Community Health Assistants Research Articles

Community Health Volunteers' experiences of implementing COVID-19 vaccine education and promotion in Kenya: a qualitative descriptive study.

Vaccination was a key measure in the COVID-19 pandemic response, though much work was needed to promote vaccine uptake and acceptance. In Kenya, Community Health Volunteers (CHVs) played a key role in vaccine education and promotion. We conducted this study to explore CHVs' experiences of implementing COVID-19 vaccine education and promotion during the pandemic to increase COVID-19 vaccine uptake in two areas of Kenya. In a qualitative descriptive study, we conducted 30 structured in-depth interviews with 20 CHVs and 10 Community Health Assistants from rural Kilifi County and Kangemi, an urban informal settlement of Nairobi County in Kenya between April 2022 and July 2022. Thematic analysis generated five key themes in relation to CHVs' experiences of implementing COVID-19 vaccine education and promotion: Five key themes emerged regarding CHVs' experiences of implementing COVID-19 vaccine education and promotion: (1) vaccine preferences influenced acceptance, (2) the fear of side effects was a barrier, (3) misinformation was widespread (4) lack of trust in government and politicization of vaccines was a barrier, and (5) CHVs' efforts were a facilitator to increased uptake. Extensive community outreach from CHVs contributed to the high uptake of primary vaccines and boosters during the COVID-19 pandemic. CHVs acting as role models by receiving vaccinations first was particularly important in influencing communities to accept vaccinations. Findings provide evidence for prioritizing CHVs in the planning and implementation of future vaccination initiatives in Kenya and other countries.

Dementia U-Care: Comprehensive Cognitive Screening Application for Seniors

The prevalence of cognitive impairment increases with age, particularly impacting seniors as it advances to severe dementia. These conditions pose significant challenges for afflicted individuals and their caregivers, manifesting as profound impacts on daily life and imposing considerable emotional and financial burdens on families. Mild cognitive impairment (MCI) denotes an intermediate stage between normal cognitive function and dementia, signifying a decline in cognitive abilities while maintaining normal daily life activities. Identifying MCI early in seniors within the community is pivotal to preventing further cognitive decline.In response to the challenge of traditional cognitive function assessments, which require trained healthcare professionals and take 20-30 minutes per case, we introduce "Dementia U-Care," an innovative app designed to assist community health workers in screening, monitoring, and collecting cognitive data. Accessible on mobile devices, it allows seniors to respond through drawing and writing, simplifying data collection compared to paper forms. Dementia U-Care streamlines preliminary assessments, empowering professionals and reducing fatigue and errors. This tool enables prompt screening, minimizing test-related stress, with an average testing time of 13.06 minutes, ranging from 9 to 20 minutes. The evaluation indicates high satisfaction with Dementia U-Care, with a mean score of 9.37±1.12. Users are generally pleased with its quality and user experience, demonstrating its effectiveness in meeting their needs and providing a positive experience.

Spatial multi‐objective optimization of primary healthcare facilities: A case study in Singapore

AbstractPrimary healthcare plays a pivotal role in enhancing health conditions. In Singapore, such services are predominantly manifested through the implementation of the Community Health Assistance Scheme (CHAS). CHAS is an initiative aimed at providing fundamental preventive and therapeutic services, especially for those seniors and low‐income adults with chronic diseases. In spite of considerable efforts in policy and research in this domain, there is a dearth of studies focusing on the spatial optimization of these primary healthcare services. In this study, an innovative multi‐objective medical service facility siting model has been developed based on coarse‐grained parallel genetic algorithm to address the intricate challenges associated with the optimization of locations for CHAS clinics. The proposed optimization model aims to simultaneously maximize accessibility, minimize inequity, and minimize the number of clinics. The successful application of this model in the siting of CHAS clinics in Singapore demonstrates its effectiveness in enhancing residents' access to healthcare services. Apart from its novel academic contributions to the field of spatial optimization of primary healthcare facilities in general, we have also discussed the inherent limitations and identified certain aspects as the future directions of this research.

