Village health workers as health diplomats: negotiating health and study participation in a malaria elimination trial in The Gambia

Background Although many success stories exist of Village Health Workers (VHWs) improving primary health care, critiques remain about the medicalisation of their roles in disease-specific interventions. VHWs are placed at the bottom of the health system hierarchy as cheap and low-skilled volunteers, irrespective of their highly valued social and political status within communities. In this paper, we shed light on the political role VHWs play and investigate how this shapes their social and medical roles, including their influence on community participation. Method The study was carried out within the context of a malaria elimination trial implemented in rural villages in the North Bank of The Gambia between 2016 and 2018. The trial aimed to reduce malaria prevalence by treating malaria index cases and their potentially asymptomatic compound members, in which VHWs took an active role advocating their community and the intervention, mobilising the population, and distributing antimalarial drugs. Mixed-methods research was used to collect and analyse data through qualitative interviews, group discussions, observations, and quantitative surveys. Results and discussion We explored the emic logic of participation in a malaria elimination trial and found that VHWs played a pivotal role in representing their community and negotiating with the Medical Research Council to bring benefits (e.g. biomedical care service) to the community. We highlight this representative role of VHWs as ‘health diplomats’, valued and appreciated by community members, and potentially increasing community participation in the trial. We argue that VHWs aspire to be politically present and be part of the key decision-makers in the community through their health diplomat role. Conclusion It is thus likely that in the context of rural Gambia, supporting VHWs beyond medical roles, in their social and political roles, would contribute to the improved performance of VHWs and to enhanced community participation in activities the community perceive as beneficial.

Care Giver Competency in Prevention Risk of Diabetic Foot Ulcer in Diabetes Mellitus Patients

Increasing in the incidence of diabetic foot ulcer (DFU) among diabetes mellitus patients (DM), which then access to health services is so far, as well as the lack of knowledge of the local community in preventing and caring for DFU made researchers try to initiate training related to prevention and basic wound care for village health cadres, community leaders, and families family members with DM and at risk for UKD. The activity, which carried out in March 2021, involved the puskesmas in Sui District. Raya, Kab. Kubu Raya. After obtained a permit to carry out activities, the Team briefly contacted the community with the assistance of the Head of RT and RW. Participants who toke part in this activity were those who lived or have a family with diabetes mellitus. Participants were given training related to prevention and treatment of basic wounds, which in the end evaluation followed by publication.

The Correlation Between Self-Care Behavior with Application of Eastern Wisdom and Resilience Among Village Health Volunteers: A Cross-Sectional Study in Southern Thailand

The job of village health volunteers (VHVs) is to coordinate between Thai government departments and the public. Such work can lead to boredom, discouragement, and physical and mental exhaustion. Therefore, strengthening the positive ability of VHVs can help them cope with fatigue. It is essential to continue supporting VHVs; consequently, it is necessary to incorporate Eastern wisdom into healthcare provided for village health volunteers. Purposive sampling was used in this descriptive research to study the relationship between self-care behaviors by applying Eastern wisdom to support and enhance the mental strength of the VHVs. The sample consisted of 77 VHVs in Southern Thailand. Demographic data questionnaire, self-care behavior questionnaire by applying Eastern wisdom, and resilience questionnaire were used to collect data. Pearson’s correlation was used to analyze data. The relationship between self-care behavior by applying Eastern wisdom and resilience was found to have a statistically significant positive correlation (r = .246, p < .05). The relationship between self-care behavior by applying Eastern wisdom and resilience in this study was weak, but there was a positive correlation. Thus, health care providers should promote and integrate Eastern wisdom into self-care activities with VHVs.

Community overview on the differential prevalence of Hepatitis E in two Sub Counties in Kitgum District: A qualitative study

Background There was an epidemic of Hepatitis E infection in Kitgum District in 2007. More than 10,422 people were infected, and over 166 deaths were registered due to the Hepatitis E virus. Kitgum District Health Management Information Systems (HMIS) showed that Hepatitis E cases continued to occur more in Mucwini than Kitgum Matidi Sub County despite instituting similar epidemic control measures in the two communities. The tenacity of the virus in Mucwini Sub County had remained unclear. Objective To assess communities’ views and perspectives on the differential prevalence of Hepatitis E in the two Sub Counties of Kitgum Matidi and Mucwini in Northern Uganda. Methods A cross-sectional study using qualitative methods was conducted. Four Focus Group discussions and six key informant interviews were conducted with village health teams, local council chairpersons, health workers, and community members. These persons were chosen purposively because of their expertise and experience in community and health services. Face-to-face interview guides were administered to obtain detailed information on factors associated with the differential occurrence of Hepatitis E in the two Sub Counties. This study was approved by a local IRB and Uganda National Council of Science and Technology (UNCS&T). Results The most significant findings from this study were the differences in prevention and control practices in the two communities. Residents of Mucwini were less compliant to infection, prevention, and control guidelines, and disagreements between local councilors and village health teams in Mucwini led to poor implementation and non-adherence to guidelines on community control of Hepatitis E. Conclusion A differentially higher prevalence of Hepatitis E in Mucwini than Kitgum Matidi Sub County resulted from poor personal and community hygiene and non-adherence to behavior change communication among residents Mucwini compared to their counterparts in Kitgum Midi. The authors recommend a more proactive approach in managing the epidemic by securing the willingness of the affected community to adopt appropriate infection prevention and control guidelines. In addition, disagreements among stakeholders should be resolved timely so that all community members adhere to control measures.

