Community Health Officers Research Articles

Ensuring excellence: A deep dive into the quality monitoring of Ayushman Bharat health and wellness Centre

This review evaluates the quality monitoring mechanisms of Ayushman Bharat Health and Wellness Centres, integral to India's pursuit of Universal Health Coverage. AB-HWCs are designed to deliver comprehensive primary healthcare, particularly targeting undeserved communities. Despite the significant expansion and progress in healthcare access, the review identifies persistent service quality and infrastructure disparities. The study underscores the necessity of a robust quality monitoring framework, incorporating standardized checklists to ensure consistent and high-quality service delivery. These checklists play a crucial role in systematically assessing the availability of medical supplies, infrastructure adequacy and others, facilitating timely interventions and modification. Additionally, the integration of cultural competence into healthcare delivery is emphasized to enhance the acceptance and effectiveness of services among diverse populations. The review also highlights the critical roles of Community Health Officers and mid-level healthcare providers in the successful operation of HWCs. While acknowledging the commendable progress made by the AB-HWCs initiative, the study concludes that achieving sustainable and equitable health outcomes necessitates ongoing quality monitoring, strategic resource allocation, and adaptive policy measures. The consistent application of checklists in quality assurance processes is essential for maintaining high care standards and advancement of India towards its UHC objectives.

Enhancing maternal health service utilization among highly vulnerable pregnant women through a human-centered design process: Study protocol for a quasi-experimental study in Oromia, Ethiopia

Background Disproportionate uptake of and access to maternal and child health services remain significant challenges across and within countries. Differing geographic, economic, environmental, and social factors contribute to varying degrees of vulnerabilities among individuals, which manifest as disparities in maternal and newborn health outcomes. Designing solutions according to need is vital to improve maternal and child health outcomes. In this paper, we describe our study protocol on evaluating the effectiveness of an intervention package developed through a human-centered design (HCD) process in improving maternal health service uptake among vulnerable pregnant women in rural areas of Ethiopia. Methods The study has two distinct phases. For both phases, solutions will be developed leveraging HCD approaches to improve institutional delivery and antenatal care uptake among vulnerable pregnant women. Final solutions will be implemented in collaboration with community health workers and health officers. A community-based, quasi-experimental, mixed-method study design is used to assess differences between intervention and control arms. A panel sample will be enrolled after screening for pregnancy and vulnerability level and surveyed at baseline and midline in Phase 1. In Phase 2, a post-only study will be conducted in the same intervention and control sites. Pregnant women will receive refined solutions for six months, which will be evaluated using end-line assessment. Qualitative interviews will be conducted among vulnerable pregnant women and healthcare providers. Conclusions and Implications Our sequential approach to evaluating initial solutions, which in turn will be used to inform the enhancement of solutions, will provide practical insights into how solutions are accepted among vulnerable women and how they can be better integrated into women’s lives and health systems. Our findings on program effectiveness and implementation research will be disseminated to the Ethiopian Ministry of Health and its partners to inform large-scale implementation at the national level.

High Responsibility, limited authority, and endless expectations: a policy critique of the Community Health Officer’s role in the government healthcare delivery systems in India

BackgroundThe shortage of qualified healthcare providers in rural areas of India has led to a emergence informal and unqualified practitioners and poses significant risks to population health. Community Health Officers (CHOs) were introduced as mid-level health providers (MLHP) at Sub-health Centres (SHC) to bridge the healthcare resource gap and serve as the primary point of contact for rural communities.MethodsThis qualitative cross-sectional study aimed to explore the CHOs experiences and performance at sub-health centre Health and Wellness Centres (SHC-HWCs) in India. CHOs and Medical Officers (MOs) from randomly selected SHC-HWCs and Primary Health Centre-Health and Wellness Centres (PHC-HWCs) across different geographic zones were interviewed. Semi-structured interviews were conducted with CHOs, MOs, and State Nodal Officers (SNOs) to gather information on drug provisioning, prescription practices, and perspectives on the roles and capacities of CHOs. The study is based on 40 in-depth interviews of health providers sampled at different levels of healthcare system in India.ResultsThe study revealed barriers and challenges faced by CHOs in meeting the expectations outlined in the Comprehensive Primary Health Care (CPHC) guidelines. These included a lack of agency, difficulties in team dynamics with existing healthcare professionals, and inadequate availability of medicines at sub-health centres. Due to the existing contradictions and prescription restrictions, CHOs found themselves failing to meet community expectations and foster trust.ConclusionCHOs encounter significant challenges in fulfilling their roles as mid-level health providers. Addressing these challenges is crucial for optimizing their effectiveness and strengthening the delivery of primary healthcare in rural areas. Clear protocols, supportive policies, and capacity-building initiatives are necessary to enhance the role and impact of CHOs in the healthcare system.

