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 expan
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ding 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.
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What We Know, What We Don’t Know, and What We Need to Do
The seven essential features of practice for scaling up are described with great clarity. They are practical and universal, and encourage local innovation. They include policy, funding
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and local management structure, as well as working with all possible partners and developing local context adaptations. The case studies give ideas and inspiration to develop new programmes and find ways around obstacles in existing programmes, especially through involving those with most at stake including users and their families and local community leaders
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Evaluation Report
Evaluation Office
July 2014
This report was made possible through support provided by the One Million Community Health Workers Campaign, mPowering Frontline Health Workers, Intel, and USAID. This report was authored by Cindil Redick for mPowering Frontline Health
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Workers under the terms of Contract No. GHS-A-00-08-00002-00. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID.
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Technical brief by the H4+ (UNAIDS, UNFPA, UNICEF, UN Women, WHO and the World Bank)
This six-day training is intended for case managers/community health volunteers/field supervisors who help households affected by HIV in India.
Blended Learning Modulef or the Health Extension Programme
In this study session, you will learn about the general features of faeco-oraldiseases: the main types commonly found in Ethiopia, their general symptomsand signs, how to treat mild cases and
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when to refer patients with severeconditions for specialised treatment, or laboratory tests to confirm thediagnosis. You will also learn about the importance of giving effective healtheducation to your community on ways to prevent and control faeco-oraldiseases.
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A new global Police Handbook aims to address some of the most difficult challenges that survivors of violence face when accessing police and justice sector services around the world.
The practical guidance in the operational handbook aims to inform the development or revision of national policies and related implementation guidance on the management of TB in children and adolesc
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ents under programmatic circumstances and at different levels of the health system. The operational handbook can also help countries adequately plan for the uptake of interventions to better address the specific needs of children and adolescents with or at risk of TB. It can contribute to national efforts to build capacity among national and subnational programme managers and among health workers at all levels of the health care system.
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Bulletin of the World Health Organization Volume 93, Number 9, September 2015, 589-664
Empfehlungen zur Diagnostik und Therapie nichttuberkulöser Mykobakteriosen des Deutschen Zentralkomitees zur Bekämpfung der Tuberkulose (DZK) und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP).
Schönfeld N et al. Recommendations of the German Central Committee… Pneumolo
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gie 2016; 70: 250–276
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