Teamwork in community health committees: a case study in two urban informal settlements

BackgroundCommunity health committees (CHCs) are mechanisms for community participation in decision-making and overseeing health services in several low-and middle-income countries (LMICs). There is little research that examines teamwork and internal team relationships between members of these committees in LMICs. We aimed to assess teamwork and factors that affected teamwork of CHCs in an urban slum setting in Nairobi, Kenya.MethodsUsing a qualitative case-study design, we explored teamwork of two CHCs based in two urban informal settlements in Nairobi. We used semi-structured interviews (n = 16) to explore the factors that influenced teamwork and triangulated responses using three group discussions (n = 14). We assessed the interpersonal and contextual factors that influenced teamwork using a framework for assessing teamwork of teams involved in delivering community health services.ResultsCommittee members perceived the relationships with each other as trusting and respectful. They had regular interaction with each other as friends, neighbors and lay health workers. CHC members looked to the Community Health Assistants (CHAs) as their supervisor and “boss”, despite CHAs being CHC members themselves. The lay-community members in both CHCs expressed different goals for the committee. Some viewed the committee as informal savings group and community-based organization, while others viewed the committee as a structure for supervising Community Health Promoters (CHPs). Some members doubled up as both CHPs and CHC members. Complaints of favoritism arose from CHC members who were not CHPs whenever CHC members who were CHPs received stipends after being assigned health promotion tasks in the community. Underlying factors such as influence by elites, power imbalances and capacity strengthening had an influence on teamwork in CHCs.ConclusionIn the absence of direction and support from the health system, CHCs morph into groups that prioritize the interests of the members. This redirects the teamwork that would have benefited community health services to other common interests of the team. Teamwork can be harnessed by strengthening the capacity of CHC members, CHAs, and health managers in team building and incorporating content on teamwork in the curriculum for training CHCs.

Research-practice partnership: supporting rural cancer survivors in Montana.

The objective of this Research-Practice Partnership was to disseminate and implement strategies to assist Community Health Centers in improving the care of rural cancer survivors in Montana. Funded by the National Cancer Institute's Community Outreach and Engagement mechanism, this project utilized the MAP-IT (Mobilize, Assess, Plan, Implement, Track) program planning framework from Healthy People 2020. Partners included Montana's Department of Public Health and Human Services' Cancer Control Program, Montana Primary Care Association, One Health Community Health Center, and Huntsman Cancer Institute at the University of Utah. Project activities focused on (1) Planning, creating, implementing, and evaluating provider/care team education sessions through the Project ECHO tele-mentoring platform and through short webinars and (2) Building processes for identifying, documenting, and connecting with survivors using electronic health records (EHRs) and other resources. Lessons learned from this project include the value of aligning partner goals from the outset to foster sustained commitment, the importance of adapting implementation plans to address challenges and leverage opportunities, and the need for accurate EHR data and formal processes for identifying and engaging with cancer survivors.

Inclusive innovation: World health organization (WHO) task-shifting principles in community health workers living with disabilities through women’s cancer screening in the EMPOWER Program.

e22512 Background: The W.H.O estimates that people with disabilities make up 15% of the world’s population. In the Horn of Africa (Djibouti, Kenya, Ethiopia & Uganda) there have been several disability inclusion programs in Education, livelihoods and empowerment through the Development Response to Displacement Impacts Project (DRDIP). In Kenya, the Government has continued to leverage on the private sector to accelerate progress towards inclusion. A strategic partnership with Safaricom enabled provision of Assistive devices and medical cover exceptional approval to a tune of USD 223,000 to Persons with Disabilities in the formal and informal economy in Kenya. Women CHVs were selected to reduce cultural barriers because many women in the communities are more comfortable being screened by a fellow woman. Objectives: To identify and deploy women living with disabilities as community health volunteers in the county EMPOWER Clinics; To build capacity of women living with disabilities and enable them to accurately screen for breast and cervical cancer. Methods: A total of 25 women living with disabilities and 7 able-bodied women from Meru and Kisumu counties were selected for the training program through county disability coordinators. The training program consisted of a basic community health volunteer (CHV) module and focused on Breast and cervical cancer awareness topics. The CHVs were equipped with mobile phones with assistive technology (AT) features such as braille keyboards, magnifiers, and text-to-speech technology. The training was delivered through Amref Health Innovations' (AHI) LEAP platform in collaboration with 5 county community health assistants. The CHVs' understanding of the material was evaluated through performance tracking on the LEAP platform. The CHVs were also given regular feedback on their progress, and any areas of difficulty were addressed through additional support and guidance. Results: The trained CHVs demonstrated an increased understanding of breast and cervical cancer screening, as well as the skills necessary to perform medical tactile breast exams. The trained CHVs were then commissioned to be integrated into the community health workforce, with a focus on breast and cervical cancer screening and awareness. Conclusions: The deployment of inclusion-centered learning for women Community Health Volunteers (CHVs) living with disabilities is a promising approach for improving access to health services for this marginalized group. This program provides a model for promoting disability inclusion in health services and underscores the need for continued investment in disability-inclusive programs. The findings of this program can inform the development of similar programs in other regions and contribute to the achievement of universal health coverage and health for all.

