was to guide the practical implementation of rural workforce training, development, and support strategies in low and middle-income countries (LMICs). It was intended for any LMICs, stakeholder, health worker, context, or health problem.Method: Multi-methods involved: (1) focus group concept testing; (2) a policy analysis; (3) a scoping review of LMIC literature; (4) consultation with a global Expert Reference Group and; (5) field-testing over an 18-month period.Results: The Checklist included eight actions for implementing rural pathways in LMICs: establishing community needs; policies and partners; exploring existing workers and scope; selecting health workers; education and training; working conditions for recruitment and retention; accreditation and recognition of workers; professional support/up-skilling and; monitoring and evaluation. For each action, a summary of LMICs-specific evidence and prompts was developed to stimulate reflection and learning. To support implementation, rural pathways exemplars from different WHO regions were also compiled. Field-testing showed the Checklist is fit for purpose to guide holistic planning and benchmarking of rural pathways, irrespective of LMICs, stakeholder, or health worker type.Conclusion: The Rural Pathways Checklist provides an agreed global conceptual framework for the practical implementation of “grow your own” strategies in LMICs. It can be applied to scale-up activity for rural workforce training and development in LMICs, where health workers are most limited and health needs are greatest.

scholarly journals A Practical Measure of Health Facility Efficiency: an Innovation in the Application of Routine Health Information to Determine Health Worker Productivity in Ethiopia

2021 ◽  
Author(s):  
Md Zabir Hasan ◽  
Girmaye D. Dinsa ◽  
Peter Berman
Keyword(s):  
Health Worker ◽  
Health Facility ◽  
Health Workers ◽  
Principal Component ◽  
Practical Application ◽  
Summary Measure ◽  
Worker Productivity ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract BackgroundA simple indicator of technical efficiency, such as productivity of health workers, measured using routine health facility data, can be a practical approach that can inform initiatives to improve efficiency in low and middle-income countries. This paper presents a proof of concept of using routine information from primary healthcare (PHC) facilities to measure health workers’ productivity and its application in three regions of Ethiopia.MethodsIn four steps, we constructed a productivity measure of the health workforce of Health Centers (HCs) and demonstrated its practical application: (1) developing an analytical dataset using secondary data from health management information systems (HMIS) and human resource information system (HRIS); (2) principal component analysis and factor analysis to estimate a summary measure of output from five indicators (annual service volume of outpatient visits, family planning, first antenatal care visits, facility-based deliveries by skilled birth attendance, and children [<1 year] with three pentavalent vaccines); (3) calculating a productivity score by combining the summary measure and the total number of health workers (input); and (4) implementing regression models to identify the determinant of productivity and ranking HCs based on their adjusted productivity score. ResultsWe developed an analytical dataset of 1,128 HCs; however, significant missing values and outliers were reported in the data. The principal component and factor scores developed from the five output measures were highly consistent (correlation coefficient = 0.98). We considered the factor score as the summary measure of outputs for estimating productivity. A very weak association was observed between the summary measure of output and the total number of staff. The result also highlighted a large variability in productivity across similar health facilities in Ethiopia, represented by the significant dispersion in summary measure of output occurring at similar levels of the health workers. ConclusionsWe successfully demonstrated the analytical steps to estimate health worker productivity and its practical application using HMIS and HRIS. The methodology presented in this study can be readily applied in low and middle-income countries using widely available data – such as DHIS2 – that will allow further explorations to understand the causes of technical inefficiencies in the health system.

scholarly journals A practical measure of health facility efficiency: an innovation in the application of routine health information to determine health worker productivity in Ethiopia

