Community Health Workers Activities Research Articles

Costs of Promoting Exclusive Breastfeeding at Community Level in Three Sites in South Africa

BackgroundCommunity-based peer support has been shown to be effective in improving exclusive breastfeeding rates in a variety of settings.MethodsWe conducted a cost analysis of a community cluster randomised-controlled trial (Promise-EBF), aimed at promoting exclusive infant feeding in three sites in South Africa. The costs were considered from the perspective of health service providers. Peer supporters in this trial visited women to support exclusive infant feeding, once antenatally and four times postpartum.ResultsThe total economic cost of the Promise-EBF intervention was US$393 656, with average costs per woman and per visit of US$228 and US$52, respectively. The average costs per woman and visit in an operational ‘non research’ scenario were US$137 and US$32 per woman and visit, respectively. Investing in the promotion of exclusive infant feeding requires substantial financial commitment from policy makers. Extending the tasks of multi-skilled community health workers (CHWs) to include promoting exclusive infant feeding is a potential option for reducing these costs. In order to avoid efficiency losses, we recommend that the time requirements for delivering the promotion of exclusive infant feeding are considered when integrating it within the existing activities of CHWs.DiscussionThis paper focuses on interventions for exclusive infant feeding, but its findings more generally illustrate the importance of documenting and quantifying factors that affect the feasibility and sustainability of community-based interventions, which are receiving increased focus in low income settings.

Predictors and a Framework for Fostering Community Advocacy as a Community Health Worker Core Function to Eliminate Health Disparities

Using a mixed-method, participatory research approach, we investigated factors related to community health worker (CHW) community advocacy that affect social determinants of health. We used cross-sectional survey data for 371 CHWs to assess demographics, training, work environment, and leadership qualities on civic, political, and organizational advocacy. We present advocacy stories to further articulate CHW activities. The data reported are from the recently completed National Community Health Workers Advocacy Study. CHWs are involved in advocacy that is community-focused, although advocacy differs by intrinsic leadership, experience, training, and work environment. We propose a framework to conceptualize, support, and evaluate CHW advocacy and the iterative processes they engage in. These processes create opportunities for community voice and action to affect social and structural conditions that are known to have wide-ranging health effects on communities. The framework presented may have utility for CHWs, their training programs, and their employers as well as funders and policymakers aiming to promote health equity.

1 million community health workers in sub-Saharan Africa by 2015

1 million community health workers in sub-Saharan Africa by 2015

Community Health Workers Providing Government Community Case Management for Child Survival in Sub-Saharan Africa: Who Are They and What Are They Expected to Do?

We describe community health workers (CHWs) in government community case management (CCM) programs for child survival across sub-Saharan Africa. In sub-Saharan Africa, 91% of 44 United Nations Children's Fund (UNICEF) offices responded to a cross-sectional survey in 2010. Frequencies describe CHW profiles and activities in government CCM programs (N = 29). Although a few programs paid CHWs a salary or conversely, rewarded CHWs purely on a non-financial basis, most programs combined financial and non-financial incentives and had training for 1 week. Not all programs allowed CHWs to provide zinc, use timers, dispense antibiotics, or use rapid diagnostic tests. Many CHWs undertake health promotion, but fewer CHWs provide soap, water treatment products, indoor residual spraying, or ready-to-use therapeutic foods. For newborn care, very few promote kangaroo care, and they do not provide antibiotics or resuscitation. Even if CHWs are as varied as the health systems in which they work, more work must be done in terms of the design and implementation of the CHW programs for them to realize their potential.

Community Health Workers’ Perspectives on Their Contribution to Rural Health and Well-Being in Iran

The activities of community health workers (CHWs) have been identified as key to improvements in the health of Iran's rural population. We explored the perceptions of CHWs regarding their contribution to rural health in Iran. Three research assistants familiar with the Iranian primary health care network conducted face-to-face interviews with CHWs in 18 provinces in Iran. Findings showed that Iranian CHWs have an in-depth understanding of health, including its social determinants, and are responsible for a wide range of activities. Respondents reported that trust-based relationships with rural communities, an altruistic motivation to serve rural people, and sound health knowledge and skills are the most important factors facilitating successful implementation of the CHW program in Iran. By contrast, high workload and the lack of a support system were mentioned as barriers to effective performance. The CHW program in Iran is a compelling example of comprehensive primary health care, in that CHWs provide basic health care but also work with community members and other sectors to address the social determinants of health.

