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We reviewed the evidence on community-based interventions for the prevention and control of cutaneous leishmaniasis (CL). Community initiatives tailored towards awareness and mobilisation are regard
...
ed as a priority area in the Neglected Tropical Disease Roadmap 2021–2030 by the World Health Organization. We searched nine electronic databases for intervention-based
studies. Two independent reviewers screened and assessed the articles for methodological quality using predefined criteria. We conducted a meta-analysis using a random effects model, along with narrative synthesis. Thirteen articles were eligible for inclusion, of which 12 were quantitative studies (quasi-experimental with control group and pre-post interventions) and one qualitative
study. All articles reported on health education interventions aimed at changing people’s knowledge, attitudes, and practices (KAP) in relation to CL. Participant groups included students, mothers, housewives, volunteer health workers, and residents in general. An increased score was recorded for all outcomes across all interventions: knowledge (SMD: 1.85, 95% CI: 1.23, 2.47), attitudes (SMD:
1.36, 95% CI: 0.56, 2.15), and practices (SMD: 1.73, 95% CI: 0.99, 2.47). Whilst our findings show that educational interventions improved people’s knowledge, attitudes, and practices about CL, we argue that this approach is not sufficient for the prevention and control of this disease. Knowledge does not always translate into action, particularly where other structural barriers exist. Therefore,
we recommend the design of more innovative community-based interventions with a broader focus (e.g., stigma, financial barriers, and healthcare access).
more
Community-Based Interventions for the Prevention and Control of Cutaneous Leishmaniasis
Polidano, K.; Wenning, B.; Ruiz-Cadavid. et al
Multidisciplinary Digital Publishing Institute MDPI
(2022)
CC
Cutaneous leishmaniasis (CL) is a parasitic disease caused by infection with a vector-borne protozoan parasite of the genus Leishmania spp. The parasite is transmitted by the bite of an infected phlebotomine sand fly. Infection results in skin lesions which take a long time to heal and may leave per
...
manent, disfiguring scars (de Vries et al. 2015). CL is classified as a neglected tropical disease (NTD), and in common with several other NTDs, is associated with psychosocial effects including stigma, social exclusion, and declining mental health (Bailey et al. 2019; Bennis et al. 2018; Wenning et al. 2022). Emerging evidence suggests that people with CL are at a higher risk of experiencing anxiety, depression, decreased body satisfaction, loss of social status, and lower quality of life (Bennis et al. 2018; Yanik et al. 2004). The global mean age-standardised disability-adjusted life years (DALYs) lost by CL was 0.58 per 100,000 people (Karimkhani et al. 2016). Notably, this statistic only considers the physical effects of the lesions and does not account for the potentially considerable psychological and social effects of CL (Bailey et al. 2017; Bailey et al. 2019; Wenning et al. 2022).
more
The PS Centre has released three publications addressing the need for MHPSS tools and guidance in Ukraine and surrounding countries.
The Introduction to Psychological First Aid, presents a training module on basic psychological first aid skills for people affected by the international armed confl
...
ict in Ukraine which can be delivered in four hours. It is an adaption of another PS Centre publication, Training in Psychological First Aid for Red Cross and Red Crescent Societies. Module 1. An introduction to PFA.
more
The* Facilitator manual on community-based psychosocial support *and the* Volunteers manual on community-based psychosocial support* provides resources for trainers and participants in key aspects o
...
f psychosocial support, including understanding the impact of crisis events, supportive communication, protection issues and self-care.
more
Despite the increasing uptake of information and communication technologies (ICT) within healthcare services across developing countries, community healthcare workers (CHWs) have limited knowledge to fully utilise computerised clinical systems and m
...
obile apps. The ‘Introduction to Information and Communication Technology and eHealth’ course was developed with the aim to provide CHWs in Malawi, Africa, with basic knowledge and computer skills to use digital solutions in healthcare delivery. The course was delivered using a traditional and a blended learning approach.
more
Interpeace has been working with the government and non-governmental actors in Rwanda for over 20 years, focusing on societal healing and participatory governance. Currently, Interpeace is implementing a holistic peacebuilding programme titled ‘Reinforcing
...
community capacity for social cohesion and reconciliation through societal trauma healing in Rwanda’. This programme has four pillars: mental health and support; social cohesion and reconciliation; collaborative livelihoods; and prisoner rehabilitation and reintegration.
Interpeace and its partners have collaborated with national and international experts to design structured psycho-social interventions, scientifically known as ‘protocols’, which aim to support healing and peace processes. These protocols include resilience-oriented therapy, adaptations of sociotherapy, multifamily therapy, the collaborative livelihoods (COLIVE) protocol, the prisoner rehabilitation and reintegration curriculum, and the socio-emotional skills curriculum.
