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This study highlights the challenges and areas in need of improvement as perceived by CHWs and beneficiaries, in regards to a nationwide scale-up of CHW interventions in a resource-challenged countr...y. Identifying and understanding these barriers, and addressing them accordingly, particularly within the context of performance-based financing, will serve to strengthen the current CHW system and provide key guidance for the continuing evolution of the CHW system in Rwanda.
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Background: Community Health Workers (CHWs) have a positive impact on the provision of community-based
primary health care through screening, trea...tment, referral, psychosocial support, and accompaniment. 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.
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Standards for improving quality of maternal and newborn care in health facilities
recommended
Bernadette Daelmans, Olufemi Oladapo, Özge Tuncalp et al
World Health Organization (WHO)
(2016)
C_WHO
The standards of care cover the routine care and management of complications occurring for women and their babies during labour, childbirth and the early postnatal period, including those ...s="attribute-to-highlight medbox">of small babies during the first week of life. They define priorities for improving the quality of maternal and newborn care for use by planners, managers and health care providers
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BMC Health Services Research (2017) 17:623 DOI 10.1186/s12913-017-2567-7
Brucellosis is widespread in both humans and livestock in many developing countries. The authors have performed a series of epidemiological studies on brucellosis in agro-pastoral areas in Tanzania ...since 2015, with the aim of the disease control. Previously, the potential of a community-based brucellosis control initiative, which mainly consisted of the sale of cattle with experience of abortion and vaccinating calves, was assessed as being effective and acceptable based on a quantitative approach. This study was conducted to investigate the feasibility of community-based brucellosis control program using participatory rural appraisals (PRAs) and key-informant interviews. Four PRAs were performed together with livestock farmers and livestock and medical officers in 2017. In the PRAs, qualitative information related to risky behaviors for human infection, human brucellosis symptoms, willingness to sell cattle with experience of abortion, and willingness to pay for calf vaccination were collected, and a holistic approach for a community-based disease control project was planned. All of the communities were willing to implement disease control measures. To avoid human infection, education, especially for children, was proposed to change risky behaviors. The findings of this study showed that community-based disease control measures are promising.
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This is the sixth of our 11-paper supplement entitled “Community Health Workers at the Dawn of New Era”. Expectations ...-highlight medbox">of community health workers (CHWs) have expanded in recent years to encompass a wider array
of services to numerous subpopulations, engage communities to collaborate with and to assist health systems in responding to complex and sometimes intensive threats. In this paper, we explore a set of key considerations for training of CHWs in response to their enhanced and changing roles and provide actionable recommendations based on
current evidence and case examples for health systems leaders and other stakeholders to utilize.
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This document presents an evidence-informed Checklist for implementing rural pathways to train and support the rural
health workforce in low and middle income countries (LMIC). Rural areas are the most underserviced around the world.
Health and Socio-Economic Impacts of Physical Distancing for Covid-19 in Africa
Barasa, E.; et al.
KEMRI-Wellcome Trust Research Programme and African Academy of Sciences
(2020)
CC
Physical distancing measures are important to reduce COVID-19 transmission. However, when stringently applied, they can result in negative health and socio-economic impacts. This report draws on a rapid review ...box">of available literature, case studies from across Africa and expert knowledge to make recommendations on adapting classic physical distancing measures to the contextual realities in Africa and on mitigating potential negative impacts.
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WHO South-East Asia Journal of Public Health, April 2017, 6(1) 8 pp. 211 kB
Donor financing to low- and middle-income countries for reproductive, maternal, newborn, and child health increased substantially from 2008 to 2013. However, increased spending by donors might not improve outcomes, if funds are delivered in ways tha...t undermine countries’ public financial management systems and incur high transaction costs for project implementation
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BMJ Open2018;8:e020423. doi:10.1136/bmjopen-2017-02042
EC has been increasingly used in the evaluation of maternal and child health programmes.12–15 For instance, Nesbitt ...o-highlight medbox">et al compared crude coverage and EC of pregnant women with facility-based obstetric services in Ghana and estimated that although 68% of the women studied had service access only 18% received high-quality care provided by a skilled birth attendant.16 Similarly, by comparing EC of young children receiving Strengths and limitation of this study. Using multiple data sources (direct observation, vignettes, facility inventories) this study comprehensively assessed under 5-year-old child service
performance of first-line health facilities. We conducted this study in around 500 primary-level health facilities and within 7000 households
across six regions in Burkina Faso.
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COVID-19 has altered health sector capacity in low-income and middle-income countries (LMICs). Cost data to inform evidence-based priority setting are urgently needed. Consequently, in this paper, we calculate the full economic ...e-to-highlight medbox">health sector costs of COVID-19 clinical management in 79 LMICs under different epidemiological scenarios.
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PLoS ONE 11(1): e0144662. doi:10.1371/journal.pone.0144662
This study of Adolescent Boys and Young Men highlights the importance of engaging adolescent boys and young men in sexual and reproductive health a...nd rights (srhr) and gender equality. This paper establishes a conceptual framework for engaging adolescent boys and young men. It reviews current research on boys’ and young men’s specific risks and realities in relation to their general health status, violence, sexuality and sexual and reproductive health, media violence, sexual exploitation, and other vulnerabilities.
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Introduction to HIV, AIDS and Sexually Transmitted Infection Surveillance - Overview of the HIV/AIDS Epidemic with an Introduction to Public Health Surveillance
United States Department of Health and Human Services; Centers for Disease Control and Prevention (HHS-CDC); Global AIDS Program (GAP); et al.
United States Department of Health and Human Services; Centers for Disease Control and Prevention (HHS-CDC); Global AIDS Program (GAP); et al.
(2011)
C2
Participant Manual
February 2011
Edition 3.0
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. Howe...ver, consolidation of CHVs position within formal health 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.
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For humanitarian organisations to respond effectively to complex crises, they require access to up-to-date evidence-based guidance. The COVID-19 crisis has highlighted the importance of updating global guidance to context-specific and evolving needs... in humanitarian settings. Our study aimed to understand the use of evidence-based guidance in humanitarian responses during COVID-19. Primary data collected during the rapidly evolving pandemic sheds new light on evidence-use processes in humanitarian response.
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