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Md Zabir Hasan ◽  
Girmaye D. Dinsa ◽  
Peter Berman
Keyword(s):  
Health Worker ◽  
Health Facility ◽  
Health Workers ◽  
Principal Component ◽  
Practical Application ◽  
Summary Measure ◽  
Worker Productivity ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Background A simple indicator of technical efficiency, such as productivity of health workers, measured using routine health facility data, can be a practical approach that can inform initiatives to improve efficiency in low- and middle-income countries. This paper presents a proof of concept of using routine information from primary healthcare (PHC) facilities to measure health workers’ productivity and its application in three regions of Ethiopia. Methods In four steps, we constructed a productivity measure of the health workforce of Health Centers (HCs) and demonstrated its practical application: (1) developing an analytical dataset using secondary data from health management information systems (HMIS) and human resource information system (HRIS); (2) principal component analysis and factor analysis to estimate a summary measure of output from five indicators (annual service volume of outpatient visits, family planning, first antenatal care visits, facility-based deliveries by skilled birth attendants, and children [< 1 year] with three pentavalent vaccines); (3) calculating a productivity score by combining the summary measure of outputs and the total number of health workers (input), and (4) implementing regression models to identify the determinant of productivity and ranking HCs based on their adjusted productivity score. Results We developed an analytical dataset of 1128 HCs; however, significant missing values and outliers were reported in the data. The principal component and factor scores developed from the five output measures were highly consistent (correlation coefficient = 0.98). We considered the factor score as the summary measure of outputs for estimating productivity. A very weak association was observed between the summary measure of output and the total number of staff. The result also highlighted a large variability in productivity across similar health facilities in Ethiopia, represented by the significant dispersion in summary measure of output occurring at similar levels of the health workers. Conclusions We successfully demonstrated the analytical steps to estimate health worker productivity and its practical application using HMIS and HRIS. The methodology presented in this study can be readily applied in low- and middle-income countries using widely available data—such as DHIS2—that will allow further explorations to understand the causes of technical inefficiencies in the health system.

Design & Development of a digital assistant to support teleconsultations between remote doctors and frontline health workers in low and middle-income countries (Preprint)

2020 ◽  
Author(s):  
Neha Verma ◽  
Harold Lehmann ◽  
Amal Afroz Alam ◽  
Youseph Yazdi ◽  
Soumyadipta Acharya
Keyword(s):  
Community Health ◽  
Health Worker ◽  
Community Health Workers ◽  
Unmet Needs ◽  
Health Workers ◽  
User Needs ◽  
Middle Income ◽  
Middle Income Countries ◽  
Frontline Health Workers ◽  
Low And Middle Income

BACKGROUND Many low and middle-income countries (LMICs) have adopted telemedicine programs that connect frontline health workers (FHWs) such as nurses, midwives, or community health workers in rural and remote areas with doctors in urban areas to deliver care to patients. By leveraging technology to reduce temporal, financial, and geographic barriers, these health worker-to-doctor telemedicine programs have the potential to increase quality, to expand the specialties available to patients, and to reduce the time and cost required to deliver care. OBJECTIVE We aimed to identify, validate, prioritize unmet needs in this healthcare space of health worker-to-doctor telemedicine programs, and develop and refine a solution that addresses those needs. METHODS We collected information regarding user needs through ethnographic research, direct observation, and semi-structured interviews with 37 stakeholders (5 doctors, 1 public health program manager, 12 community health workers, and 19 patients) at two telemedicine clinics in rural West Bengal, India. We used the Spiral-Innovative Iteration model to design and develop a prototype solution to meet these needs. RESULTS We identified 74 unmet needs through our immersion in health worker-to-doctor telemedicine programs. We identified a critical unmet need that achieving optimal teleconsultations in LMICs often requires shifting tasks such as history taking and physical examination, from high-skilled remote doctors to the frontline health worker (FHW). To solve this need, we developed a prototype digital assistant that would allow frontline health workers to assume some of the tasks carried out by remote clinicians. The user needs of multiple stakeholder groups (patients, FHWs, doctors, and health organizations) informed this task-shifting tool. CONCLUSIONS The final prototype developed was released as an open source digital public good and may improve the quality and efficiency of care delivery in health worker-to-doctor telemedicine programs.

scholarly journals Approaches to motivate physicians and nurses in low- and middle-income countries: a systematic literature review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jaya Gupta ◽  
Mariya C. Patwa ◽  
Angel Khuu ◽  
Andreea A. Creanga
Keyword(s):  
Systematic Review ◽  
Randomized Trial ◽  
Health Worker ◽  
Work Motivation ◽  
Health Workers ◽  
Trial Group ◽  
Middle Income ◽  
Group Design ◽  
Middle Income Countries ◽  
Worker Motivation