These protocols guide interventions in healing spaces for Genocide survivors, Genocide perpetrators, former combatants, and their descendants. They facilitate mutual healing and reconciliation, strengthen the mental resilience of individuals and communities, promote family cohesion, and address the intergenerational transmission of Genocide legacies. They also underpin initiatives to develop collaborative livelihoods and skills development, and the psychological rehabilitation and reintegration of prisoners, particularly those convicted of Genocide crimes.
more
Community Engagement During Public Health Emergencies Like COVID-19: An Action Framework and Toolkit
This handbook offers a simple framework of action for actors in local government, and in particular, health leaders such as Civil Surgeons (CSs) and Upazila Health and Family Planning Officers (UHFPQOs), to take ownership and leadership to combat COVID-19 at each district and upazila respectively, w
...
ith support and guidance from elected representatives and local administration, and through effective engagement of various segments of society including informal health care providers, religious leaders, journalists, police and law enforcement agencies, etc. The toolkit draws extensively from the experiences in Chapainawabganj, Savar and other areas and contains relevant best practises that have already proven effective in these places, which should be readily adaptable to various contexts.
It is important to note that while this framework has been developed in the context of COVID-19 and with related best practises, it is by no means limited to COVID-19 response. Indeed, the experience from Savar shows that the same approach has proven extremely effective in combating the dengue outbreak and the severe floods in 2020, and hence can be used to combat future public health emergencies in Bangladesh and other countries having similar contexts.
more
Mental health problems are common and cause great suffering to individuals and communities around the world. They have a significant impact not only on the physical and mental health of those affected but also on their families and the communities they live in. At the same time, all communities have
...
their own traditional mechanisms for support and contain a range wide of resources that can be helpful in preventing mental health conditions from developing, promoting positive mental health and supporting the recovery of people that are struggling with a mental health condition.
In the wider context, people living with a mental health condition are often excluded from their communities and experience various violations to their basic human rights (discrimination, violence, exclusion from employment opportunities). The World Health Organization (WHO) estimates that the mean prevalence of global mental health disorders is 10.8% while the prevalence in emergency settings is 22.1% in any conflict-affected population.
During emergencies and crisis, the stigma, exclusion and discrimination towards people living with mental health conditions is often higher, which can cause isolation and protection issues. Communities can play a crucial role in promoting mental health as well as enhancing primary care and access. Their role is to help reduce mental health inequalities by providing community resources that connect people to community-based resources and by providing mental health education. This also helps to reduce the massive mental health treatment gap.
more
This two-site randomised trial compared the effectiveness of a voluntary sector-led, community-based diabetes prevention programme to a waiting-list control group at 6 months, and included an observational follow-up of the intervention arm to 12 m
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onths.
more
This Community Conversation Kit (CCK) is designed to help people who have a leadership role speak with people in their community about how to protect themselves and those they care about from becomi
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ng ill with an infectious disease. This kit will help lead conversations that get people talking with each other and thinking differently about their health so they can take action. Using some simple tips and suggestions, the information in this kit will allow communities to exchange practical information that will help them know how to confidently protect their health.
more
Background: Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of
...
a CHW programme. In this study, we evaluated expanding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC).
Methods: We conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20–40 households for monthly (or more frequent) visits.
Findings: The intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (−0.8 percentage points (pp) (95% credible interval: −2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: −0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (−0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (−0.6 per 1000 (95% CI −2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges.
more
Community Health Worker Training Curriculum - Facilitator's Guide
Baylor Tingathe Community Outreach Programme
Baylor College of Medicine Children’s Foundation Malawi
(2016)
CC
This curriculum was designed to train newly recruited health care workers (HCW) in the basic knowledge and skills needed to improve different HIV services within the health facility including identification, linkage, retention and support. In addition to HIV basics, the training has supplementary un
...
its focused on PMTCT, psychosocial support, opportunistic infections, tuberculosis and HIV, nutrition and family planning in order to give a more well-rounded and comprehensive training of related topics.
more
The article "Capacity-Building in Community-Based Drug Treatment Services" by Michael J. Cole focuses on the global challenges in providing adequate community-based drug treatment services. It highl
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ights the gaps in availability, quality, and accessibility of evidence-based care. The article discusses the principles and strategies for capacity-building at three levels: individual, organizational, and service sector. It emphasizes using an empowerment model, engaging community stakeholders, and creating sustainable practices. The paper also addresses the need for systematic planning, assessment, and collaboration to strengthen drug treatment systems globally.
more
Community Capacity Building for Physical Activity Promotion among Older Adults—A Literature Review
Ubert, T.; Forberger, S.; Gansefort, D. et al.