Acceptability of a Whatsapp Triage, Referral, and Transfer System for Obstetric Patients in Rural Liberia.

Maternal mortality continues to disproportionately affect low- and middle-income countries, including Liberia. Though the relationship between obstetric triage systems and improved maternal outcomes is well documented, standardized triage protocols are lacking in rural Liberia. Mobile health interventions are a promising method to triage obstetric patients. This study explores the acceptability of a WhatsApp Triage, Referral, and Transfer (WAT-RT) system among Liberian midwives and community health assistants. Individual interviews and focus group discussions were conducted among midwives (n = 18) and community health assistants (n = 112). Interviews were designed to understand the current referral system in rural Liberia, how a WAT-RT System can address referral limitations, and the acceptability of the WAT-RT System. Data were audio recorded, transcribed, and translated into English. Data analysis was conducted via NVivo12 with independent and cooperative techniques among multiple researchers. The current referral system is not standardized with limitations including a lack of triage protocols, transportation difficulties, and inconsistent communication of patient information, which could be addressed by a WAT-RT System. The acceptability for the WAT-RT System was high. Facilitators to implementation included utilizing a pre-existing communication and referral infrastructure, access and competency surrounding mobile phones, and increased opportunities for training and inter-provider collaboration. Barriers included disproportionate phone access between midwives and community health assistants, network reliability, and a lack of data standards. Recommendations for successful implementation included centralizing phone financing and standardizing triage protocols. The WAT-RT System demonstrated high acceptability among frontline health care providers in rural Liberia. Barriers to program success could be reasonably addressed with simple interventions and planning. Multiple benefits included addressing care delays for obstetric patients, promoting bidirectional provider communication, and increasing the quality of obstetric triage. Future studies should focus on piloting the WAT-RT System among this population and recruiting other key stakeholders to determine intervention feasibility.

Measuring Health System Responsiveness in a national community health worker primary care program in rural Liberia.

As many low- and middle-income countries scale up community health worker (CHW) programs to achieve universal health coverage, ensuring quality as well as access is critical. Health system responsiveness (HSR) is a core domain of quality patient-centred care, but has not been widely measured in CHW-delivered care. We report results from a household survey measuring HSR and health systems quality of CHW-delivered care in two Liberian counties where the national CHW program of Community Health Assistants (CHAs) for communities five kilometres or more from a health center has been implemented. We conducted a cross-sectional population-based household survey in 2019 in Rivercess (RC) and Grand Gedeh (GG) counties, using a two-stage cross-sectional cluster sampling approach. We included validated HSR questions on six responsiveness domains and patient-reported health system outcomes, such as satisfaction and trust in the CHA's skills and abilities. The HSR questions were administered to women aged 18-49 who reported seeking care from a CHA in the three months prior to the survey. A composite responsiveness score was calculated and divided into tertiles. Multivariable analysis using Poisson regression with log link and adjusting for respondent characteristics was used to determine the association between responsiveness and patient-reported health system outcomes. The proportion of individuals rating responsiveness as very good or excellent were similar across all domains within a district, with ratings were lower in RC (23-29%) than GG (52-59%). High ratings in both counties were seen for high trust in the CHA's skills and abilities (GG 84%, RC 75) and high confidence in CHA (GG 58%, RC 60%). Compared with women in the lowest responsiveness tertile (score ≤3), women in the highest tertile (score 4.25) were significantly more likely to report high quality of CHA-delivered care (prevalence ratio, PR=14.1), very good/excellent at meeting health needs (PR=8.0), high confidence in the CHA to provide future care (PR=2.4), and high level of trust in CHA's skills and abilities (PR=1.4). Controlling for respondent characteristics, the composite responsiveness score was significantly associated with all patient-reported health system outcomes (P<0.001). We found that HSR was associated with important patient-reported health system quality outcomes, including satisfaction, trust, and confidence in the CHA. Measuring patients' experience and outcomes of care is important to complement more common measures of technical quality for CHW-delivered care to ensure that this domain of quality is central to community health program design and delivery.

