Abstract
BackgroundDisplaced populations in fragile settings experience health disparities that are seldom attended to. Task-shifting, which involves training non-specialized community health workers (CHW) to deliver basic education and health services is a favorable strategy to address this problem, however very little data exist on this topic in the Middle East region. We conducted a long-term evaluation of the Women’s Health Certificate delivered to Syrian refugees and host community in informal tented settlements in Lebanon under the Mobile University for Health (MUH) program. The training was delivered through a mobile classroom approach that incorporated a blended learning modality.MethodsWe collected short-term data from the 42 trained CHW (knowledge assessments and satisfaction measures) during the delivery of the intervention between March and August 2019, and long-term data (semi-structured interviews with 8 CHW and focus group discussion with 9 randomly selected community members) one year later between July and August 2020. The evaluation approach was informed by the Kirkpatrick evaluation model, and the qualitative data were analyzed using qualitative content analysis.ResultsData from the CHWs and community members were triangulated, and they showed that the training enhanced access to education due to its mobile nature and provided opportunities for CHWs to engage and interact with learning material that enhanced their knowledge and favorable behaviors regarding women’s health. In turn, CHWs were empowered to play an active role in their communities to transfer the knowledge they gained through educating community members and providing women’s health services and referrals. Community members benefited from the CHWs and called for the implementation of more similar training programs.ConclusionThis is one of few studies reporting a long-term community-level evaluation of a task-shifting program on women’s health among displaced populations in Lebanon. Our findings support the need to increase funding for similar programs, and to focus on delivering programs for a variety of health challenges. It is also essential to enhance the reach and length of recruitment to wider communities, to design concise, interactive, and engaging sessions, and to provide tools to facilitate circulation of learning material, and resources for referrals to health services.
Highlights
The global health challenges associated with widespread displacement are a major concern for health practitioners, policy-makers, researchers, and civil societies aroundNaal et al Hum Resour Health (2021) 19:37 the world [1]
Lebanon, which is the focus of this study, and which has been affected by several conflicts in the Middle East and North Africa (MENA) region, hosts over 1.5 million Syrian refugees, amounting to approximately 25% of its population [5]
This was followed by validation meetings in February 2018 and roundtable discussions in May 218 with key stakeholders in Lebanon, such as directors and representatives of the Ministry of Public Health, Primary Healthcare Centers (PHC), nongovernmental organizations, and humanitarian agencies, which pointed towards similar results
Summary
The global health challenges associated with widespread displacement are a major concern for health practitioners, policy-makers, researchers, and civil societies aroundNaal et al Hum Resour Health (2021) 19:37 the world [1]. Lebanon, which is the focus of this study, and which has been affected by several conflicts in the MENA region, hosts over 1.5 million Syrian refugees, amounting to approximately 25% of its population [5] Such high levels of displacement, along with subsequent settling of populations in specific areas, have led to large-scale problems such as overcrowding, poor sanitation, limited access to food and basic necessities, and an overstretched healthcare system, to name a few. The study suggested that a lack of available women’s health services, including limited access to specialists, has increased the salience of related health problems In this regard, and given the increased insecurity and longterm disruptions to healthcare access, women and girls in humanitarian settings face a unique set of health challenges. The training was delivered through a mobile classroom approach that incorporated a blended learning modality
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