Exploring community needs in combating aedes mosquitoes and dengue fever: a study with urban community in the recurrent hotspot area

BackgroundAedes mosquitoes are the main vector of dengue infection, a global health threat affecting millions of people annually. Conventional prevention and control methods against dengue outbreaks have only achieved marginal success. Recognizing the complex issue at hand, a multilevel participatory approach is crucial. Thus, alternative strategies that involve community engagement are increasingly being considered and attempted. While community-based vector control programs have been conducted, sustaining behavioral changes among the population remains a challenge. This study aimed to identify the specific community needs in combating Aedes mosquitoes and dengue fever as a basis to guide the development of community-driven initiatives and foster a deeper sense of ownership in the fight against dengue.MethodsBetween 1 August 2022 and 30 November 2022, we conducted a study in Hulu Langat district, Selangor, using a mixed-method design. All participants consented to the study, which comprised 27 participants (FGDs) and 15 participants (IDIs). The IDIs included two participants with a history of dengue fever, one community leader, one faith leader, seven local authorities, and four district health officers. Semi-structured interviews and discussions were performed among stakeholders and community members recruited via purposive and snowball sampling techniques. All interviews were audio-recorded before being analyzed using reflexive thematic analysis.ResultsThese results derived from qualitative data explored the perspectives and needs of communities in combating Aedes mosquitoes and dengue fever. Interviews were conducted with various stakeholders, including community members, leaders, and health officers. The study identified the necessity of decisive actions by authorities to address the impact of the dengue epidemic, the importance of community engagement through partnerships and participatory approaches, the potential benefits of incentives and rewards to enhance community participation, and the need for sustained community engagement and education, especially via the involvement of young people in prevention efforts. These findings provide valuable insights into the design of effective strategies against Aedes mosquitoes and dengue fever.ConclusionsIn short, there is an urgent need for a comprehensive approach involving multiple stakeholders in the fight against Aedes mosquitoes and dengue fever. The approach should incorporate efforts to raise awareness, provide practical resources, and foster community responsibility. The active involvement of teenagers as volunteers can contribute to long-term prevention efforts. Collaboration, resource allocation, and community engagement are crucial for effective dengue control and a healthier environment.

Strengthening linkages between tertiary care hospitals and Primary Health care facilities Experiences from an online capacity building program for Community Health Officers of Odisha

Strengthening linkages between tertiary care hospitals and Primary Health care facilities Experiences from an online capacity building program for Community Health Officers of Odisha

IJCM_115A: Assessing control status of diabetes and hypertension in adults in rural Nagpur: A Formative Approach

Background: Formative research is the process by which researchers aim to understand the current behaviours, perceptions and needs of the target population which affects their decisions and actions. There is gap in literature regarding the health system preparedness to tackle the increasing burden of lifestyle diseases, especially in post-COVID era. This study proposes to identify the various barriers and facilitators in optimising control status among those already diagnosed with lifestyle diseases, through formative approach. Objective: To describe the various barriers and facilitators important for maintaining optimum control of blood sugar and blood pressure among adults with diabetes and hypertension in rural Nagpur Methodology: Rural Nagpur (Populations served by RHTC Bela) Population: 1-Stakeholders including adult consenting diabetic and hypertensive patients. 2-Private and Govt. Medical Practitioner Sampling Technique: Purposive sampling of diabetic and Hypertensive patients was done based on their vocal and willingness to participate in Barrier Analysis. All health care providers from public health facilities (Medical officers and Community health officers from the selected PHC) were considered for in-depth interviews without any sampling. Data collection: Ethnographic analysis including Barrier Analysis through-semi- structured interview, free-listing and Pile sorting using standard techniques. Verbatim recording was followed by coding and analysis. Data Analysis: Analysis was done using Atlas. Ti and Anthropac Software. Smiths Saliency Score was generated wherever appropriate and cognitive map was created. Results: From interim analysis, through triangulation of data, some of the themes that emerged were “Frequent Refill”, “Healthcare Worker Reluctanc”, “Unavailability of medications” as the top barriers to maintaining good control status of diabetes and hypertension. Conclusion: This study will identify the barriers and facilitators at individual, family and at the health system level in controlling the lifestyle diseases, paving the way for the development of future implementation packages appropriate in the cultural context.