Examining the gender imbalance in the National Community Health Assistant Programme in Liberia: a qualitative analysis of policy and Programme implementation.

The Revised National Community Health Services Policy (2016-2021) (RNCHSP) and its programme implementation, the Liberian National Community Health Assistant Programme (NCHAP), exhibit a critical gender imbalance among the Community Health Assistants (CHAs) as only 17% are women. This study was designed to assess the gender responsiveness of the RNCHSP and its programme implementation in five counties across Liberia to identify opportunities to improve gender equity in the programme. Using qualitative methods, 16 semi-structured interviews were conducted with policymakers and 32 with CHAs, other members of the community health workforce and community members. The study found that despite the Government of Liberia's intention to prioritize women in the recruitment and selection of CHAs, the planning and implementation of the RNCHSP were not gender responsive. While the role of community structures, such as Community Health Committees, in the nomination and selection of CHAs is central to community ownership of the programme, unfavourable gender norms influenced women's nomination to become CHAs. Cultural, social and religious perceptions and practices of gender created inequitable expectations that negatively influenced the recruitment of women CHAs. In particular, the education requirement for CHAs posed a significant barrier to women's nomination and selection as CHAs, due to disparities in access to education for girls in Liberia. The inequitable gender balance of CHAs has impacted the accessibility, acceptability and affordability of community healthcare services, particularly among women. Strengthening the gender responsiveness within the RNCHSP and its programme implementation is key to fostering gender equity among the health workforce and strengthening a key pillar of the health system. Employing gender responsive policies and programme will likely increase the effectiveness of community healthcare services.

The potential of intervention-based community development programs in reducing multiple health risk behaviors among adolescent: A scoping review of the latest RCTs.

Background: Adolescents are more likely than adults to engage in risky health behaviors such as smoking, drinking, and sexual activity. Community development plays a role in reducing adolescents’ personal, cognitive, and social skill deficits. A review of the effectiveness of community-development interventions is required to advance our understanding of how the intervention reduce health risk behaviors. This study analyze type and effectiveness of adolescents’ community development programs reduce multiple health risk behaviors among adolescents.Methods: This scoping review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). With a date range of 2015–2021, searches were conducted in PubMed, EBSCO, and ProQuest using keywords (((Life skill education) OR (community development)) AND ((health risk behavior) OR (risk behavior)) AND ((adolescent) OR (adolescence) OR (teenagers) OR (teens) OR (youth))). After title and abstract checking, full-text retrieval, and data extraction, data were synthesized based on the main objectives. The most important data were tabulated. Results: Most studies showed that community development–based interventions effectively reduce adolescents’ health risk behaviors, including risky sexual behaviors, drug and alcohol use. Interventions were carried out in schools, places of worship, and communities, involving adolescents, educational institutions, health professionals, religious leaders, and families. Conclusion: This review can assist community health nurses, policymakers, researchers, and teachers in developing and implementing effective community-development programs that ensure knowledge, attitudes, and skills transfer to reduce health risk behaviors.

