Perceptions Of Health Workers Research Articles

Community and Health Worker Perceptions and Preferences Regarding Integration of Other Health Services With Routine Vaccinations: Four Case Studies

Integration of routine vaccination and other maternal and child health services is becoming more common and the services being integrated more diverse. Yet knowledge gaps remain regarding community members and health workers acceptance, priorities, and concerns related to integration. Qualitative health worker interviews and community focus groups were conducted in 4 African countries (Kenya, Mali, Ethiopia, and Cameroon). Integration was generally well accepted by both community members and health workers. Most integrated services were perceived positively by the communities, although perceptions around socially sensitive services (eg, family planning and human immunodeficiency virus) differed by country. Integration benefits reported by both community members and health workers across countries included opportunity to receive multiple services at one visit, time and transportation cost savings, increased service utilization, maximized health worker efficiency, and reduced reporting requirements. Concerns related to integration included being labor intensive, inadequate staff to implement, inadequately trained staff, in addition to a number of more broad health system issues (eg, stockouts, wait times). Communities generally supported integration, and integrated services may have the potential to increase service utilization and possibly even reduce the stigma of certain services. Some concerns expressed related to health system issues rather than integration, per se, and should be addressed as part of a wider approach to improve health services. Improved planning and patient flow and increasing the number and training of health staff may help to mitigate logistical challenges of integrating services.

Percepcija zdravstvenih radnika koja se odnosi na broj i karakteristike dece žrtava zlostavljanja i zlostavljača

University Children's Clinic and Institute for Health Protection of Mother and Child 'Dr Vukan Čupić' in Belgrade have an incomplete database from which we could not get the social demographics of abused children who were patients of their institutions or the information about their abusers. That is why we decided to gather this data through perceptions of health professionals. Aim of the research was to investigate the perception of health professionals concerning the number and characteristics of child victims of abuse and abusers, as well as the phenomenology of child abuse. This phenomenological study used a quantitative method, and the technique used for data collection was a survey. The research instrument used was a questionnaire with mostly closed-ended questions. The sample included 135 doctors and nurses of both genders from the two largest and by type of organization most similar child care institutions in Serbia, the University Children's Clinic (UDC) and the Institute for Health Protection of Mother and Child 'Dr Vukan Čupić' (IMD). We tried to make a profile of the child victim of abuse based on perceptions of health workers on the form of abuse to which the child was exposed, and the age and gender of the child victims. Those children are aged between 1 and 5 years and are victims of physical abuse. Perception of health workers indicates that the most common abusers of children are members of their families.

Pengetahuan, Sikap, dan Persepsi Petugas Gawat Darurat Terhadap Kesalahan Medik

Medical error is known to occur mostly in the intensive care unit, operation room, and emergency unit. The objective of this study is to obtain information on knowledge, attitude, and perception of health workers on medical error. Study was conducted to manager, head of section, head of room, head of nursing team, doctors, and nurse. Qualitative method was employed including in-depth interview, observation, and document review. Analysis was conducted using content analysis that compare study results with theory. The study found that knowledge, attitude, and perception are relatively good, but has not been followed by appropriate action and not supported by sufficient facilities and monitoring system. Not very good referral system was an obstacle for patient’s family. Medical error was infleunced to happen by the presence of difficult cases, big number of patients, and in hurry action. The source of medical error was human factor, communication, and patient. Insufficiency or less equipped room was also perceived as source of medical error. Moreover, the attitude of management regarding medical error was not really appropriate. To minimize medical error, it is necessary to conduct trainings, refreshing course, collaboration between teams, communication improvement, and SOP compliance. Key words: Medical error, emergency unit, knowledge, attitude, health workers

Removing user fees for basic health services: a pilot study and national roll-out in Afghanistan

