scholarly journals Trust of community health workers influences the acceptance of community-based maternal and child health services

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Merridy Grant ◽  
Aurene Wilford ◽  
Lyn Haskins ◽  
Sifiso Phakathi ◽  
Ntokozo Mntambo ◽  
...  
Keyword(s):  
Child Health ◽  
Health Services ◽  
Health System ◽  
Maternal And Child Health ◽  
Health Workers ◽  
Child Health Services ◽  
Community Members ◽  
Community Based ◽  
Complex Relationships ◽  
And Child Health

Background: Community health workers (CHWs) are a component of the health system in many countries, providing effective community-based services to mothers and infants. However, implementation of CHW programmes at scale has been challenging in many settings.Aim: To explore the acceptability of CHWs conducting household visits to mothers and infants during pregnancy and after delivery, from the perspective of community members, professional nurses and CHWs themselves.Setting: Primary health care clinics in five rural districts in KwaZulu-Natal, South Africa.Methods: A qualitative exploratory study was conducted where participants were purposively selected to participate in 19 focus group discussions based on their experience with CHWs or child rearing.Results: Poor confidentiality and trust emerged as key barriers to CHW acceptability in delivering maternal and child health services in the home. Most community members felt that CHWs could not be trusted because of their lack of professionalism and inability to maintain confidentiality. Familiarity and the complex relationships between household members and CHWs caused difficulties in developing and maintaining a relationship of trust, particularly in high HIV prevalence settings. Professional staff at the clinic were crucial in supporting the CHW’s role; if they appeared to question the CHW’s competency or trustworthiness, this seriously undermined CHW credibility in the eyes of the community.Conclusion: Understanding the complex contextual challenges faced by CHWs and community members can strengthen community-based interventions. CHWs require training, support and supervision to develop competencies navigating complex relationships within the community and the health system to provide effective care in communities.

scholarly journals Lessons for responding to COVID-19, from Exemplars in Under-five Mortality Reduction

2020 ◽  
Vol 4 ◽  
pp. 120
Author(s):  
Lisa R Hirschhorn ◽  
Nathaniel Gerthe ◽  
David E Phillips ◽  
Oliver Rothschild ◽  
Manpreet Singh ◽  
...  
Keyword(s):  
Child Health ◽  
Health Services ◽  
Health Systems ◽  
Maternal And Child Health ◽  
Health Workers ◽  
Child Health Services ◽  
Data Systems ◽  
Under Five ◽  
Success Stories ◽  
And Child Health

COVID-19 may not have the same direct effects on children as it does on older adults, but its indirect effects still pose a threat to child health, by disrupting delivery of routine health services like immunizations. This has happened during previous crises, and early indications point towards similar disruptions due to the coronavirus pandemic. To mitigate this, countries need to build resilient health systems capable of maintaining essential maternal and child health interventions, while also responding to COVID. How can this be accomplished? To find some answers, we can learn from countries in the past who improved health outcomes in the face of challenging circumstances. Specific to child health, countries with positive-outlier performance in reducing under-five mortality provide helpful strategies. These lessons include a clear national plan that drives rapid response, leveraging existing data systems to inform decision-making, engaging communities via community health workers, and focusing on equity. Today, countries around the world are facing the challenge of responding to the pandemic while building resilient health systems that continue to deliver invaluable maternal and child health services. Studying lessons from previous success stories can help inform the road ahead.

scholarly journals Pelaksanaan Permainan Ular Tangga dalam Kelas Ibu Hamil

2020 ◽  
Vol 1 (1) ◽  
pp. 23-28
Author(s):  
Lisda Widianti Longgupa ◽  
Nurfatimah Nurfatimah ◽  
Nilda Yulita Siregar
Keyword(s):  
Child Health ◽  
Health Services ◽  
Pregnant Women ◽  
Maternal And Child Health ◽  
Health Workers ◽  
Child Health Services ◽  
Flip Chart ◽  
Post Test ◽  
And Child Health