Influence of community dialogues on social accountability in the health system in Nairobi County, Kenya

Background: Social accountability encompasses a variety of strategies that enable citizens to express their concerns about the performance of health-care services. Community dialogues provide a forum for community engagement and participation in the health care system. However, there is little documentation on how it is used to improve social accountability within government community health structures. The purpose of this study was to determine the influence of community dialogues on social accountability in Nairobi County, Kenya.Methods: A qualitative study was conducted that included in-depth interviews with key stakeholders purposively selected. A total of three focus group discussions with 23 participants, eight key informant interviews and document review of minutes were conducted. Data analysis was done using thematic analysis.Results: Findings showed that community dialogues were held quarterly. The forums were mostly used for education purposes with little evidence on community engagement. Minutes showed what the community health assistant and community health volunteer said to the community with minimal input from the community members. Feedback was a challenge because the health management team hardly attended community dialogues due to logistic and workload issues.Conclusions: There is need of practical strengthening community dialogues through use of tools like chalk board and community scorecard as advocated in the community health policy. However, in practice, these tools were hardly used resulting to missed opportunity for the community to voice their opinions on health services.

Acceptability and impact of group interpersonal therapy (IPT-G) on Kenyan adolescent mothers living with human immunodeficiency virus (HIV): a qualitative analysis

BackgroundTask shifting is a well-tested implementation strategy within low- and middle-income countries that addresses the shortage of trained mental health personnel. Task shifting can increase access to care for patients with mental illnesses. In Kenya, community health workers (CHWs) are a combination of community health assistants and community health volunteers and have played a crucial role on this front. In our study, we seek to assess the acceptability and feasibility of Group Interpersonal Psychotherapy (IPT-G) delivered by CHWs among depressed postpartum adolescents (PPAs) living with human immunodeficiency virus (HIV).MethodThe study used theoretical framework of behaviour change including: Capability, Opportunity and Motivation (COM-B model) to help understand behavioural changes due to IPT-G intervention delivered by the CHWs. 24 PPAs were administered IPT-G by trained CHWs from two health centres. A two-arm study design (IPT-G intervention and treatment as usual) with an intent to treat was used to assess the acceptability and feasibility of IPT-G. With purposeful sampling, participants who scored > 10 on the Edinburgh postnatal depression scale and who were 6–12 weeks postpartum were eligible for the study. Participants were equally distributed into two groups: one group for intervention and another as a wait-listed group. This was achieved by randomly allocating numerical numbers and separating those with odd numbers (intervention group) and even numbers (wait-listed group). Focus group discussions and in-depth interviews ascertained the experiences and perceptions of the PPAs and the CHWs during IP-G delivery process. In addition to weekly face-to-face continuous supportive supervision for the CHWs, the researchers also utilized phone calls, short messages services and WhatsApp instant messaging services.ResultsThe CHWs found the intervention useful for their own knowledge and skill-set. With regards to participation, 21 out of the 24 adolescents attended all sessions. Most of the adolescents reported an improvement in their interpersonal relationships with reduced distress and lessening of HIV-related stigma. Primary healthcare workers embraced the intervention by accommodating the sessions in their routine clinic activities.ConclusionOur study demonstrates the possible benefits of task shifting in addressing mental health problems within low-resource settings in Kenya, and IPT-G is demonstrated to be both acceptable and feasible by health workers and adolescents receiving care.

Prevalence of chronic noncommunicable diseases and their associated factors in adults over 39 years in riverside population in the Western Brazilian Amazon region