AbstractPoor health worker motivation, and the resultant shortages and geographic imbalances of providers, impedes the provision of quality care in low- and middle-income countries (LMICs). This systematic review summarizes the evidence on interventions used to motivate health workers in LMICs. A standardized keyword search strategy was employed across five databases from September 2007 -September 2017. Studies had to meet the following criteria: original study; doctors and/or nurses as target population for intervention(s); work motivation as study outcome; study design with clearly defined comparison group; categorized as either a supervision, compensation, systems support, or lifelong learning intervention; and conducted in a LMIC setting. Two independent reviewers screened 3845 titles and abstracts and, subsequently, reviewed 269 full articles. Seven studies were retained from China (n = 1), Ghana (n = 2), Iran (n = 1), Mozambique (n = 1), and Zambia (n = 2). Study data and risk of bias were extracted using a standardized form. Though work motivation was the primary study outcome, four studies did not provide an outcome definition and five studies did not describe use of a theoretical framework in the ascertainment. Four studies used a randomized trial—group design, one used a non-randomized trial—group design, one used a cross-sectional design, and one used a pretest–posttest design. All three studies that found a significant positive effect on motivational outcomes had a supervision component. Of the three studies that found no effects on motivation, two were primarily compensation interventions and the third was a systems support intervention. One study found a significant negative effect of a compensation intervention on health worker motivation. In conducting this systematic review, we found there is limited evidence on successful interventions to motivate health workers in LMICs. True effects on select categories of health workers may have been obscured given that studies included health workers with a wide range of social and professional characteristics. Robust studies that use validated and culturally appropriate tools to assess worker motivation are greatly needed in the Sustainable Development Goals era.

scholarly journals The importance of context in early autism intervention: A qualitative South African study

Autism ◽  
2017 ◽  
Vol 22 (8) ◽  
pp. 1005-1017 ◽  
Author(s):  
Jessy Guler ◽  
Petrus J de Vries ◽  
Noleen Seris ◽  
Nokuthula Shabalala ◽  
Lauren Franz
Keyword(s):  
Autism Spectrum Disorder ◽  
South African ◽  
Health Workers ◽  
Contextual Factors ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Middle Income ◽  
Middle Income Countries ◽  
Treatment Type ◽  
Low And Middle Income

The majority of individuals with autism spectrum disorder live in low- and middle-income countries and receive little or no services from health or social care systems. The development and validation of autism spectrum disorder interventions has almost exclusively occurred in high-income countries, leaving many unanswered questions regarding what contextual factors would need to be considered to ensure the effectiveness of interventions in low- and middle-income countries. This study qualitatively explored contextual factors relevant to the adaptation of a caregiver-mediated early autism spectrum disorder intervention in a low-resource South African setting. We conducted four focus groups and four in-depth interviews with 28 caregivers of young children with autism spectrum disorder and used thematic analysis to identify key themes. Eight contextual factors including culture, language, location of treatment, cost of treatment, type of service provider, support, parenting practices, and stigma emerged as important. Caregivers reported a preference for an affordable, in-home, individualized early autism spectrum disorder intervention, where they have an active voice in shaping treatment goals. Distrust of community-based health workers and challenges associated with autism spectrum disorder-related stigma were identified. Recommendations that integrate caregiver preferences with the development of a low-cost and scalable caregiver-mediated early autism spectrum disorder intervention are included.

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

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.

scholarly journals Factors influencing the migration intention of health professionals in low and middle income countries: Critical review with a theoretical model

2020 ◽  
Vol 6 (6) ◽  
Author(s):  
Sara Hajian ◽  
Shahram Yazdani ◽  
MohammadPooyan Jadidfard ◽  
MohammadHossein Khoshnevisan
Keyword(s):  
Health Workers ◽  
Final Decision ◽  
Middle Income ◽  
Poor Countries ◽  
Middle Income Countries ◽  
Medical Graduates ◽  
Factors Influencing ◽  
Decision To Stay ◽  
Push And Pull ◽  
Low And Middle Income