The efforts to reduce maternal and infant mortality can be done by increasing the coverage and quality of maternal and child health services. One effort is made to bring health services closer to the community through the pregnant mothers class program. Pregnant woman class is a study group of pregnant women with gestational age between 4 weeks to 36 weeks with a maximum number of 10 participants. In this class, pregnant women will learn together, discuss and exchange experiences on overal maternal and child health, facilitated by midwives or health workers by using the class package for pregnant women, namely flip chart, guidelines for implementing classes of pregnant women,  class facilitator’s handbook pregnant women, exercise books for pregnant women  and books on maternal and child health (MCH). Based on the results of community service activities with participants of 40 pregnant women there was an increase in correct answers to all participants after participating in class activities for snakes ladderss of pregnant women. From the pre-test result it turns out that most of the results obtained were less than 60. This shows that the knowledge ability of pregnant women is still lacking. However, after holding the snakes ladder pregnant class, there was an increase in the knowledge of pregnant women with an increase in the post-test score point in the range between 21-30 (47.5%).

scholarly journals Assessment of gaps of knowledge and practices of frontline community workers in Chandragiri Mandal, Chittoor district, Andhra Pradesh: maternal and child health services

2021 ◽  
Vol 8 (3) ◽  
pp. 1299
Author(s):  
Shankar Reddy Dudala ◽  
Sathyendra Nath Ponna ◽  
Venkata Prasad Upadrasta ◽  
Hemalatha Bathina ◽  
Renuka Sadasivuni ◽  
...  
Keyword(s):  
Child Health ◽  
Health Services ◽  
Vitamin A ◽  
Community Health ◽  
Maternal And Child Health ◽  
Andhra Pradesh ◽  
Health Workers ◽  
Child Health Services ◽  
Frontline Workers ◽  
And Child Health

Background: The undernutrition status among the vulnerable groups in rural areas still persists, despite provision of Anganwadi services in villages. Assessment knowledge and practices about maternal and child health services of frontline workers, will identify knowledge and implementation gaps. Objective was to assess the knowledge, attitude and practices of community health workers of maternal and child health services for identifying gaps for designing and implementing intervention.Methods: In this community based prospective, pre and post intervention-based study, Knowledge, Attitude and Practices (KAP) of the community health workers, in 16 villages and 13 Anganwadi centres of Chandragiri Mandal, Chittoor district, Andhra Pradesh about maternal and child health services were collected. The basic infrastructure of the anganwadis and health centres of Auxiliary nurse midwifes were assessed using a prevalidated survey instrument. Descriptive analysis was used.Results: The knowledge of antenatal and postnatal care was least among Anganwadi workers. Awareness regarding need of colostrum feeding was high in AWW compared to ASHA. ANM and AWW had lesser knowledge about duration of the exclusive breast feeding to the infant. Only 57.1% of ANM had sufficient knowledge about protein energy malnutrition consequences. AWW, ASHA did not have knowledge of vitamin A deficiency signs and symptoms although providing massive dose of vitamin A to children. ASHAs did not have awareness about anaemia and the knowledge was below 50% in ANMs.Conclusions: The study emphasizes the need for proper training with interactive sessions to these frontline workers, which will enhance their knowledge and skills for provision of quality services.

scholarly journals Barriers in utilization of maternal and child health services among Musahar in Dudhauli Municipality of Sindhuli district, Nepal

2020 ◽  
Vol 8 (1) ◽  
pp. 1
Author(s):  
Laxmi Gautam ◽  
Jwala Subedi
Keyword(s):  
Public Health ◽  
Child Health ◽  
Health Services ◽  
Maternal And Child Health ◽  
Quantitative Methods ◽  
Health Workers ◽  
Child Health Services ◽  
Health Concern ◽  
P Value ◽  
And Child Health