Penanggulangan Kasus Gizi Kurang dengan Intervensi Penyuluhan dan Pengukuran Antropometri di Desa Rugemuk Kecamatan Pantai Labu

<p><em>Medan is part of North Sumatra Province. The prevalence of undernutrition and malnutrition in Medan in 2013 was 19.3%, consisting of 4.2% malnutrition and 15.1% malnutrition. The prevalence rate is close to the national figure, which is 19.6%. Based on the 2015 MDGs target, the prevalence of malnutrition and children under five is 15.5%, this prevalence rate is included in the high category. The method used in this community service is counseling, demonstration and measurement of nutritional status. held on 6, 12 and 24 February 2020 in Rugemuk Village. The result of the service, namely counseling was carried out 3 times. It was conducted once at the Puskesmas Rugemuk Village, 2 times at the Posyandu Hamlet 1 and Hamlet III in Rugemuk Village, Pantai Labu District. From the results of the intervention and observations made, there are several children in Rugemuk Village whose nutritional status is less. Counseling is not only carried out at the Posyandu, but also students conduct counseling at the Rugemuk Village Health Center, Dusun II. Participants seemed satisfied with the holding of nutrition counseling with the theme according to the counseling target. Participants seemed enthusiastic when participating in nutrition counseling activities for each target group. The conclusion in this service is that intervention activities carried out to solve problems are counseling to the community as well as data collection and measurement of height and weight in children. All activities are carried out well and smoothly, outreach to the community as well as data collection and measurement of children's height and weight.</em><em></em></p>

PEMBENTUKAN BUDAYA PELAYANAN PRIMA PADA KADER KESEHATAN DI KELURAHAN JABUNGAN BANYUMANIK KOTA SEMARANG

ABSTRAKKader kesehatan desa merupakan warga yang tinggal di wilayah kerja kader yang bekerja secara sukarela sebagai penggerak program kesehatan. Menjadi kader kesehatan desa tentu banyak tantangannya, seperti tidak memiliki pengetahuan dasar pelayanan terhadap masyarakat, direndahkan ataupun dianggap galak. Berdasarkan data di lapangan menunjukkan bahwa pengetahuan dan keterampilan kader dalam melaksanakan tugas masih jauh dari harapan. Hal ini dillihat dari pelaksanaan kegiatan posyandu yang monoton dan tidak berkembang yang nantinya akan berdampak terhadap pelaksanaan program desa siaga. Kegiatan pengabdian masyarakat ini terdiri dari beberapa tahap meliputi tahap perencanaan, pelaksanaan dan evaluasi. Pembentukan pelayanan budaya prima pada kader kesehatan merupakan kegiatan untuk mempersiapkan kader kesehatan agar mau dan mampu berperan serta dalam mengembangkan program kesehatan di desanya. Kegiatan pengabmas dengan sasaran kader kesehatan di Kelurahan Jabungan menggunakan metode pelatihan yang diselenggarakan secara daring dengan memberikan dasar pengetahuan tentang pelayanan prima kepada masyarakat. Menyiasati keadaan wilayah Kota Semarang yang masih dilanda pandemi Covid, maka pengabmas dilaksanakan secara virtual menggunakan media zoom meeting. Luaran pengabdian masyarakat tentang Pembentukan Budaya Pelayanan Prima pada Kader Kesehatan di Kelurahan Jabungan Banyumanik Kota Semarang berupa peningkatan pemahaman dan keterampilan masyarakat, sertifikat dan Buku Saku Pelayanan Prima Bagi Kader Kesehatan Desa serta hasil pengabmas dijurnalkan di jurnal pengabdian masyarakat. Kata kunci: pelayanan prima; kader kesehatan. ABSTRACTVillage health cadres are residents who live in the working area of cadres and work voluntarily as drivers of health programs. There are many challenges for village health cadres, such as not having basic knowledge of community services, being humiliated, or being considered fierce. Based on field data, shows that the knowledge and skills of cadres in carrying out their duties are still far from expectations. It can be seen from the monotonous and undeveloped implementation of posyandu activities which will have an impact on the implementation of the standby village program. This community service activity consists of several phases including the planning, implementation, and evaluation phase. The establishment of excellent cultural services for health cadres is an activity to prepare health cadres to be willing and able to participate in developing health programs in their villages. Community service activities targeting health cadres in Jabungan Village use online training methods by providing a basic knowledge of excellent service to the community. Dealing with the condition of the Semarang City which is still hit by the Covid pandemic, the community service is carried out virtually using zoom meeting. Outcomes of community service regarding the Formation of Culture of Excellent Service for Health Cadres in Jabungan Village Banyumanik, Semarang City in the form of increasing community understanding and skills, certificates, and Excellent Service Pocket Books for Village Health Cadres and community service results are journalized in community service journals. Keywords: excellent service; health cardres.

