Scaling community-based services in Gauteng, South Africa: A comparison of three workforce-planning scenarios

Background: The introduction of community-based services through community health workers is an opportunity to redefine the approach and practice of primary health care. Based on bestpractice community oriented primary care (COPC), a COPC planning toolkit has been developed to model the creation of a community-based tier in an integrated district health system.Aim: The article describes the methodologies and assumptions used to determine workforce numbers and service costs for three scenarios and applies them to the poorest 60% of the population in Gauteng, South Africa.Setting: The study derives from a Gauteng Department of Health, Family Medicine (University of Pretoria) partnership to support information and communication technology (ICT)-enabled COPC through community-based health teams (termed as ward-based outreach teams).Methods: The modelling uses national census age, gender and income data at small area level, provincial facility and national burden of disease data. Service calculations take into account multidimensional poverty, demand-adjusted burden of disease and available work time adjusted for conditions of employment and geography.Results: Assuming the use of ICT for each, a health workforce of 14 819, 17 925 and 7303 is required per scenario (current practice, national norms and full-time employed COPC), respectively. Total service costs for the respective scenarios range from R1.1 billion, through R947 million to R783 million.Conclusion: Modelling shows that delivering ICT-enabled COPC with full-time employees is the optimal scenario. It requires the smallest workforce, is the most economical, even when individual community health worker costs of employment are twice those of current practice, and is systemically the most effective.

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District health managers perspectives of introducing a new service: a qualitative study of the community-based newborn care programme in Ethiopia

BMC Health Services Research ◽

10.1186/s12913-021-06792-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Della Berhanu ◽

Iram Hashmi ◽

Joanna Schellenberg ◽

Bilal Avan

Keyword(s):

Qualitative Study ◽

Health System ◽

Community Health ◽

Health Workers ◽

Newborn Care ◽

District Level ◽

District Health ◽

Community Based ◽

Care Programme

Abstract Background The planning, resourcing, implementation and monitoring of new programmes by district health managers is integral for success and sustainability. Ethiopia introduced the Community-Based Newborn Care programme in 2014 to improve newborn survival: an innovative component allowed community health workers to provide antibiotics for young infants with possible serious bacterial infection when referral was not possible. Informed by the World Health Organization health system building block framework, we aimed to study the capacity and operational challenges of introducing this new health service from the perspective of programme implementers and managers at the district level 20 months after programme initiation. Methods This qualitative study was part of a programme evaluation. From November to December of 2015, we conducted 28 semi-structured interviews with staff at district health offices, health centres and implementing Non-Governmental Organisations in 15 districts of four regions of Ethiopia. Verbatim transcripts were analysed using a priori and emerging themes. Results In line with the government's commitment to treat sick newborns close to their homes, participants reported that community health workers had been successfully trained to provide injectable antibiotics. However, the Community-Based Newborn Care programme was scaled up without allowing the health system to adapt to programme needs. There were inadequate processes and standards to ensure consistent availability of (1) trained staff for technical supervision, (2) antibiotics and (3) monitoring data specific to the programme. Furthermore, Non-Governmental Organizations played a central implementing role, which had implications for the long-term district level ownership and thus for the sustainability of the programme. Conclusion In settings where sustainable local implementation depends on district-level health teams, new programmes should assess health system preparedness to absorb the service, and plan accordingly. Our findings can inform policy makers and implementers about the pre-conditions for a health system to introduce similar services and maximize long-term success.

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A job analysis of selected health workers in a district health system in KwaZulu Natal - Part two: Job analysis of nurses in primary health care settings

Curationis ◽

10.4102/curationis.v26i3.829 ◽

2003 ◽

Vol 26 (3) ◽

Cited By ~ 8

Author(s):

S Mbambo

Keyword(s):

Health System ◽

Current Practice ◽

Health Workers ◽

Job Analysis ◽

District Health ◽

District Health System ◽

Primary Health ◽

Kwazulu Natal ◽

Descriptive Survey ◽

Primary Health Care Settings

The aim of this descriptive survey was to do a job analysis of different categories of nurses in a District Health System in order to clarify job expectations, describe current practice of nurses in hospitals and clinics and to make recommendations about skills mix in district services. This article deals with the clinics only.