Background: Maternal and Child Health remains a public health challenge in Nepal. This study explored information regarding barriers in the utilization of Maternal and Child Health services among women of Musahar community.Methods: A cross-sectional study was carried out in Dudhauli Municipality, Sindhuli using qualitative and quantitative methods. Qualitative data were obtained from, In Depth Interview among health workers and a Focus Group Discussion among FCHVs of Musahar community. Interview was carried out using questionnaire for quantitative study among 121 mothers of under 5 children. The data was analyzed using SPSS software version 21. Chi Square test was applied to test the associations while p value <0.05 was considered significant.Results: The average age and age at marriage of respondents were 24.6±5.7 years and 16.22±2.8 respectively, 76% were illiterate, 93.2% lies below poverty line and 73.6% were home maker. Among them, 29.8 did not have ANC while 47.1 had 4 or more ANC visits, 64.5% institutional delivery and 29.8% PNC visit. Social barriers and lack of information are major barriers contributing to more than half of no ANC visit and which contribute to >60% in case of PNC. Home delivery for first child was 56.2% while for last child was 33.9%. Almost 1/5th of the children were not vaccinated. Qualitative study identified social factors like negligence, family pressure, shyness, and unhealthy financial decisions as important barriers.Conclusions: Utilization of maternal and child health services was poor among Musahar mothers and children which indicates a serious public health concern.

scholarly journals Influence of Conditional Cash Transfers on the Uptake of Maternal and Child Health Services in Nigeria: Insights From a Mixed-Methods Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Uchenna Ezenwaka ◽  
Ana Manzano ◽  
Chioma Onyedinma ◽  
Pamela Ogbozor ◽  
Uju Agbawodikeizu ◽  
...  
Keyword(s):  
Child Health ◽  
Health Services ◽  
Health System ◽  
Pregnant Women ◽  
Maternal And Child Health ◽  
Health Workers ◽  
Unintended Consequences ◽  
Data Set ◽  
Financial Barriers ◽  
And Child Health

Background: Increasing access to maternal and child health (MCH) services is crucial to achieving universal health coverage (UHC) among pregnant women and children under-five (CU5). The Nigerian government between 2012 and 2015 implemented an innovative MCH programme to reduce maternal and CU5 mortality by reducing financial barriers of access to essential health services. The study explores how the implementation of a financial incentive through conditional cash transfer (CCT) influenced the uptake of MCH services in the programme.Methods: The study used a descriptive exploratory approach in Anambra state, southeast Nigeria. Data was collected through qualitative [in-depth interviews (IDIs), focus group discussions (FGDs)] and quantitative (service utilization data pre- and post-programme) methods. Twenty-six IDIs were conducted with respondents who were purposively selected to include frontline health workers (n = 13), National and State policymakers and programme managers (n = 13). A total of sixteen FGDs were conducted with service users and their family members, village health workers, and ward development committee members from four rural communities. We drew majorly upon Skinner's reinforcement theory which focuses on human behavior in our interpretation of the influence of CCT in the uptake of MCH services. Manual content analysis was used in data analysis to pull together core themes running through the entire data set.Results: The CCTs contributed to increasing facility attendance and utilization of MCH services by reducing the financial barrier to accessing healthcare among pregnant women. However, there were unintended consequences of CCT which included a reduction in birth spacing intervals, and a reduction of trust in the health system when the CCT was suddenly withdrawn by the government.Conclusion: CCT improved the utilization of MCH, but the sudden withdrawal of the CCT led to the opposite effect because people were discouraged due to lack of trust in government to keep using the MCH services. Understanding the intended and unintended outcomes of CCT will help to build sustainable structures in policy designs to mitigate sudden programme withdrawal and its subsequent effects on target beneficiaries and the health system at large.

scholarly journals A retrospective study of the impact of health worker strikes on maternal and child health care utilization in western Kenya

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michael L. Scanlon ◽  
Lauren Y. Maldonado ◽  
Justus E. Ikemeri ◽  
Anjellah Jumah ◽  
Getrude Anusu ◽  
...  
Keyword(s):  
Child Health ◽  
Health Services ◽  
Maternal And Child Health ◽  
Health Workers ◽  
Child Health Services ◽  
Control Group ◽  
Western Kenya ◽  
The Impact ◽  
And Child Health ◽  
Risk Ratios