Evaluating Maternal Health Services Within the Reproductive, Maternal, Newborn, Child Health and Adolescents (RMNCH+A) Framework Amidst the COVID-19 Pandemic in Rural India: A Comprehensive Mixed-Methods Analysis.

Background Around half of the pregnant women in India do not receive full antenatal care. During the year 2020, routine health services were further affected by COVID-19. This study was conducted to assess the effect of the pandemic on the delivery/utilization of reproductive, maternal, newborn, child health, and adolescent(RMNCH+A) services. Methodology The study, conducted in Wardha district, Maharashtra, from July to December 2020, aimed to assess maternal health. In Wardha block, 200 pregnant and postnatal women were surveyed using a multistage sampling approach. Adequate knowledge was gauged through Mother and Child Protection Card comprehension. Health system data for April to December 2020 was compared with 2019 district-wide. In-depth interviews were conducted with beneficiaries, including pregnant and post-natal women and healthcare workers. The qualitative inquiries involved medical officers, supervisory staff, community health officers, an auxiliary nurse and midwife (ANMs), Taluka Health Officers, and focus group discussions with accredited social health activists (ASHA), Anganwadi workers (AWW), and Village Health Nutrition and Sanitation Committee members. Results Essential services were delivered to both antenatal and postpartum women, though family planning services and health education were the worst affected. Among the survey respondents, 75% of the post-partum women were not using any contraceptives. District-wide coverage of post-abortion/MTP contraception fell by around 90% as compared to the previous year. The most common difficulties faced by the respondents in availing of the services were related to finances and arranging transport to visit health facilities. Conclusion Learning from the current pandemic for system strengthening, adequate manpower, and planning to prevent disruption of essential services and promoting e-health and m-health initiatives may prevent such catastrophic events in the future from affecting the delivery of routine services.

Assessment of Knowledge on Palliative Care among the Community Health Officers in Rural Area of Purba Medinipur District, West Bengal, India.

Palliative care deals with patients who are facing problems of life-threatening diseases. Under the Ayushman Bharat programme, a new cadre of Community Health Officers (CHOs) is provisioned at Health and Wellness Centres (HWCs) who are nursing graduates. Being the team leader at the HWC level, having a low level of knowledge of palliative care would compromise their service. The study assessed the knowledge of CHOs about palliative care services in a rural district of Purba Medinipur, West Bengal, India. A descriptive study with a cross-sectional design was carried out among 314 CHOs posted in different HWCs of Purba Medinipur, West Bengal, during July-August' 2022. We used to collect data based on questionnaires of 'Palliative-Care-Knowledge Questionnaire-Basic' comprising items related to palliative care, the requirement of palliative care, pain management, communication, and dealing with psychosocial issues. A chi-square test was performed to check the association with educational- and experience-related variables and knowledge. Overall, adequate knowledge was present in 216 (68.8%) and inadequate knowledge in 98 (31.2%) of CHOs. Improper knowledge was present regarding the role of oxygen supplementation in dying patients, the need for palliative care in human immunodeficiency virus/acquired immunodeficiency syndrome, chronic non-malignant diseases, pain management, and communication about the prognosis of disease. The proportion of CHOs who had adequate knowledge who were highly educated (70%) and those who had previous job as CHO (73.3%). Almost similar knowledge scores were found among those who ever cared for or never cared for either terminally ill patients (P = 0.89) or cancer patients (P = 0.853). In-depth knowledge was lacking among the CHOs. Training and re-training of CHOs to develop technical and communication skills will help them deliver proper palliative care.