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A Community-Based Participatory Diabetes Prevention and Management Intervention in Rural India Using Community Health Workers

The Diabetes Educator ◽

10.1177/0145721712459890 ◽

2012 ◽

Vol 38 (6) ◽

pp. 822-834 ◽

Cited By ~ 45

Author(s):

Padmini Balagopal ◽

N. Kamalamma ◽

Thakor G. Patel ◽

Ranjita Misra ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Diabetes Prevention ◽

Health Workers ◽

Rural India ◽

Community Based ◽

Management Intervention

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A job analysis of selected health workers in a district health system in KwaZulu Natal - Part one: Job analysis of nurses in hospital settings

Curationis ◽

10.4102/curationis.v26i3.828 ◽

2003 ◽

Vol 26 (3) ◽

Cited By ~ 5

Author(s):

L.R. Uys

Keyword(s):

Health System ◽

Current Practice ◽

Health Workers ◽

Job Analysis ◽

District Health ◽

District Health System ◽

Job Expectations ◽

Kwazulu Natal ◽

Descriptive Survey

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The status of Ghanaian community health workers’ supervision and service delivery: descriptive analyses from the 2017 Performance Monitoring and Accountability 2020 survey

Gates Open Research ◽

10.12688/gatesopenres.12979.3 ◽

2019 ◽

Vol 3 ◽

pp. 1468

Author(s):

Dan Schwarz ◽

June-Ho Kim ◽

Hannah Ratcliffe ◽

Griffith Bell ◽

John Koku Awoonor-Williams ◽

...

Keyword(s):

Service Delivery ◽

Community Health ◽

Service Provision ◽

Performance Monitoring ◽

Communicable Disease ◽

Community Based ◽

Disease Treatment ◽

Facility Type ◽

Community Based Services ◽

Non Communicable Disease

Introduction: Community-based services are a critical component of high-quality primary healthcare. Ghana formally launched the National Community Health Worker (CHW) program in 2014, to augment the pre-existing Community-based Health Planning and Services (CHPS). To date, however, there is scant data about the program’s implementation. We describe the current supervision and service delivery status of CHWs throughout the country. Methods: Data were collected regarding CHW supervision and service delivery during the 2017 round of the Performance Monitoring and Accountability 2020 survey. Descriptive analyses were performed by facility type, supervisor type, service delivery type, and regional distribution. Results: Over 80% of CHWs had at least monthly supervision interactions, but there was variability in the frequency of interactions. Frequency of supervision interactions did not vary by facility or supervisor type. The types of services delivered by CHWs varied greatly by facility type and region. Community mobilization, health education, and outreach for loss-to-follow-up were delivered by over three quarters of CHWs, while mental health counseling and postnatal care are provided by fewer than one third of CHWs. The Western region and Greater Accra had especially low rates of CHW service provision. Non-communicable disease treatment, which is not included in the national guidelines, was reportedly provided by some CHWs in nine out of ten regions. Conclusions: Overall, this study demonstrates variability in supervision frequency and CHW activities. A high proportion of CHWs already meet the expected frequency of supervision. Meanwhile, there are substantial differences by region of CHW service provision, which requires further research, particularly on novel CHW services such as non-communicable disease treatment. While there are important limitations to these data, these findings can be instructive for Ghanaian policymakers and implementers to target improvement initiatives for community-based services.

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Kompetensi Bidan Puskesmas dalam Meningkatkan Pelayanan Antenatal (Studi Kasus di Puskesmas Tambak Rejo, Surabaya)

Jurnal Manajemen Kesehatan Indonesia ◽

10.14710/jmki.7.1.2019.1-8 ◽

2019 ◽

Vol 7 (1) ◽

pp. 1-8

Author(s):

Andy Asmara

Keyword(s):

Community Health ◽

Health Center ◽

Community Health Centers ◽

Health Workers ◽

Perinatal Care ◽

Community Health Center ◽

Community Empowerment ◽

District Health ◽

Soft Skill ◽

Birth Attendance

The daily facts indicated that an individual is the key factor to achieve organization’s success. Every organization with its best performance is always related to its human resources’ balanced competency. The midwife has role, function, and competencies to provide maternal services for women. The midwife’s role is not only a doer, but also an organizer, an educator, and a researcher. Therefore, the midwife is expected to focus on prevention and health promotion aspect with basis of partnership, and community empowerment collaboration with other health workers in order to be readily prepare the health services for anyone who is in need.This was qualitative research method with case study approach. The informant was the midwives of Tambakrejo Community Health Center of Surabaya. According to the data of antenatal care attendance, trained birth attendance, and perinatal care, there were 859 pregnant women, 581 persons on phase of K1 (67.64%), and 551 persons on phase of K4 (64.14%). The birth attendances by trained birth attendants are 513 people (62.56%), while perinatal care recorded 570 people attending the health service (69.51%). The data indicated the performance by the midwives of Tambakrejo Community Health Center categorized in the lowest position among 63 community health centers in Surabaya. The result showed poor soft skill competency and poor hard skill competency on midwives. In conclusion, poor soft skill competency including personal competence and social competence should be trained and developed by obstetrics and gynecology specialist of Soewandhi Public Hospital of Surabaya. The study suggested Surabaya District Health Office needs to conduct training of technology information and computer in order to increase the service quality and to solved the problem related to hard skill competencies on technology and computer skill.