International Journal of Environmental Research and Public Health
(2017)
CC
The document reviews strategies for community-based physical activity promotion among older adults, focusing on capacity-building approaches such as coalition building, professional training, raising awareness, and allocating resources. It highlight
...
s the importance of community involvement to promote sustainable health behaviors but notes inconsistent results regarding the effectiveness of these strategies. More rigorous research is recommended to optimize community capacity-building efforts for older populations.
more
The Community-based Health System Model Series briefs identify and discuss critical health system inputs and processes that have contributed to the implementation and expansion of community-based se
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rvice delivery in different countries.
Countries were selected for their geographic diversity, type of service delivery model, and programmatic scale-up.
This brief reviews Malawi’s community health model to inform future policy, program design, and implementation in other countries.
more
Community Health: Malawi is in the process of implementing its first-ever National Community Health Strategy (NCHS, 2017-2022); the NCHS is embedded in the Health Sector Strategic Plan (HSSPII) and
...
the community health workforce includes both formal and non-formal cadres
more
Since the Alma Ata Declaration in 1978, community health volunteers (CHVs) have been at the forefront, providing health services, especially to underserved communities, in low-income countries. However, consolidation of CHVs position within formal h
...
ealth systems has proved to be complex and continues to challenge countries, as they devise strategies to strengthen primary healthcare. Malawi’s community health strategy, launched in 2017, is a novel attempt to harmonise the multiple health
service structures at the community level and strengthen service delivery through a team-based approach. The core community health team (CHT) consists of health surveillance assistants (HSAs), clinicians, environmental health officers and CHVs. This paper reviews Malawi’s strategy, with particular focus on the interface between HSAs, volunteers in community-based programmes and
the community health team. Our analysis identified key challenges that may impede the strategy’s implementation:
(1) inadequate training, imbalance of skill sets within CHTs and unclear job descriptions for CHVs; (2) proposed community-level interventions require expansion of pre-existing roles for most CHT members; and (3) district authorities may face challenges meeting financial obligations and filling community-level positions. For effective implementation, attention and further deliberation is needed on the appropriate forms of CHV support, CHT composition with possibilities of co-opting trained CHVs
from existing volunteer programmes into CHTs, review of CHT competencies and workload, strengthening coordination and communication across all community actors, and financing mechanisms. Policy support through the development of an addendum to the strategy, outlining opportunities for task-shifting between CHT members, CHVs’ expected duties and interactions with paid CHT personnel is recommended.
more
The Government of Malawi is committed to improving health and livelihoods in Malawi through community health – the
provision of basic health services in rural and urban communities with the participation of people who live there.
Historically,
...
Community Health has significantly contributed to improvements in Malawi’s health outcomes in particular
attainment of MDG4. However, the community health system faces resource constraints and inconsistencies around quality
of service – which negatively affect health outcomes.
more
Background: Community Health Workers (CHWs) have a positive impact on the provision of community-based
primary health care through screening, treatment, referral, psychosocial support, and accompan
...
iment. With a
broad scope of work, CHW programs must balance the breadth and depth of tasks to maintain CHW motivation for
high-quality care delivery. Few studies have described the CHW perspective on intrinsic and extrinsic motivation to
enhance their programmatic activities.
Methods: We utilized an exploratory qualitative study design with CHWs employed in the household model in Neno
District, Malawi, to explore their perspectives on intrinsic and extrinsic motivators and dissatisfiers in their work. Data
was collected in 8 focus group discussions with 90 CHWs in October 2018 and March–April 2019 in seven purposively
selected catchment areas. All interviews were audiotaped, transcribed verbatim, coded, and analyzed using Dedoose.
Results: Themes of complex intrinsic and extrinsic factors were generated from the perspectives of the CHWs in
the focus group discussions. Study results indicate that enabling factors are primarily intrinsic factors such as positive
patient outcomes, community respect, and recognition by the formal health care system but can lead to the chal-
lenge of increased scope and workload. Extrinsic factors can provide challenges, including an increased scope and
workload from original expectations, lack of resources to utilize in their work, and rugged geography. However, a posi-
tive work environment through supportive relationships between CHWs and supervisors enables the CHWs.
Conclusion: This study demonstrated enabling factors and challenges for CHW performance from their perspec-
tive within the dual-factor theory. We can mitigate challenges through focused efforts to limit geographical distance,
manage workload, and strengthen CHW support to reinforce their recognition and trust. Such programmatic empha-
sis can focus on enhancing motivational factors found in this study to improve the CHWs’ experience in their role. The
engagement of CHWs, the communities, and the formal health care system is critical to improving the care provided
to the patients and communities, along with building supportive systems to recognize the work done by CHWs for
the primary health care systems.
more
Community health workers (CHWs) play a vital role in facilitating social connectedness, building trust, decrease stigma, and link communities to essential healthcare and social support services. More studies are needed to understand the factors faci
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litating these interactions among CHWs, clients, and community members.
more