BACKGROUND User fees for primary care tend to suppress utilization, and many countries are experimenting with fee removal. Studies show that additional inputs are needed after removing fees, although well-documented experiences are lacking. This study presents data on the effects of fee removal on facility quality and utilization in Afghanistan, based on a pilot experiment and subsequent nationwide ban on fees. METHODS Data on utilization and observed structural and perceived overall quality of health care were compared from before-and-after facility assessments, patient exit interviews and catchment area household surveys from eight facilities where fees were removed and 14 facilities where fee levels remained constant, as part of a larger health financing pilot study from 2005 to 2007. After a national user fee ban was instituted in 2008, health facility administrative data were analysed to assess subsequent changes in utilization and quality. RESULTS The pilot study analysis indicated that observed and perceived quality increased across facilities but did not differ by fee removal status. Difference-in-difference analysis showed that utilization at facilities previously charging both service and drug fees increased by 400% more after fee removal, prompting additional inputs from service providers, compared with facilities that previously only charged service fees or had no change in fees (P = 0.001). Following the national fee ban, visits for curative care increased significantly (P < 0.001), but institutional deliveries did not. Services typically free before the ban-immunization and antenatal care-had immediate increases in utilization but these were not sustained. CONCLUSION Both pilot and nationwide data indicated that curative care utilization increased following fee removal, without differential changes in quality. Concerns raised by non-governmental organizations, health workers and community leaders over the effects of lost revenue and increased utilization require continued effort to raise revenues, monitor health worker and patient perceptions, and carefully manage health facility performance.

Community health workers perception about prenatal care

Objective. To describe the perception community health workers (CHW) have about prenatal care. &#x0D; Methodology. Convergent-care and qualitative study, carried out following the Paulo Freire’s pedagogical principles. The perceptions about difficulties found in the development of health care pro­motion activities of 15 community health workers who support prenatal care, were studied in a health institution of Santa Catalina (Brazil) between March and May of 2009. With a previous informed consent the communi­ty health workers participated in 6 workshops, in which their perceptions about knowledge and behaviors in prenatal care were evaluated using the policies of basic care of the health ministry. Data were categorized using the thematic analysis by Minayo. &#x0D; Results. Three categories emerged: previous knowledge, actions built by the CHW and teamwork-supportive work. &#x0D; Conclusion. CHW have previous knowledge about prenatal care, however it is not enough for them to understand and assess the effective­ness of their actions.

Health insurance for undocumented immigrants: opportunities and barriers on the Mexican side of the US border

This article aims to identify opportunities, barriers and challenges in Mexico's policy networks for the development of healthcare programs for undocumented migrants in the USA and their families. We used policy analysis, in-depth interviews and a case study. Key stakeholders at the federal, state and municipal levels in one major migrant-sending state were interviewed. We also conducted an in-depth case study of one community to obtain the perceptions of local health workers, migrant families and local nongovernmental organizations. Findings identified opportunities and barriers involving the stakeholders, institutions, social interactions and types of relationships necessary for further progress on binational policies. There was wide interest in creating binational health insurance with different degrees of potential involvement by political actors and variation in local actors' willingness to be covered by some type of health insurance scheme. The use of the opportunities to overcome barriers depends on the identification of high, medium or low interaction among key stakeholders, integration of coalitions and negotiating skills of all stakeholders involved.

Utilisation of sexual health services by female sex workers in Nepal

BackgroundThe Nepal Demographic Health Survey (NDHS) in 2006 showed that more than half (56%) of the women with sexually transmitted infections (STIs), including HIV, in Nepal sought sexual health services. There is no such data for female sex workers (FSWs) and the limited studies on this group suggest they do not even use routine health services. This study explores FSWs use of sexual health services and the factors associated with their use and non-use of services.MethodsThis study aimed to explore the factors associated with utilisation of sexual health services by FSWs in the Kathmandu Valley of Nepal, and it used a mixed-method approach consisting of an interviewer administered questionnaire-based survey and in-depth interviews.ResultsThe questionnaire survey, completed with 425 FSWs, showed that 90% FSWs self-reported sickness, and (30.8%) reported symptoms of STIs. A quarter (25%) of those reporting STIs had never visited any health facilities especially for sexual health services preferring to use non-governmental clinics (72%), private clinics (50%), hospital (27%) and health centres (13%). Multiple regression analysis showed that separated, married and street- based FSWs were more likely to seek health services from the clinics or hospitals. In- depth interviews with 15 FSWs revealed that FSWs perceived that personal, structural and socio-cultural barriers, such as inappropriate clinic opening hours, discrimination, the judgemental attitude of the service providers, lack of confidentiality, fear of public exposure, and higher fees for the services as barriers to their access and utilisation of sexual health services.ConclusionFSWs have limited access to information and to health services, and operate under personal, structural and socio-cultural constraints. The 'education' to change individual behaviour, health worker and community perceptions, as well as the training of the health workers, is necessary.