The prevalence of Chronic Noncommunicable Disease (CND) are rocketting over the world, including in young adults. The WHO estimates that more than half of the deaths in the world are caused by CND.&#x0D; A cross-sectional study was carried out from june to november 2016. The researchers visited 16 communities, with a sample size of 183 adult individuals performed for convenience. The patients went through screening and verified: weight, height, abdominal circumference, blood pressure, clinical-epidemiological history and performed physical and laboratory examination. Prevalence ratios were calculated with confidence intervals of 95% and with statistical significance with p&lt;0.05.&#x0D; This study aims to estimate the prevalence of CND and its associated factors in the elderly riverside population of the Rio Madeira in Humaitá, Amazonas State, Western Brazilian Amazon.&#x0D; The prevalence of systemic arterial hypertension (SAH) was 44.7%, 52.6% in female. Of the individuals with SAH, 77.5% did not use medication. About 51.5% of them had Grade I SAH. The prevalence of type 2 diabetes mellitus was 16.4%, where no patient used medication and about 40.4% of the studied population fits in the glucose intolerance range. Metabolic syndrome presented a prevalence of 24.0%, with a higher frequency in females (33.8%) (p=0.007). Concerning chronic kidney disease, a prevalence of 12.1% was observed in both genders. The associated factors found were alcoholism, smoking, sedentary lifestyle and obesity, and more than 45% of the patients had at least two associated factors.&#x0D; The population had a high prevalence of CND and associated factors, low frequency of medication use, revealing inefficiency of the local health system. Increased coverage of the Governmental Family Health Strategy (GFHS) and the increase in number of trained Community Health Assistants , together with health education actions can increase the population’s health standard.

Commentary on “Promising careers? A critical analysis of a randomised control trial in community health worker recruitment in Zambia,” by James Wintrup

“Promising careers? A critical analysis of a randomised control trial in community health worker recruitment in Zambia” (Wintrup, 2021) raises important questions about the uses of randomized controlled trials (RCTs) and uses our RCT embedded in Zambia's National Community Health Assistant (CHA) Program (Ashraf et al., 2020a) as a case study to illustrate the pitfalls of the RCT methodology and especially its potential to do harm. This commentary clarifies the misunderstandings at the heart of Wintrup (2021)'s critique.

Mapping services at two Nairobi County primary health facilities: identifying challenges and opportunities in integrated mental health care as a Universal Health Coverage (UHC) priority

IntroductionThere is a need to scale-up mental health service provision in primary health care. The current extent of integration of mental health in primary care is pertinent to promoting and augmenting mental health at this level. We describe a facility mapping exercise conducted in two low-income/primary health facilities in Kenya to identify existing barriers and facilitators in the delivery of mental health services in general and specifically for peripartum adolescents in primary health care as well as available service resources, cadres, and developmental partners on the ground.Method and measuresThis study utilized a qualitative evidence synthesis through mapping facility-level services and key-stakeholder interviews. Services-related data were collected from two facility in-charges using the Nairobi City County Human Resource Health Strategy record forms. Additionally, we conducted 10 key informant interviews (KIIs) with clinical officers (Clinicians at diploma level), Nurses, Community Health Assistants (CHAs), Prevention of Mother-to-child Transmission of HIV Mentor Mothers (PMTCTMs), around both general and adolescent mental health as well as psychosocial services they offered. Using the World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) as a guideline for the interview, all KII questions were structured to identify the extent of mental health integration in primary health care services. Interview transcripts were then systematically analyzed for common themes and discussed by the first three authors to eliminate discrepancies.ResultsOur findings show that health care services centered around physical health were offered daily while the mental health services were still vertical, offered weekly through specialist services by the Ministry of Health directly or non-governmental partners. Despite health care workers being aware of the urgent need to integrate mental health services into routine care, they expressed limited knowledge about mental disorders and reported paucity of trained mental health personnel in these sites. Significantly, more funding and resources are needed to provide mental health services, as well as the need for training of general health care providers in the identification and treatment of mental disorders. Our stakeholders underscored the urgency of integrating mental health treatment, prevention, and well-being promotive activities targeting adolescents especially peripartum adolescent girls.ConclusionThere is a need for further refining of the integrated care model in mental health services and targeted capacity-building for health care providers to deliver quality services.