A study to assess the level of stress among community health officers working in selected health centers of Jabalpur

A study to assess the level of stress among community health officers working in selected health centers of Jabalpur

Conirmatory Factor Analysis of Depression, Anxiety and Stress 21 (DASS 21) scale in a study on Occupational Health Psychology in Health Care Professionals from Anand, Gujarat

Introduction: Confirmatory factor analysis (CFA) is a statistical technique to verify the factor structure of a set of observed variables. Objective: The study was conducted with an objective to study the psychometric properties of DASS 21 scale by Confirmatory factor analysis Method: This study used a Multi Method Design (Multiple approach Design), one was a cross sectional study of 228 participants and the other was a Solomon 4 group Design with total 64 participants. Four groups of health care professionals viz Allopathic doctors, Physiotherapists, Nursing professionals and Community Health Officers (CHOs) were chosen for the study. Convenience sampling was done at two stages. Results: Confirmatory factor analysis was used to evaluate the construct validity of DASS 21 scale. The model was overidentified as the estimated parameters were less than the number of observed variances and covariances. CMIN/DF(Chi square (minimum discrepancy function) /Degree of freedom) value was 2.021 which was < 5. Goodness of Fit Index (GFI) value (0.892) was near to .9. Root Mean square Residuals (RMR) and Root Mean Square Error of Approximation (RMSEA) value were 0.031 and 0.063 respectively which were less than 0.08. Average variance extracted (AVE) for the three constructs were less than the squared interconstruct correlation. Conclusion: DASS-21 scale demonstrated a good convergent validity, but in this study, discriminant validity was found to be poor as determined by average variance extracted in comparison to squared Interconstruct correlation.

Empowering Communities: A Review of Community-Based Outreach Programs in Controlling Hypertension in India.

India's epidemiological shift from communicable to non-communicable diseases (NCDs) signifies the impact of healthcare advancements and changing lifestyles. Despite declines in infectious diseases, challenges related to chronic conditions such as cardiovascular diseases and diabetes have risen. Approximately one in four Indian adults has hypertension, with only 12% maintaining controlled blood pressure. To meet the 25% relative reduction target in hypertension prevalence by 2025, India must enhance treatment access and public health initiatives. A global report underscores the urgency of preventing, detecting, and managing hypertension, especially in low- and middle-income countries like India, where 188.3 million adults are estimated to have hypertension. Loss to follow-up persists in both communicable and non-communicable diseases, driven by factors such as stigma and socioeconomic barriers. Community outreach programs have proven effective, incorporating mobile health interventions, community health worker engagement, and door-to-door screenings. Hypertension management faces similar challenges, with community outreach tailored to lifestyle factors and cultural beliefs showing promise. The comprehensive strategy to control hypertension involves strengthening primary healthcare centers, promoting wellness centers, and capacitating Community Health Officers. While community-led, tech-enabled private sector interventions can screen and manage NCDs, integration with the public health system is crucial for widespread adoption and cost-effectiveness. In conclusion, tailored strategies, such as community outreach integrated into healthcare systems, are essential to address loss to follow-up and enhance health management success in both communicable and non-communicable diseases.

Effectiveness of Continued Nursing Education programme on Knowledge regarding concept of Middle Level Health Provider (MLHP) in bridging Health Gap at Peripheral level among Undergraduate Nursing Students of selected Nursing College at Bangalore South, Karnataka, India

The public health system in India was designed with an architectural correction in mind to deliver Primary Health Care. The Indian government has introduced a new position under mid-level healthcare providers: the community health officer. When patients are seeking treatment at HWCs, MLHPs also serve as the primary healthcare providers. Aim: The aim of this study was to determine the effectiveness of Continued Nursing Education Programme on enhancing the Knowledge of Undergraduate Nursing Students on concept of MLHP. Methodology: Quantitative approach with one group Pre-test and Post-test Research Design was used for the study. The Sample Consist of Undergraduate Nursing Students and Non probability purposive sampling technique was used for this study. Study conducted in selected Nursing College of Bangalore. The sample size was 60 Undergraduate Nursing students. Data was gathered through Structured Knowledge Questionnaire on various Concept of MLHP. Result: Post-test Mean percentage knowledge score (Mean percentage =74.28 and SE = 0.341) was found higher than Pre-test Mean percentage knowledge score (Mean percentage = 49.48 and SE = 0.348). Enhancement of Mean Percentage was 24.80%. Conclusion: The study found that Continued Nursing Education Programme was effective in improving the knowledge of undergraduate nursing students on Concept of MLHP. For MLHPs to perform better, they must have access to ongoing training materials.

The public healthcare sector of Mauritius: knowledge of and attitudes toward hearing loss among community health workers.