From their own perspective - constraints in the Polio Eradication Initiative: perceptions of health workers and managers in a district of Pakistan's Punjab province.

BackgroundThe success of the Global Polio Eradication Initiative was remarkable, but four countries - Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan reportedly achieved all milestones except interrupting virus transmission. This paper describes the perceptions of health workers and managers regarding constraints in the Polio Eradication Initiative (PEI) to ultimately provide evidence for designing future interventions.MethodsA qualitative cross-sectional study using focus group discussions and in-depth interviews was conducted in the Nankana Sahib District of Pakistan's Punjab province. Study subjects included staff at all levels in the PEI at district headquarters, in all 4 tehsils (sub-districts) and at 20 randomly selected primary health centers. In total, 4 FGD and 7 interview sessions were conducted and individual session summary notes were prepared and later synthesized, consolidated and subjected to conceptual analysis.ResultsThe main constraints identified in the study were the poor condition of the cold chain in all aspects, poor skills and a lack of authority in resource allocation and human resource management, limited advocacy and communication resources, a lack of skills and training among staff at all levels in the PEI/EPI in almost all aspects of the program, a deficiency of public health professionals, poor health services structure, administrative issues (including ineffective means of performance evaluation, bureaucratic and political influences, problems in vaccination areas and field programs, no birth records at health facilities, and poor linkage between different preventive programs), unreliable reporting and poor monitoring and supervision systems, limited use of local data for interventions, and unclear roles and responsibilities after decentralization.ConclusionThe study highlights various shortcomings and bottlenecks in the PEI, and the barriers identified should be considered in prioritizing future strategies.

Rural male health workers in Western Jamaica: Knowledge, attitudes and practices toward prostate cancer screening.

Background:Statistics have shown that since 1988, a significant percentage of males are unwilling to seek medical care. The question is if they had the knowledge, worked in the health system and were educated, would this be any different?Aim:The current study aims to fill this void in the literature by examining the perception of rural male health workers (from the Western Region) about prostate examination, and why they are reluctant to inquire about the probability of having, or the likelihood of not having prostate cancer.Materials and Methods:The study utilized primary cross-sectional data that was collected during February and March 2008 from 170 males (ages 29 years and older), health-care workers who were employed in particular rural health institutions in Jamaica (i.e. Western Regional Health Authority). SPSS was used to analyze the data.Results:When the respondents were asked “Have you ever heard about the screening procedure for prostate?” 71.2% indicated yes, but only 27.1% had got their prostate checked by a health practitioner. When respondents were asked to state what influenced their choice of not doing a digital rectal examination, 20.6% indicated comfort level; 9.4% stated the gender of the health practitioner, 5.3% mentioned fear and others did not respond. Of those who had the examination 2 years ago, 96.5% did not state the choice of method.Conclusion:The current study is limited in terms of its generalizability to rural males or rural males in Western Jamaica, but it does provide an insight into the difficulty of men in breaking away from culture.

P64 Perception of Nigerian health workers towards maternal demand for caesarean sections

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S430-S430 Poster presentations P64 Perception of Nigerian health workers towards maternal demand for caesarean sections S. Okonkwo, S. OkonkwoSearch for more papers by this authorO. Ojengbede, O. OjengbedeSearch for more papers by this authorT. Adedokun, T. AdedokunSearch for more papers by this authorI. Morhason-Bello, I. Morhason-BelloSearch for more papers by this author S. Okonkwo, S. OkonkwoSearch for more papers by this authorO. Ojengbede, O. OjengbedeSearch for more papers by this authorT. Adedokun, T. AdedokunSearch for more papers by this authorI. Morhason-Bello, I. Morhason-BelloSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)61556-3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S430-S430 RelatedInformation

Implementation experience during an eighteen month intervention to improve paediatric and newborn care in Kenyan district hospitals