Improvements in malaria testing and treatment after a national community health worker program in rural Liberia

Background Progress in reducing malaria incidence and deaths has stalled, in part due to limited access to quality malaria testing and treatment amongst rural populations. This time-series analysis aims to describe changes in rural malaria diagnosis and treatment before and during the rollout of Liberia’s National Community Health Assistant (CHA) program. It also explores how malaria service delivery changed during the COVID-19 epidemic. Methods Malaria diagnosis and treatment data from 315 rural health facility catchments supported by Liberia’s National CHA Program were collected from Liberia’s Health Management Information System and analyzed. Trends in malaria service delivery coverage and quality were assessed between January 2011 and December 2020. Results By 2020, four years after the program’s introduction, Liberia’s Community Health Assistants diagnosed 50% of rapid diagnostic test (RDT) or microscopy-confirmed malaria cases and carried out 51% of malaria treatments amongst children under age five in rural areas where CHAs were present. Furthermore, the percentage of malaria diagnoses that were confirmed by microscopy or RDT increased from 71% prior to the program to 95% in 2020. These results were effectively sustained in rural and remote communities during COVID-19 in 2020. Conclusions The introduction of Liberia’s CHA program was associated with improvements in the quality of malaria diagnoses and contributed to treating a significant share of the malaria burden amongst children under age five in remote rural communities across Liberia, and these improvements were sustained during COVID-19. Investments made in rural community health systems can be leveraged by policy makers to strengthen malaria diagnosis, treatment and control, especially in the age of COVID-19.

HUBUNGAN FAKTOR MANUSIA, ORGANISASI DAN TEKNOLOGI TERHADAP NET-BENEFIT DARI SIKP KABUPATEN DEMAK

Sistem Informasi Kesehatan Puskesmas (SIKP) is a variation of the puskesmas management information system used by puskesmas in Demak Regency. SIKP began to be used to assist community health centers in managing patient services since 2016. However, in reality, there are still some obstacles in terms of human, organizational and technical factors. The purpose of this study was to determine the relationship between human, organizational and technological factors (HOT-Fit) with the Net-Benefit of using SIKP at Dempet Health Center and Gajah 2 Health Center, Demak Regency. This research is a quantitative research using explanatory research method and cross sectional study design. The total population of SIKP users are 43 officer respondents, with details of 4 Registration officers, 9 BP-UMUM officers, 28 KIA officers, 4 Pharmacy officers. The results showed that most respondents were users of information systems aged 31-40 years (44%), and had a work period of more than 15 years (39.5%). The results of the correlation test showed that there was a weak positive relationship between human factors and the net-benefit of SIKP (p-value = 0.021, r = 0.351), but there is no relationship between the other 2 variables, between organizational factors and Net-benefit (p value = 0.392, r = 0.194) and between technology factors and Net-benefit (p value = 0.994, r = 0.001). It is recommended that monitoring and evaluation of routine use from both the Puskesmas and the Health Office are recommended so that it can add to the positive net-benefits of SIKP.

Strengthening the community health program in Liberia: Lessons learned from a health system approach to inform program design and better prepare for future shocks.

BackgroundArising from the Ebola virus disease (EVD) outbreak, the 2015-2021 Investment Plan aimed to improve the health status of the Liberian population through building a resilient health system that contributes to achieving equitable health outcomes. Recognizing the significance of community participation in overcoming the EVD outbreak, strengthening community systems emerged as one of the most important strategies for bridging the gap in accessing primary health care (PHC) services. This study reviewed the community health policy development process in order to draw lessons from the health system strengthening efforts in Liberia post-EVD crisis.MethodsA government-led health system analysis approach was applied to assess, review and revise the community health program in Liberia. The mixed method approach combines the use of an adapted tool to assess bottlenecks and solutions during workshops, a qualitative survey (key informant interviews and focus group discussions) to assess perceptions of challenges and perspectives from different stakeholders, and an inter-agency framework – a benchmarks matrix – to jointly review program implementation gaps using the evidence compiled, and identify priorities to scale up of the community program.ResultsStakeholders identified key health system challenges and proposed policy and programmatic shifts to institutionalize a standardized community health program with fit for purpose and incentivized community health assistants to provide PHC services to the targeted populations. The community health program in Liberia is currently at the phase of implementation and requires strengthened leadership, local capacities, and resources for sustainability. Lessons learned from this review included the importance of: establishing a coordination mechanism and leveraging partnership support; using a systems approach to better inform policy shifts; strengthening community engagement; and conducting evidence-based planning to inform policy-makers.ConclusionsThis article contributes toward the existing body of knowledge about policy development processes and reforms on community health in Liberia, and most likely other African settings with weak health systems. Community-based systems will play an even bigger role as we move toward building resilience for future shocks and strengthening PHC, which will require that communities be viewed as actors in the health system rather than just clients of health services.