Mauritius does not have community health workers trained in identifying risk factors for hearing loss or in referring patients for diagnostic testing. It is crucial to gather information about the knowledge of and attitudes toward hearing loss among community health workers before involving them in the identification and intervention of hearing loss in Mauritius. To describe the knowledge of and attitudes toward hearing loss among community health workers in Mauritius. A descriptive survey design with quantitative analysis was used. Using non-probability purposive sampling, 125 community health workers which included 94 community health officers and 31 community-based rehabilitation officers were recruited from the five catchment areas of the public healthcare sector. Participants filled in a 15-item paper-based questionnaire on the knowledge of and attitudes toward hearing loss. The questionnaire was internally consistent, with Cronbach alpha scores of 0.759 and 0.863. The overall knowledge of community health workers regarding risk factors and the identification of hearing loss was poor (38.3%). 92.6% of community health workers reported positive attitudes toward hearing loss. General knowledge of hearing loss (P=0.015) and knowledge of risk factors and identification of hearing loss (P=0.005) were significant predictors of attitudes toward hearing loss. Knowledge of and attitudes toward hearing loss were significantly associated with working experience and practice setting (P=0.004). There remains a need to educate community health workers about the risk factors and identification of hearing loss to ensure timely diagnosis and management of hearing loss at the community level.

Improving Malaria Case Management and Referral Relationships at the Primary Care Level in Ghana: Evaluation of a Quality Assurance Internship.

In Ghana, Community-based Health Planning and Services (CHPS) compounds managed by trained nurses and midwives called community health officers (CHOs) play a major role in malaria service delivery. With heavy administrative burdens and minimal training in providing patient care, particularly for febrile illnesses, including malaria, CHOs struggle to comply with the World Health Organization's test, treat, and track initiative guidelines and appropriate referral practices. A clinical training and mentorship program was implemented for CHOs to prevent and manage uncomplicated malaria and offer appropriate pre-referral treatment and referrals to district hospitals. Medical officers, pharmacists, midwives, health information officers, and medical laboratory scientists at 52 district referral hospitals were trained as mentors; CHOs from 520 poorly performing CHPS compounds underwent a 5-day internship at their assigned district referral hospital to improve knowledge and clinical skills for malaria case management. Three months later, mentors conducted post-training mentoring visits to assess knowledge and skill retention and provide ongoing on-the-job guidance. Significant percentage-point increases were observed immediately post-internship for history taking (+12.0, 95% confidence interval [CI]=8.3, 15.1; P<.001); fever assessment (+24.9, 95% CI=20.9, 29.3; P<.001); severe malaria assessment and referral (+32.0, 95% CI=28.2, 35.8; P<.001); and knowledge assessment (+15.8, 95% CI=10.0, 21.3; P<.001). Three months later, a third assessment revealed these gains were largely maintained. Analysis of national health management information system data showed statistically significant improvements in testing, treatment, and referral indicators at intervention CHPS compounds after the intervention that were not observed in comparison CHPS compounds. This training and mentorship approach offers a replicable model to build primary care provider competencies in malaria prevention and management and demonstrates how developing relationships between primary care and first-level referral facilities benefits both providers and clients. More methodologically rigorous studies are needed to measure the impact of this approach.

Utilization and challenges of ‘Swasthya Ingit’ services faced in a district of West Bengal, India: a mixed methods approach

Abstract Background: “Telemedicine” is used to provide accessible, quality healthcare to distant people. Globally and also in India, telemedicine was implemented and accelerated during the COVID-19 pandemic. In West Bengal, telemedicine is known as “Swasthya Ingit.” The purpose of the study was to find out the utilization of Swasthya Ingit and to explore challenges faced by community health officers (CHO) and medical officers during consultation in a hub of South 24 Parganas in West Bengal. Materials and Methods: A descriptive record-based, cross-sectional approach with convergent parallel mixed methods was undertaken for 3 months (May–July 2023). A total of 6,775 consultations with Swasthya Ingit was used for quantitative purpose. Data were analyzed using Microsoft Excel 2019 by suitable descriptive statistics. An in-depth interview was conducted for the qualitative strand, and the data were analyzed thematically. Results: A total of 6,775 Teleconsultations were given, of which 76% were utilized by South 24 Parganas district. The maximum consultation was provided to the Baruipur block. Of the attended patients, 71% were female, 73% were adults, and 37% suffered from noncommunicable diseases (NCDs). During the consultation, CHO identified network issues, overburden, lack of workforce resources, and target achievement. Conclusion: Most of the population of South 24 Parganas utilized teleconsultation for NCDs. Lifestyle modification is necessary, along with medication, to combat the then-on-communicable disease burden. The thematic analysis revealed challenges faced by CHO—CHO overburdened with work, weak network issues, pressure of target achievement, and lack of workforce and resources.