BackgroundWe have conducted an intervention study aiming to improve hospital care for children and newborns in Kenya. In judging whether an intervention achieves its aims, an understanding of how it is delivered is essential. Here, we describe how the implementation team delivered the intervention over 18 months and provide some insight into how health workers, the primary targets of the intervention, received it.MethodsWe used two approaches. First, a description of the intervention is based on an analysis of records of training, supervisory and feedback visits to hospitals, and brief logs of key topics discussed during telephone calls with local hospital facilitators. Record keeping was established at the start of the study for this purpose with analyses conducted at the end of the intervention period. Second, we planned a qualitative study nested within the intervention project and used in-depth interviews and small group discussions to explore health worker and facilitators' perceptions of implementation. After thematic analysis of all interview data, findings were presented, discussed, and revised with the help of hospital facilitators.ResultsFour hospitals received the full intervention including guidelines, training and two to three monthly support supervision and six monthly performance feedback visits. Supervisor visits, as well as providing an opportunity for interaction with administrators, health workers, and facilitators, were often used for impromptu, limited refresher training or orientation of new staff. The personal links that evolved with senior staff seemed to encourage local commitment to the aims of the intervention. Feedback seemed best provided as open meetings and discussions with administrators and staff. Supervision, although sometimes perceived as fault finding, helped local facilitators become the focal point of much activity including key roles in liaison, local monitoring and feedback, problem solving, and orientation of new staff to guidelines. In four control hospitals receiving a minimal intervention, local supervision and leadership to implement new guidelines, despite their official introduction, were largely absent.ConclusionThe actual content of an intervention and how it is implemented and received may be critical determinants of whether it achieves its aims. We have carefully described our intervention approach to facilitate appraisal of the quantitative results of the intervention's effect on quality of care. Our findings suggest ongoing training, external supportive supervision, open feedback, and local facilitation may be valuable additions to more typical in-service training approaches, and may be feasible.

Perception and attitude of hospital workers towards pre-operative HIV screening of patients in an eye hospital

Aims: This study is aimed at assessing the perception and attitude of health workers in Guinness Eye Hospital, Onitsha, towards preoperative HIV screening of patients. Methodology: Semi-structured questionnaire designed to collect information on HIV and its transmission, the perception and attitude to the preoperative HIV screening were administered to the subjects. Data analysis was manual and use of electronic calculator, simple percentage and contingency c2 test. Results: Eighty seven questionnaires were distributed, 78(89.7%) were retrieved and analyzed. Sixteen (20.5%) of the subjects were males and 62 (79.5%) females. All the subjects were aware of HIV infection. Seventy seven (98.7%) of the respondents knew that preoperative HIV screening is done in Guinness Eye Centre, Onitsha. Seventy three subjects (93.6%) were in favour of preoperative HIV screening in the hospital, 4(5.1%) were against and 1(1.3%) had no opinion. All clinical staff supported preoperative HIV screening in the hospital. Conclusion: Preoperative screening is recommended for all patients undergoing surgery. Seminars should be organized for all hospital workers and public to improve knowledge of the HIV/AIDS pandemic. Keywords: Perception, Attitude, Hospital Workers, HIV screening, Eye clinicPort Harcourt Medical Journal Vol. 3 (1) 2008: pp. 91-95

Health beliefs and breast cancer screening behaviors among female health workers in Turkey

The purpose of this study was to evaluate health beliefs and breast cancer screening behaviors in female health workers in Turkey. This descriptive study was conducted in various health centers located in Erzurum, Turkey. The sample consisted of 268 female health workers (physicians, n=51; nurses, n=169; and midwives, n=48). Data were collected by using a self-administered questionnaire and the Turkish version of Champion's Health Belief Model Scales (CHBMS). The mean age of participants was 31.31 (S.D.=6.89), and 49.9% of them were married. It was found that only 21.9% of the female health workers performed breast self-examination (BSE) regularly, and 12.5% of them had a mammogram. Physicians' health motivation and BSE self-efficacy perceptions were higher than the nurses and midwives. Susceptibility, health motivation to BSE, BSE benefits, BSE self-efficacy perceptions of female health workers who performed BSE were significantly higher than those who did not, and a result indicating that positive health beliefs are effective in stimulating performance of BSE of female health workers. Among the variables related with mammography, only susceptibility perceptions of female health workers who had a mammogram was significantly higher than those who had not had a mammogram.