Abstract Background There have been dozens of strikes by health workers in Kenya in the past decade, but there are few studies of their impact on maternal and child health services and outcomes. We conducted a retrospective survey study to assess the impact of nationwide strikes by health workers in 2017 on utilization of maternal and child health services in western Kenya. Methods We utilized a parent study to enroll women who were pregnant in 2017 when there were prolonged strikes by health workers (“strike group”) and women who were pregnant in 2018 when there were no major strikes (“control group”). Trained research assistants administered a close-ended survey to retrospectively collect demographic and pregnancy-related health utilization and outcomes data. Data were collected between March and July 2019. The primary outcomes of interest were antenatal care (ANC) visits, delivery location, and early child immunizations. Generalized estimating equations were used to estimate risk ratios between the strike and control groups, adjusting for socioeconomic status, health insurance status, and clustering. Adjusted risk ratios (ARR) were calculated with 95% confidence intervals (95%CI). Results Of 1341 women recruited in the parent study in 2017 (strike group), we re-consented 843 women (63%) to participate. Of 924 women recruited in the control arm of the parent study in 2018 (control group), we re-consented 728 women (79%). Women in the strike group were 17% less likely to attend at least four ANC visits during their pregnancy (ARR 0.83, 95%CI 0.74, 0.94) and 16% less likely to deliver in a health facility (ARR 0.84, 95%CI 0.76, 0.92) compared to women in the control group. Whether a child received their first oral polio vaccine did not differ significantly between groups, but children of women in the strike group received their vaccine significantly longer after birth (13 days versus 7 days, p = 0.002). Conclusion We found that women who were pregnant during nationwide strikes by health workers in 2017 were less likely to receive WHO-recommended maternal child health services. Strategies to maintain these services during strikes are urgently needed.

scholarly journals Evaluation of a community-based intervention for health and economic empowerment of marginalized women in India

2020 ◽  
Author(s):  
Shantanu Sharma ◽  
Devika Mehra ◽  
Faiyaz Akhtar ◽  
Sunil Mehra
Keyword(s):  
Child Health ◽  
Health Services ◽  
Maternal And Child Health ◽  
Qualitative Interviews ◽  
Child Health Services ◽  
Access To Health Services ◽  
Community Based ◽  
Access To Health ◽  
Marginalized Women ◽  
And Child Health

Abstract Background Empowered women have improved decision-making capacity and can demand equal access to health services. Community-based interventions (CBI) based on building women’s groups for awareness generation on maternal and child health (MCH) are the best and cost-effective approaches in improving their access to health services. The present endeavour evaluates a community-based intervention aimed at improving marginalized women’s awareness and utilization of maternal, and child health services, and access to livelihood and savings using the peer-led approach from two districts of India. Methods We used peer educators as mediators of knowledge transfer among women and for creating a supportive environment at the household and community levels. The intervention was implemented in two marginalized districts of Uttar Pradesh, namely Banda and Kaushambi. Two development blocks in each of the two districts were selected randomly, and twenty-four villages in each of the four blocks were selected based on the high percentage of a marginalized population. The evaluation of the intervention involved a non-experimental, pre- and post-research design, using a mixed-method approach. Data were collected at three points in time, including a rapid assessment (quantitative and qualitative interviews) at baseline, qualitative interviews at the end line and tracking data of the intervention population (n=37,324) through an online management information system. Results Most of the women in Banda (90%) and Kaushambi (85%) attended at least 60% of the education sessions. Around 39% of women in Banda and 35% of women in Kaushambi registered for the livelihood scheme, and 94% and 80% of them had worked in these two places, respectively under the scheme. Women during group discussions informed that their awareness about MCH increased post-intervention. The money earned after getting work under the livelihood scheme or from daily savings was deposited in the bank account by the women. These savings helped the women investing money at times of need, such as starting their work, in emergencies for the medical treatment of their family members, education of their children, etc. Conclusion Peer-led model of intervention can be explored to improve the combined health and economic outcomes of marginalized women.

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