Objective Migration of healthcare workers could result in shortage of human resources and rising inequalities in service provision in resource poor countries. The aim of this review was to determine the factors influencing the migration decisions of medical and dental graduates migrating from low- and middle-income countries as well as introducing a practical model for health professional’s migration. Methods Google Scholar and PubMed were searched together with relevant journals for English studies from January 2005 to January 2020. The original studies which evaluated the motivational factors of dental and medical graduates migrating from low or middle income countries were included. The migration model was developed by investigating the factors and frameworks of selected studies. Results Twenty-five articles were met the inclusion criteria. Push and pull theory was the most popular way to describe the driving factors of migration. These factors were classified into three macro-, meso- and micro-level with eight key domains.  Poor income, unfavorable socio-economic situation, political instability, lack of professional and educational opportunities together with family and personal concerns found as strong common reasons perpetuating migration. Conclusion Despite the fact that health workers migrate for different reasons, they follow a same route for decision to stay or leave their home countries. Un-fulfillment of expectations in mother land in addition to media reconstructed reality of life in foreign land can develop a positive attitude for better quality of life improvement after migration. Once individuals could overpass their national identity and barriers of migration, the final decision toward migration would be more feasible.

Abstract P681: Implementation of Stroke Prevention Interventions in Low- and Middle-Income Countries: A Scoping Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nessa Ryan ◽  
Vida Rebello ◽  
Desiree Gutierrez ◽  
Kameko Washburn ◽  
Alvaro Zevallos Barboza ◽  
...  
Keyword(s):  
Scoping Review ◽  
Stroke Prevention ◽  
Health Workers ◽  
Evidence Based ◽  
Community Based Interventions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Implementation Outcomes ◽  
Prevention Interventions ◽  
Low And Middle Income

Background: Stroke is the second leading cause of death globally and an increasing concern in low- and middle-income countries (LMIC) where, due to limited capacity to treat stroke, preventative efforts are critically important. Although some research on evidence-based interventions for stroke prevention in LMIC exists, there remains a significant gap in understanding of their implementation across various contexts in LMIC. Objectives: In this scoping review, our objective was to identify and synthesize the implementation outcomes (using Proctor et al.’s taxonomy, 2011) for stroke prevention interventions, as well as to describe the diverse interventions employed. Methods: Eligible studies were empirical, focused on implementation of stroke prevention programs or policies, and occurred in at least one LMIC. Five databases were searched, including PubMed, PsycINFO, CINAHL, EMBASE, and Web of Science. Two reviewers independently assessed studies for selection and charted data; discrepancies were resolved through discussion with a third reviewer until consensus was reached. Narrative synthesis was used to analyze and interpret the findings. Results: Studies were predominantly focused in Asia, targeting primary or secondary prevention, and facility-based. Interventions were conducted at the level of individual (n=11), system (n=12), or both (n=4). Various implementation outcomes were reported, most commonly cost (n=10), acceptability (n=7), fidelity (n=7), and feasibility (n=6), but also adoption (n=4), penetration (n=3), appropriateness (n=1), and sustainability (n=1). Conclusions: Findings highlight the breadth of evidence-based interventions for stroke prevention available to implement in LMIC settings, including culturally acceptable education interventions, cost-effective medications, and community-based interventions implemented by community health workers. Implementation outcomes remain under-reported, and more rigorous research is needed to better plan and evaluate the implementation of these interventions to prevent stroke.

Conclusion

2021 ◽  
pp. 195-202
Author(s):  
Laura Hakimi ◽  
Anne Geniets ◽  
James O’Donovan ◽  
Niall Winters
Keyword(s):  
Community Health ◽  
Case Studies ◽  
Health Worker ◽  
Community Health Worker ◽  
Middle Income ◽  
Middle Income Countries ◽  
Methodological Research ◽  
Training And Supervision ◽  
Low And Middle Income

Training and supervision are paramount to well-functioning, adaptable Community Health Worker (CHW) programmes. Balancing theoretical and methodological research, lessons from health worker practice, and case studies, this volume has sought to provide a resource to practitioners, policymakers and academics striving to design equitable, participatory CHW programmes. Weaving together interdisciplinary and multiregional perspectives, this book has focussed on the design, implementation and evaluation of technology-based programmes for training and supervision of CHWs, particularly in low- and middle income countries. In doing so, it has set out a roadmap for future equitable, pedagogy-driven CHW programmes.

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