Knowledge and perception of health workers towards tele-medicine application in a new teaching hospital in Lagos

To determine the perception of health workers in the health-care towards tele-medicine application in a new tertiary teaching hospital, a modified structured questionnaire using a prospective postal survey was administered to a cross-section of health workers in Lagos State University Teaching Hospital (LASUTH)/Lagos State University College of Medicine (LASUCOM). Only 60.9% of respondents were familiar with this new emerging concept of tele-medicine / tele-health in the health care system. Although, 50% of health workers had expressed concern about the ethical and medico-legal consideration of tele medicine practice, this was irrespective of their socio-religious background. The principal factors weighing in favour of willingness to use tele-health services were knowledge of tele-health applications (28.1%); perception of tele-health benefits (14.1%), reduced barriers to tele-health care among others. Most of the respondents believed that tele-health would enhance direct access to health care services (23.4%), improve quality of care (14.1%) among others. It is desirable to offer tele-medicine to patients especially for emergency and chronic medical conditions. Key words: Tele-medicine / tele-health, health workers, perception, knowledge, Lagos.

Danger signs of neonatal illnesses: perceptions of caregivers and health workers in northern India

To assess household practices that can affect neonatal health, from the perspective of caregivers and health workers; to identify signs in neonates leading either to recognition of illness or health-care seeking; and to ascertain the proportion of caregivers who recognize the individual items of the integrated management of neonatal and childhood illnesses (IMNCI) programme. The study was carried out in a rural community in Sarojininagar Block, Uttar Pradesh, India, using qualitative and quantitative research designs. Study participants were mothers, grandmothers, grandfathers, fathers or "nannies" (other female relatives) caring for infants younger than 6 months of age and recognized health-care providers serving the area. Focus group discussions (n = 7), key informant interviews (n = 35) and structured interviews (n = 210) were conducted with these participants. Many household practices were observed which could adversely affect maternal and neonatal health. Among 200 caregivers, 70.5% reported home deliveries conducted by local untrained nurses or relatives, and most mothers initiated breastfeeding only on day 3. More than half of the caregivers recognized fever, irritability, weakness, abdominal distension/vomiting, slow breathing and diarrhoea as danger signs in neonates. Seventy-nine (39.5%) of the caregivers had seen a sick neonate in the family in the past 2 years, with 30.38% in whom illness manifested as continuous crying. Health care was sought for 46 (23%) neonates. Traditional medicines were used for treatment of bulging fontanelle, chest in-drawing and rapid breathing. Because there is no universal recognition of danger signs in neonates, and potentially harmful antenatal and birthing practices are followed, there is a need to give priority to implementing IMNCI, and possible incorporation of continuous crying as an additional danger sign.

Healthcare reform involving the introduction of user fees and drug revolving funds: influence on health workers’ behavior in southeast Nigeria

Objectives To assess the perceptions of health workers towards the drug revolving fund (DRF) scheme and the perceptions of the community members about health workers since the introduction of the DRF. Methods The study was conducted in four purposively selected local government areas (LGAs) in southeast Nigeria where the Bamako initiative DRF was operational. Data was collected using in-depth interviews with randomly selected health workers and exit interviews with patients who attended the health centers. Results There were differences between the ways the DRF affected health workers in the different LGAs. In general, the motivation of the health workers to deliver health services improved significantly largely because they had basic drugs to work with and they benefited from the drug gains accruing through the operations of the DRF. However, as time went on, some got de-motivated and their attentions became more focused on revenue generation and profit making through sale of own drugs at the expense of health of the people as no incentives were paid and salaries were delayed. Curative services were provided more than promotive and preventive services and drugs are prescribed irrationally. Patients showed wide spread dissatisfaction with fees charged, waiting time before being seen, and treatment instructions given to them. Conclusion Governments need to focus not only on the provision of drugs and revenue generation but also on providing strong support for in-service training, monitoring and supervisory activities to improve health workers’ attitude to work. The governments also need to explore incentives such as working condition and monetary incentives to motivate health workers to improve their performance so as to serve the consumers better.