Establishing a Professional Profile of Community Health Workers: Results from a National Study of Roles, Activities and Training

Community Health Workers (CHWs) have gained national recognition for their role in addressing health disparities and are increasingly integrated into the health care delivery system. There is a lack of consensus, however, regarding empirical evidence on the impact of CHW interventions on health outcomes. In this paper, we present results from the 2010 National Community Health Worker Advocacy Survey (NCHWAS) in an effort to strengthen a generalized understanding of the CHW profession that can be integrated into ongoing efforts to improve the health care delivery system. Results indicate that regardless of geographical location, work setting, and demographic characteristics, CHWs generally share similar professional characteristics, training preparation, and job activities. CHWs are likely to be female, representative of the community they serve, and to work in community health centers, clinics, community-based organizations, and health departments. The most common type of training is on-the-job and conference training. Most CHWs work with clients, groups, other CHWs and less frequently community leaders to address health issues, the most common of which are chronic disease, prevention and health care access. Descriptions of CHW activities documented in the survey demonstrate that CHWs apply core competencies in a synergistic manner in an effort to assure that their clients get the services they need. NCHWAS findings suggest that over the past 50years, the CHW field has become standardized in response to the unmet needs of their communities. In research and practice, the field would benefit from being considered a health profession rather than an intervention.

Outcome effectiveness of community health workers: an integrative literature review.

Community health workers (CHWs) are promoted as a mechanism to increase community involvement in health promotion efforts, despite little consensus about the role and its effectiveness. This article reviews the databased literature on CHW effectiveness, which indicates preliminary support for CHWs in increasing access to care, particularly in underserved populations. There are a smaller number of studies documenting outcomes in the areas of increased health knowledge, improved health status outcomes, and behavioral changes, with inconclusive results. Although CHWs show some promise as an intervention, the role can be doomed by overly high expectations, lack of a clear focus, and lack of documentation. Further research is required with an emphasis on stronger study design, documentation of CHW activities, and carefully defined target populations.

Time distribution of CHW activities: does curative care preclude preventive care?

20 of the 72 active community health workers (CHWs) in 1 community health program in Kenya were randomly selected for observational visits in an attempt to assess the proportion of time spent on curative versus preventive activities by CHWs. Each CHW was notified of the visit as a supervisory visit without reference to observation. Once on site the supervisor and a recorder explained the observation process to the CHW and then joined the CHW in making home visits within the CHWs catchment area. Observations were recorded at 2-minute intervals from the start of travel to the home of the 1st client and continued until the team returned to the starting point. Observations were carried out by the local supervisor and translated into English to be tabulated by the recorder. CHW activities were assigned to categories: introductions; travel; supervision; family planning; environment; prevention and maternal and child health (MCH); and curative. 20 CHWs were observed each for a period ranging from 84-217 minutes while they visited from 1-10 homes. 1 of the 20 observations was eliminated because the CHW had prepared special homes for visiting ahead of time. The preventive activities of family planning environment and prevention/MCH accounted for an average of 33% of CHW time compared to 1% for curative care. The task entitled included general meeting conversation and evangelism. There was no significant variance in the percent of time spent on these activities between evangelists and nonevangelists and male and female workers greeting women although culturally one might expect a difference. The nonhealth components that is travel introductions and supervision accounted for 67% of CHW time expenditure. Those CHWs who receive tokens do more curative work than their unpaid colleagues. There were no significant differences between any groups in terms of the percent of time spent on family planning while there were some differences in the percent of service time spent on curative care. Due to the small number observed these differences had no statistical significance. This study demonstrates that CHWs who are involved in both preventive and curative work are able to maintain an emphasis on preventive activities.

Monitoring and evaluation of primary health care in rural Zambia. A comparative study.

This paper presents the major findings of an on-going monitoring and evaluation study of Primary Health Care with emphasis on child and maternal health services sponsored by UNICEF and the Government of Zambia. The objectives of this research are to evaluate and monitor the implementation of Primary Health Care in remote rural areas. Two contrasting ecological regions were selected for investigation, one in Western Province and the other in Northern Province and a core sample of 100 households from each area were selected to be monitored for 4 years. The research methodology included structured questionnaires, observation of community activities, designing and implementing community and household-based information systems, key informant interviewing, and reviewing health facility records and village registers. The findings regarding disease patterns, health service untilization, nutrition, maternal/reproductive data, health recording systems, and activities of community health workers are compared and constrasted for the two areas. Environmental and other constraints have impeded the effective provision of health services and has resulted in high morbidity, nutrition problems and inadequate child/maternal health, in both areas. An alternative model for health provision which emphasizes community-level needs is presented. Finally, the importance of community-based studies to national health policy planning is stressed.