Task Shifting Provision of Contraceptive Implants to Community Health Extension Workers: Results of Operations Research in Northern Nigeria

AbstractIntroductionEarly diagnosis and prompt and effective treatment is one of the pillars of malaria control Malaria case management guidelines recommend diagnostic testing before treatment using malaria Rapid Diagnostic Test (mRDT) or microscopy and this was adopted in Nigeria in 2010. However, despite the deployment of mRDT, the use of mRDTs by health workers varies by settings. This study set out to assess factors influencing utilisation of mRDT among healthcare workers in Zamfara State, Nigeria.MethodsA cross-sectional study was carried out among 306 healthcare workers selected using multistage sampling from six Local Government Areas between January and February 2017. Mixed method was used for data collection. A pre-tested self-administered questionnaire was used to collect information on knowledge, use of mRDT and factors influencing utilization. An observational checklist was used to assess the availability of mRDT in the six months prior to this study. Data were analyzed using descriptive statistics such as means and proportions. Association between mRDT use and independent variables was tested using Chi square while multiple regression was used to determine predictors of use at 5% level of significance.ResultsMean age of respondents was 36.0 ± 9.4years. Overall, 198 (64.7%) of health workers had good knowledge of mRDT; malaria RDT was available in 33 (61.1%) facilities. Routine use of mRDT was reported by 253 (82.7%) healthcare workers. This comprised 89 (35.2%) laboratory scientists/technicians, 89 (35.2%) community health extension workers/community health officers; 59 (23.3%) nurses and 16 (6.3%) doctors. Predictors of mRDT utilisation were good knowledge of mRDT (adjusted OR (aOR):3.3, CI: 1.6-6.7), trust in mRDT results (aOR: 4.0, CI: 1.9 - 8.2), having being trained on mRDT (aOR: 2.7, CI: 1.2 - 6.6), and provision of free mRDT (aOR: 2.3, CI: 1.0 - 5.0).ConclusionThis study demonstrated that healthcare worker utilisation of mRDT was associated with health worker and health system-related factors that are potentially modifiable. There is need to sustain training of healthcare workers on benefits of using mRDT and provision of free mRDT in health facilities.

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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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Task-Shifting to Community Health Workers: Evaluation of the Performance of a Peer-Led Model in an Antiretroviral Program in Uganda

AIDS Patient Care and STDs ◽

10.1089/apc.2011.0279 ◽

2012 ◽

Vol 26 (2) ◽

pp. 101-107 ◽

Cited By ~ 33

Author(s):

Stella Alamo ◽

Fred Wabwire-Mangen ◽

Ekoru Kenneth ◽

Pamella Sunday ◽

Marie Laga ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Task Shifting

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Retreat from Alma Ata? The WHO's report on Task Shifting to community health workers for AIDS care in poor countries

Global Public Health ◽

10.1080/17441690903334232 ◽

2009 ◽

Vol 6 (2) ◽

pp. 125-138 ◽

Cited By ~ 54

Author(s):

C. Campbell ◽

K. Scott

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Task Shifting ◽

Poor Countries

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Perceptions of health stakeholders on task shifting and motivation of community health workers in different socio demographic contexts in Kenya (nomadic, peri-urban and rural agrarian)

BMC Health Services Research ◽

10.1186/1472-6963-14-s1-s4 ◽

2014 ◽

Vol 14 (S1) ◽

Cited By ~ 15

Author(s):

Beverly Marion Ochieng ◽

Edith Akunja ◽

Nancy Edwards ◽

Diana Mombo ◽

Leah Marende ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Task Shifting

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Task shifting of frontline community health workers for cardiovascular risk reduction: design and rationale of a cluster randomised controlled trial (DISHA study) in India

BMC Public Health ◽

10.1186/s12889-016-2891-6 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 10

Author(s):

Panniyammakal Jeemon ◽

◽

Gitanjali Narayanan ◽

Dimple Kondal ◽

Kashvi Kahol ◽

...

Keyword(s):

Cardiovascular Risk ◽

Randomised Controlled Trial ◽

Community Health ◽

Health Workers ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Task Shifting ◽

Cardiovascular Risk Reduction ◽

Cluster Randomised ◽

Randomised Controlled

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Validation of Health Extension Workers Job Motivation Scale in Gamo-Gofa Zone, Southern Ethiopia: A Cross-Sectional Study

International Scholarly Research Notices ◽

10.1155/2015/250610 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Shikur Mohammed ◽

Marelign Tilahun ◽

Mesfin Kote ◽

Mohamedaman Mama ◽

Dessalegn Tamiru

Keyword(s):

Health Care ◽

Community Health ◽

Cross Sectional Study ◽

Southern Ethiopia ◽

Sectional Study ◽

Health Extension Workers ◽

Cross Sectional ◽

Job Motivation ◽

Motivation Scale ◽

Gamo Gofa

Introduction. Well-trained and highly motivated community health workers are critical for delivery of community-based health care services. Understanding what motivates especially community health care providers for better community health requires the use of psychometrically reliable and valid scale. This study was conducted to validate job motivation scale in Gamo Gofa Zone, Southern Ethiopia. Methods. A cross-sectional study was conducted in 150 health care posts in Gamo Gofa Zone, from February 01, 2013, to March 01, 2013. A total of 301 participants responded to questionnaires asking about sociodemographic characteristics and job motivation. Exploratory factor analysis with principal component extraction and varimax with Kaiser Normalization rotation were employed to develop scales for job motivation. Eigenvalues greater than 1 were used as criterion of extraction. Items with item factor loadings less than 0.4 and double loaded items were dropped. Alpha and exploratory factor analyses were examined to test reliability and validity of the scale. Results. During exploratory factor analysis eight factors emerged from the three dimensions of job motivation scale, namely, educational career, workload, financial incentive, supervisor encouragement, community recognition, access to infrastructure, living condition, and better achievement in work. The factor loadings of the items in each dimension ranged from 0.58 to 0.83. Crobach’s alpha of the scales ranged from 0.79 to 0.90. To check validities of the scales developed in this study, the previous studies conducted to develop job motivation scale were used. Conclusion. Although the present scale has the potential to measure the job motivation of health extension workers and it is low in cost and easy to administer and analyze, it should be field-tested at different settings.

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