Health workers' attitude and perception toward routine pre-marital HIV screening

More than half of all new HIV infections occur among young adults, however, the rate of new infections among women surpasses men's especially in Sub-Saharan Africa. This rising infection rates, particularly among women, exposes children to increased HIV risk even before they are born. This descriptive cross-sectional study was conducted to determine the attitude and perception of health workers to routine pre-marital HIV screening that is currently practice by some religious institutions as part of initiative directed towards controlling the spread of the infection. Three hundred (300) self-administered questionnaires distributed to the health workers in their respective units were analyzed. Majority of the respondents 270 (90%) agreed that pre-marital HIV screening is necessary and advantageous to couples intending to get married. Although more than half of the respondents (56.7%) believed that the screening exercise is associated with some disadvantages, as many as 205 (68.3%) were in support of its enforcement for all couple. Majority 260 (86.7%) agreed that religious leaders/institutions have important role to play in HIV control and most of them 265 (88.3%) would prefer that Government health facilities be used as screening centres; and medical doctors should be the person to reveal the test results to the couples 275 (91.7%). About two-third of the respondents felt that the couples should initiates request for HIV screening, and on the issue of whether or not the marriage should be contracted following a positive result in one or both partners, 180(60%) respondents felt that the decision should be made by the couple. Counseling of couples before and after HIV screening, adequate training of health workers on HIV counseling skill and making HIV screening free to couple were suggested by the respondents as incentive that would enhance voluntary pre-marital HIV testing. Afr. J. Clin. Exper. Microbiol. Vol.6(1) 2005: 46-52

Health Worker Perceptions of the Integration of Leprosy Control Services at the Primary Health Care Level in Ibadan, Nigeria

A goal of both the World Health Organization and the Nigerian National Tuberculosis and Leprosy Control (TBL) Program is to integrate leprosy control services into the front line primary health care service system. Traditionally, leprosy services had been handled by one local government officer with little involvement of other health staff, and this limited access and timeliness of services for leprosy patients. Even after the national TBL program was implemented, integration has not been achieved, and this study of 203 front line health workers in the five local government areas that comprise the Ibadan metropolitan area of Oyo State, Nigeria sought to determine the role of health worker knowledge, attitudes, and self-efficacy in fostering or inhibiting leprosy service integration. Leprosy knowledge scores were positively associated with years in service, having lectures on leprosy during basic training, and having attended in-service training (IST) on leprosy. Among the cadres interviewed, Environmental Health Officers (EHOs), who had traditionally managed leprosy services prior to the move for integrated services, had the highest scores. EHOs and those who had leprosy lectures during basic training also had better attitudes toward leprosy than their counterparts. Male health staff and those who had leprosy lectures during basic training also had higher attitude scores concerning integrating leprosy control services with primary care. Finally, the only factor associated with perceived self-efficacy to perform leprosy control services was cadre. Ironically, Community Health Extension workers, who have had little in the way of experience with and training in leprosy control, believed they could handle these responsibilities better than other cadres. The influence of basic and in-service training on enhancing leprosy control knowledge and attitudes is recognized and enhancement of curricula for all cadres on leprosy issues is recommended.

Health worker perceptions of how being observed influences their practices during consultations with ill children.

Health worker perceptions of how being observed influences their practices during consultations with ill children.

Inter-Organisational Relationships of Community Health Centres

It is often argued that community based health organisations ought to have substantial links with other organisations in their local environment in order to provide integrated, accountable clinical and preventive services. This paper reports results from a study of the links forged by staff working in four community health centres in Victoria, Australia. The pattern of links between organisations is described and their functions explored. The perceptions of community health workers and their network partners in the other organisations are compared and the strategies used by the workers to establish and build their links identified. It can be argued that links with external organisations are important in community health practice and are valued by the organisations with which the centres establish links. They have, however, received very little attention within or without the field of community health. They are taken for granted, rarely discussed, and as often inhibited as facilitated by the structures within which community health centres operate. Consequently, a great deal of valuable community health work remains unacknowledged, potentially underdeveloped and undervalued. It has not been made clear how education can best support community health staff in this aspect of their work.