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Community-Based Interventions for Stroke Provided by Nurses and Community Health Workers: A Review of the Literature

Journal of Neuroscience Nursing ◽

10.1097/jnn.0000000000000512 ◽

2020 ◽

Vol 52 (4) ◽

pp. 152-159 ◽

Cited By ~ 1

Author(s):

Gayenell S. Magwood ◽

Michelle Nichols ◽

Carolyn Jenkins ◽

Ayaba Logan ◽

Suparna Qanungo ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Review Of The Literature ◽

Community Based Interventions ◽

Community Based

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Health system readiness for innovation scale-up: the experience of community-based distribution of injectable contraceptives in Nigeria

BMC Health Services Research ◽

10.1186/s12913-019-4786-6 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Oluwaseun Akinyemi ◽

Bronwyn Harris ◽

Mary Kawonga

Keyword(s):

Health System ◽

Community Health ◽

Health Workers ◽

Scale Up ◽

Task Shifting ◽

Policy Framework ◽

Framework Analysis ◽

Community Based ◽

System Readiness ◽

Injectable Contraceptives

Abstract Background Following the successful pilot of the community-based distribution of injectable contraceptives (CBDIC) by community health extension workers (CHEWs) in Gombe, northern Nigeria in 2010, there was a policy decision to scale-up the innovation to other parts of the country. However, there is limited understanding of health system factors that may facilitate or impede the successful scale-up of this innovation beyond the pilot site. Thus, this study assessed the health system readiness to deliver CBDIC in Nigeria and how this may influence the scale-up process. Methods This study was conducted in two Local Government Areas in Gombe State in September 2016. Seven key informant interviews were held with purposively sampled senior officials of the ministries of health at the federal and state levels as well as NGO program managers. Also, 10 in-depth interviews were carried out with health workers. All transcripts were analyzed using the thematic framework analysis approach. Result The availability of a policy framework that supports task-shifting and task-sharing, as well as application of evidence from the pilot programme and capacity building programmes for health workers provided a favourable environment for scale-up. Health system challenges for the scale-up process included insufficient community health workers, resistance to the task-shifting policy from professional health groups (who should support the CHEWs), limited funding and poor logistics management which affected commodity distribution and availability. However, there were also a number of health worker innovations which kept the scale-up going. Health workers sometimes used personal resources to make up for logistics failures and poor funding. They often modify the process in order to adapt to the realities on the ground. Conclusion This study shows health system weaknesses that may undermine scale-up of CBDIC. The study also highlights what happens when scale-up is narrowly focused on the intervention without considering system context, capacity and readiness. However, agency and discretionary decision-making among frontline health workers facilitated the process of scaling up, although the sustainability of this is questionable. Benefits observed during the pilot may not be realised on a larger scale if health system challenges are not addressed.

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Supervising Community Health Workers in Community-Based Delivery of Primary Health/Family Planning Services: Experiences in Mexico, 1977–1982

International Quarterly of Community Health Education ◽

10.2190/f094-ef1f-vd76-hmjw ◽

1986 ◽

Vol 6 (4) ◽

pp. 309-322 ◽

Cited By ~ 1

Author(s):

Michele G. Shedlin ◽

Joe D. Wray ◽

Sergio Correu

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Program ◽

Health Workers ◽

Community Based ◽

Family Planning Services ◽

Roles And Responsibilities ◽

Primary Health ◽

Wide Range

The supervision of CHWs in the Mexican Rural Health Program (1977–82) illustrates a wide range of problems and strengths because it was developed within a program based on a strong political mandate to deliver services to an extremely large, as well as culturally and geographically diverse population. This article presents an in-depth perspective on the issues involved in the supervision of community health workers with a focus on the myriad roles and responsibilities which are expected from supervisory personnel. The information and observations which are offered come from program evaluation materials as well as the long-term, first hand experience of the authors with the program discussed.

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