Engaging community health workers, technology, and youth in the COVID-19 response with concurrent critical care capacity building: A protocol for an integrated community and health system intervention to reduce mortality related to COVID-19 infection in Western Kenya

Globally, the number of COVID-19 infections is approaching 63 million; more than 1 million individuals have lost their lives. In Kenya, the number of infections has surpassed 80,000 and 1469 people have lost their lives. In Kenya, the community health strategy has been used to deliver essential health services since 2007. Furthermore, the population in Kenya is young (the median age is 21 years old) and Kenya is recognized as a technology hub in the East African region. Community-based health care, youth, and technology, are assets within the Kenyan context that can be leveraged to respond to the COVID-19 pandemic with concurrent strengthening of the critical care capacity at the health system level. This is a quasi-experimental study with quantitative and qualitative methods of data collection to complete a baseline assessment of community health unit and health facility service readiness in the study site of Siaya County in western Kenya. Following the baseline assessment, service ready community health units and health facilities with oxygen capacity will form intervention groups. At the community level, the intervention will consist of training youth, community health assistants and community health workers in screening, case detection, prevention, management and referral of COVID-19 cases with maintenance of essential health services. The community intervention will be enhanced by youth and use of digital tools. At the health facility level, the intervention will consist of training health care workers in basic critical care and caring for severe COVID-19 patients with maintenance of essential health services. The primary outcome measure will be mortality related to COVID-19 infection both at community and health facility levels. This study would be the first study to evaluate the effectiveness of an integrated approach in preparing for and implementing a robust pandemic response. Registration: ClinicalTrials.gov ID NCT04501458; registered on 6 August 2020.

Raising awareness of clinical trials in dementia: A national survey testing concept designs tailored to African American caregivers and individuals at risk

AbstractBackgroundLow enrollment of African Americans into clinical trials for Alzheimer’s Disease (AD) and related dementias (ADRD) is partly a result of too few researchers offering trial opportunities and inadequate information that is culturally relevant. The National Institute on Aging (NIA) sought to develop a culturally acceptable/effective toolkit of AD/ADRD clinical trial (CT) outreach materials for community health professionals to use with African American audiences. This abstract presents the results of a national online survey testing several AD/ADRD concept designs with adults/caregivers to guide the toolkit’s development.MethodAn online national panel survey was conducted with African American adults who: 1) had a family history of AD/ADRD (n=206); 2) had no family history of AD/ADRD (n=204); and, 3) were caregivers of persons with AD/ADRD (n=206). Respondents reported their AD/ADRD and CT knowledge/attitudes/intentions; they reviewed four concept designs and indicated preferences/likelihood of each concept to impact five variables (visit website, interest in trials, attention, believability, salience). Concepts featured messages that tested well in focus groups.ResultCaregivers and those at‐risk self‐reported higher familiarity with AD/ADRD signs/symptoms than those with no family history; all groups self‐reported limited understanding of CTs. Two concepts ranked highest among all participants: emphasizing helping future generations and noting that AD/ADRD affects races differently. Most caregivers (61‐87%) and at‐risk participants (46‐89%) gave favorable scores for all impact variables across all concepts, indicating they found most concepts motivating and acceptable. Those with no family history provided lower impact scores (39‐78%). After viewing all concepts: all groups significantly increased (p&lt;.05) their “interest in participating in clinical trials”; and, the at‐risk and no‐history groups were significantly more likely to disagree with “there is nothing I can do to reduce my risk of [AD]”.ConclusionThis research identifies effective AD/ADRD ad concepts that are culturally tailored and acceptable to African Americans nationally, and addresses a known obstacle to recruitment. The combination of the messages/images successfully increased interest in CTs as an option to address AD/ADRD. Using these findings, NIA developed and offers an outreach toolkit to assist community health professionals who do not otherwise have resources to develop their own materials.