An Assessment of Knowledge, Attitude, and Practice of Medical Professionals on Factors Related to Antimicrobial Resistance in Three (3) Selected University Teaching Hospital Complexes in Sierra Leone: A Cross-Sectional Analytic Study

Although the growing increase of AMR is a major problem everywhere, developing nations like Sierra Leone are particularly at higher risk because of their limited resources to combat the problem. Medical Professionals are recognized as important determinants of antimicrobial abuse. To evaluate factors related to antimicrobial resistance patterns, a cross-sectional study was undertaken among 376 Medical Professionals. Doctors, nurses, pharmacists, laboratory Personnel and community health officer from three Sierra Leone University Teaching Hospital Complexes in Sierra Leone, formed the study population. KAP dimensions were assessed, and differences between groups were investigated, using descriptive statistics tests. The study highlighted the socio-demographic factors of health professionals (age, gender, profession, qualification, and years of experience) that were associated with antibiotic resistance training (p &lt; 0.05). In the area of attitude towards antibiotics, 54% (203) and 72.9% (274) of study participants recommended that pharmacy staff be at their workstations to deliver services and dispense antibiotics prescribed by authorized prescribers as recommended by the Ministry of Health. Out of the total survey participants, 54.5% suggested antibiotics for laboratory-confirmed diseases. To prevent antibiotic resistance, 72.9% of survey participants advised patients to finish antibiotics. This study revealed the need for pharmacy staff to always be available to provide services and dispense antibiotics. Healthcare professionals must be monitored to combat AMR. More research is needed to understand and improve antibiotic stewardship practices in Sierra Leone. Keywords: Antibiotic, Attitude, Knowledge, Practice, Resistance.

Evaluating the Impact of Mental Health Training on Awareness of Common Mental Disorders among Community Health Officers in Raisen District, Madhya Pradesh

Mental health constitutes an integral dimension of overall well-being, significantly influencing individuals' quality of life and societal harmony. In rural regions, like Madhya Pradesh, accessing adequate mental health care often poses substantial challenges due to various barriers. This study aims to evaluate the impact of training on the awareness of common mental disorders (CMDs) among Community Health Officers (CHOs) in Raisen District, Madhya Pradesh. Using a quasi-experimental design, 42 CHOs from Health &amp; Wellness Centres in the Raisen district participated in a comprehensive two-day training program covering CMD identification, assessment, and management. Baseline knowledge assessment revealed a moderate pre-training score of 18.2 out of 30, while the post-training score significantly improved to 26.8. The study emphasizes the pivotal role of such training interventions in enhancing mental health care awareness and proficiency within underserved communities ultimately contributing to improved accessibility and quality of mental health care in rural settings.

Interpersonal Challenges Faced By Community Health Officers at Health and Wellness Centres in Delivery of Comprehensive Primary Health Care in Tribal Setting of Gujarat: A Mixed Methods Study

Introduction: Multi skilling and expansion of the team members involved in operationalizing Sub-Health Centres (SHCs) to Sub-health Centres-Health and Wellness Centres (SHC-HWCs) in India tends to be a challenge. New roles are being assigned to Community Health Officer (CHO) in an exponential manner. Objective: To identify the team-based interpersonal challenges encountered by Community Health Officers (CHOs)in terms of human relations in professional forefront and extract probable solutions from them for overcoming these challenges. Method: It was a sequential type of mixed method done in two-step process, quantitative survey of the defined indicators at SHC-HWCs followed by group discussion among CHOs for qualitative data. Quantitative survey was aimed at finding utilization of services. (Triangulation of both the data) whereas qualitative survey was aimed at finding out interpersonal challenges faced for adequate service delivery. Authors targeted to collect data from all the SHC-HWCs (N=53) in Dahod block for quantitative and qualitative survey. Results: The service utilization related to Maternal health and child health; childhood and adolescent health were found in range of 90-95%, followed by community participation (70%). The qualitative analysis of data revealed that CHOs were overburdened by their superiors and perceived lack of co-operation, dedication, and accountability from fellow team members. Conclusion: Utilization of certain services like non-communicable diseases (NCD), palliative care, mental health was found to be suboptimal. Significant lack of motivation and coordination were possibly some of the contributors.

