Family health sheets: a vital instrument for village health workers providing comprehensive healthcare

Faraz Alizadeh,Immaculate Owembabazi,Sam Musominali,Gerald Paccione,Aravind Addepalli,Annie Modesta Budongo,Shombit R Chaudhuri,Gloria Fung Chaw

doi:10.1186/s12913-021-07180-y

Abstract

IntroductionCommunity Health Worker (CHW) programs have long been used to provide acute care for children and women in healthcare shortage areas, but their provision of comprehensive longitudinal care for chronic problems is rare. The Village Health Worker (VHW) program, initiated in 2007, is an example of a long standing “horizontal” CHW program in rural Southwestern Uganda that has delivered village-level care for chronic disease based on a biannual village health census that identifies individual and family health risks. To facilitate continuity of care for problems identified, health census data were electronically transformed into family-specific Family Health Sheets (FHS) in 2016 which summarize the pertinent demographic and health data for each family, as well as health topics the family would like to learn more about. The FHS, evaluated and discussed here, serves as an epidemiologically-informed “bedside” tool to help VHWs provide longitudinal care in their villages.Methods48 VHWs in the program completed a survey on the utility of the FHS and 24 VHWs participated in small discussion groups. Responses were analyzed using both quantitative and standard conceptual content analysis modelsResults46 out of 48 VHWs reported that the FHS made them a “much better VHW.” In addition to helping target interventions in child health, women’s health, and sanitation, the FHS assisted follow-up of non-communicable diseases in the community. In discussion groups, VHWs reported that the FHS helped them understand risks for future disease, facilitated earning stipends, and increased credibility and trust in the community. Limitations cited were the infrequent updates of the FHS, only biannually with the census, and the lack of cross-reference capability by health problem.DiscussionThe FHS supports VHWs in providing longitudinal and comprehensive healthcare of chronic diseases in their villages. Limitations, potential solutions, and future directions are discussed.

Highlights

Community Health Worker (CHW) programs have long been used to provide acute care for children and women in healthcare shortage areas, but their provision of comprehensive longitudinal care for chronic problems is rare
We introduce and evaluate the Family Health Sheet (FHS), a census-based tool that provides Village Health Workers in Kisoro, Uganda with familyspecific health information to guide longitudinal primary care, for chronic disease
In a follow up question, the three most common clarifying comments were that the Family Health Sheets (FHS) helps Village Health Worker (VHW) better care for their community [13 VHWs (28%)], builds VHW credibility in the community [11 VHWs (24%)], and facilitates follow-up of issues that were discovered during the census [10 VHWs (22%)]

Summary

Introduction

Community Health Worker (CHW) programs have long been used to provide acute care for children and women in healthcare shortage areas, but their provision of comprehensive longitudinal care for chronic problems is rare. There is currently a shift in CHW programs, as advocated by the WHO and UNICEF, from historically “vertical” programs – focusing on one health problem such as HIV, TB or maternal mortality – to a more holistic “horizontal” approach [9,10,11]. One such example is the integrated community-case management portfolio where CHWs are engaged in a greater range of health activities, such as the management of multiple infections and newborn conditions to further reduce under-five mortality [12]. Other horizontal CHW models, such as the Jamkhed Comprehensive Rural Health Project in India, have shown impressive improvements in morbidity, mortality and community quality of life [13]

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