EDUKASI MUSNAHKAN GIZI BURUK DI DESA MENGGALA, KABUPATEN LOMBOK UTARA, PROVINSI NUSA TENGGARA BARAT (DAERAH TERTINGGAL) MELALUI TERAPI MERDEKA MADU TRIGONA

ABSTRAKProgram pengabdian ini ditujukan untuk memberikan informasi dan menumbuhkan kesadaran masyarakat di Desa Menggala, Kabupaten Lombok Utara, Provinsi Nusa Tenggara Barat akan potensi madu trigona dan pengembangan budidayanya dalam menyelesaikan masalah gizi buruk. Usaha peningkatan kualitas sumber daya manusia dari Desa Menggala terkendala rendahnya kualitas kesehatan penduduk di Desa Menggala, hal ini dapat diketahui dari banyaknya penduduk di Desa Menggala memiliki status gizi buruk. Program pengabdian ini dilakukan untuk memperbaiki status gizi buruk dari masyarakat di Desa Menggala. Usaha peningkatan tersebut dilakukan dengan mengadakan edukasi, diskusi tentang potensi madu trigona dan pengembangan budidayanya dalam menyelesaikan masalah gizi buruk. Tahapan pelaksaanaan kegiatan meliputi observasi awal (1 September 2021) dan edukasi (2 September 2021). Walaupun tidak seluruh anggota masyarakat di Desa Menggala dikumpulkan untuk edukasi dikarenakan mengikuti protokol Covid-19, namun pada pelaksanaannya para keluarga yang memiliki anggota keluarga berstatus gizi buruk dan kader-kader kesehatan desa dapat hadir dan mengikuti kegiatan tersebut, selain itu, antusias dan respon positif dari para peserta tersebut menghasilkan berjalannya dengan baik program pengabdian ini. Kata kunci: edukasi; gizi buruk; terapi merdeka madu trigona; desa menggala. ABSTRACTThis service program is intended to provide information and raise public awareness in Menggala Village, North Lombok Regency, West Nusa Tenggara Province about the potential of Trigona honey and the development of its cultivation in solving the problem of malnutrition. Efforts to improve the quality of human resources from Menggala Village are constrained by the low quality of health of the residents in Menggala Village, this can be seen from the large number of residents in Menggala Village who have poor nutritional status. This service program is carried out to improve the poor nutritional status of the community in Menggala Village. The improvement efforts were carried out by conducting education, discussing the potential of Trigona honey and developing its cultivation in solving the problem of malnutrition. The stages of implementing the activities include initial observation (1 September 2021) and education (2 September 2021). Although not all community members in Menggala Village were gathered for education because they followed the Covid-19 protocol, in practice, families with family members with poor nutritional status and village health cadres were able to attend and participate in the activity, in addition, enthusiastic and positive responses. of the participants produced their performance with this good program of service. Keywords: education; malnutrition; trigona honey free therapy; menggala village.

“We shall have gone to a higher standard”: Training village heath teams (VHTs) to use a smartphone-guided intervention to link older Ugandans with hypertension and diabetes to care

Background: It is not clear whether village health teams (VHTs) can be empowered to participate in interventions to prevent and control hypertension and diabetes in older adults in Uganda. We conducted this study in rural Uganda to establish if VHTs could be effectively trained to use a smart phone guided intervention to link older people with hypertension and diabetes to care. We also explored the experiences of VHTs in managing older adults with health problems, their knowledge of hypertension and diabetes and their understanding of referral systems. We also explored their experiences with smartphones. Methods: We conducted in-depth interviews (IDIs) with and trained 20 VHTs randomly selected from Bukulula sub-county in Kalungu district from October 2017-December 2018. We used interview guides to explore topics relevant to our study objectives. VHTs were trained to measure blood sugar and blood pressure using digital machines. VHTs were trained on identifying symptoms of diabetes mellitus. Data from IDIs were analysed using thematic content analysis. Competence tests were used to evaluate the training. Results: Most of the VHTs were female (75%). All VHTs had some knowledge on hypertension and diabetes and other chronic diseases. They did not have any experience in treating older adults since they had been trained to deal mainly with children. Half of the VHTs owned smartphones. All were willing to participate in an intervention using a smartphone to link older adults with hypertension and diabetes mellitus to care. By the end of the training, all but three participants could comprehend the symptoms of diabetes and measure blood sugar and blood pressure. Conclusion: Village health teams in the study setting need training in managing the health needs of older adults before engaging with an intervention using smartphones to link older adults with diabetes mellitus and hypertension to care.