Training primary healthcare workers on a task-strengthening strategy for integrating hypertension management into HIV care in Nigeria: implementation strategies, knowledge uptake, and lessons learned

BackgroundWith improved access to anti-retroviral drugs, persons living with HIV/AIDS (PLWHA) are living longer but with attendant increased risks of non-communicable diseases (NCDs). The increasing burden of NCDs, especially hypertension, could reverse gains attributed to HIV care. Nurses and Community Health Officers (CHO) in Nigeria are cardinal in delivering primary health care. A task-strengthening strategy could enable them to manage hypertension in HIV care settings. This study aimed to assess their knowledge and practice of hypertension management among Healthcare workers (HCWs) and to explore the challenges involved in conducting onsite training during pandemics.MethodsNurses and CHOs in the employment of the Lagos State Primary Health Care Board (LSPHCB), Lagos State, Nigeria, were recruited. They were trained through hybrid (virtual and onsite) modules before study implementation and a series of refresher trainings. A pre-and post-training test survey was administered, followed by qualitative interviews to assess skills and knowledge uptake, the potential barriers and facilitators of task-sharing in hypertension management in HIV clinics, and the lessons learned.ResultsSixty HCWs participated in the two-day training at baseline. There was a significant improvement in the trainees' knowledge of hypertension management and control. The average score during the pre-test and post-test was 59% and 67.6%, respectively. While about 75% of the participants had a good knowledge of hypertension, its cause, symptoms, and management, 20% had moderate knowledge, and 5% had poor knowledge at baseline. There was also an increase in the mean score between the pre-test and post-test of the refresher training using paired t-tests (P < 0.05). Role-playing and multimedia video use improved the participants' uptake of the training. The primary barrier and facilitator of task sharing strategy in hypertension management reported were poor delineation of duties among HCWs and the existing task shifting at the Primary Healthcare Centres (PHC) level, respectively.ConclusionsThe task strengthening strategy is relevant in managing hypertension in HIV clinics in Nigeria. The capacity development training for the nurses and CHOs involved in the Integration of Hypertension Management into HIV Care in Nigeria: A Task Strengthening Strategy (TASSH-Nigeria) study yielded the requisite improvement in knowledge uptake, which is a reassurance of the delivery of the project outcomes at the PHCs.

Trial-based economic evaluation of the system-integrated activation of community health volunteers in rural Ghana

ABSTRACT Background Globally, steps to revitalise programmes deploying community health workers (CHWs) on a national scale have been growing, but few economic evaluations have been done on system-integrated CHW programmes. Ghana has dual cadres of CHWs: community health officers (CHOs) and community health volunteers (CHVs). CHO plays a major role in primary health services but has suffered from chronic staff shortages. We activated CHVs in communities to mitigate the negative impact due to CHO shortages. The CHVs conducted home visits and provided health education to prevent childhood diseases. Objective We evaluated the cost-effectiveness and cost-benefit of activating CHVs. Methods In a cluster-randomised trial with 40 communities in rural Ghana, the changes in disease incidence were inferred from a statistical model using a Bayesian generalised linear multilevel model. We evaluated the total incremental cost, benefit, and effectiveness for the intervention from an economic model. In cost-effectiveness analysis, disability-adjusted life years (DALYs) were estimated using a decision tree model. In the cost-benefit analysis, the cost-benefit ratio and net present value of benefit were estimated using a decision tree model, and a standardised sensitivity analysis was conducted. The decision tree model was a one-year cycle and run over 10-years. Costs, benefits, and effectiveness were discounted at a rate of 3% per year. Results According to the cost-effectiveness analysis, the programme was highly likely to exceed the WHO-CHOICE threshold (1–3 times GDP per capita), but it was unlikely to exceed the conservative threshold (10–50% of GDP per capita). In the cost-benefit analysis, the mean and median cost-benefit ratios were 6.4 and 4.8, respectively. Conclusion We found the potential economic strengths in the cost-benefit analysis. To integrate CHW programmes with national health systems, we need more research to find the most effective scope of work for CHWs.