Community Health Workers Research Articles

Task-sharing to promote caregiver mental health, positive parenting practices, and violence prevention in vulnerable families in Sierra Leone: a pilot feasibility study

Abstract Background The prevalence of household violence in low- and middle-income countries (LMICs) is high, and exposure to violence has significant adverse effects on both mental health and child development across generations. Evidence-based services to improve parenting practices and reduce household violence in LMICs are scarce, particularly across rural regions of West Africa. This study explored the feasibility, acceptability, and potential benefits of an evidence-based home-visiting intervention to promote early childhood development and reduce household violence—the Family Strengthening Intervention for Early Childhood Development and Violence-Prevention (FSI-ECD + VP)—among vulnerable families in rural regions of Sierra Leone. Methods Eighty dual-caregiver households in the Makeni region of Sierra Leone were included in the study (N = 160 caregivers; 73% female). Eligibility criteria included having at least one child aged 6–36 months and elevated scores (> 62.5) on the Difficulties in Emotion Regulation Scale (DERS). Community Health Workers (CHWs) employed in the Makeni region completed a 3-week FSI-ECD + VP training. Families were randomized to receive either the FSI-ECD + VP or treatment as usual (TAU). Research assistants blinded to treatment assignment assessed caregiver mental health, caregiver-child interactions, and household violence at baseline, post-intervention, and 3-month follow-up time points. Results Triangulation of quantitative and qualitative data showed that caregivers, CHWs, and supervisors generally perceived the intervention as beneficial, feasible, and acceptable. Mixed effects models showed that caregivers who received the FSI-ECD + VP had significantly improved caregiver-child relationship outcomes compared to TAU as assessed by the Home Observation for Measurement of the Environment and the Observation of Caregiver-Child Interactions at post-intervention. Preliminary data also suggests that caregivers receiving the FSI-ECD + VP were less likely to have experienced intimate partner physical violence during the post-intervention period, and had lower symptoms of anxiety and depression at 3-month follow-up. Conclusions FSI-ECD + VP delivery by CHWs in Sierra Leone may be feasible and acceptable; it may also help improve caregiver-child interactions and reduce the likelihood of household violence among vulnerable families with young children. Task-sharing approaches may help increase acceptability and access to evidence-based behavioral interventions that promote early childhood development and violence prevention among families in rural regions of Sierra Leone and other similar settings. Trial registration The study is registered in clinicaltrials.gov (NCT 03045640; 07/22/2020). This study follows the Consort 2010 guidelines for reporting of clinical trials.

Feasibility and challenges in sustaining a community based surveillance system in post-Ebola Sierra Leone

BackgroundIn outbreak-prone settings, community-based surveillance (CBS) systems can alert health authorities to respond in a timely manner where suspected cases of disease are being reported. After the 2014–2016 Ebola outbreak, the WHO and other stakeholders supported the establishment of CBS in Sierra Leone, for which community health workers (CHW) were trained to collect and report symptoms data of 11 priority health conditions in their communities. Our study objective was to assess feasibility and challenges to sustain CBS in a low resource setting as part of a World Bank evaluation of Sierra Leone’s Ministry of Health and Sanitation’s (MoHS) CBS and electronic Integrated Disease Surveillance & Response (eIDSR) systems.MethodsIn 2019 we conducted a mixed methods assessment consisting of a household incidence survey, health facility survey, household case verification survey, a costing analysis, and in-depth interviews and focus group discussions with key stakeholders of the CBS system in eight chiefdoms of 4 purposefully selected districts in Sierra Leone. The study period for primary data collection was February through April 2019. We also conducted secondary data analysis of surveillance data in DHIS2 of all 32 chiefdoms.ResultsIn districts where CBS was ‘fully functional’, the number and type of CBS alerts corresponded to the number and type of diseases reported through facility based eIDSR system in the same period. However under-reporting of diarrhea and measles suspects from the community still appeared to occur, and reporting deteriorated when primary health care staff including CHWs reported the stoppage of stipends. The annual budget impact for CBS was estimated at 4.4 million USD in 2018. The majority of costs were made at community level (73%) compared to regional (0.3%), primary health unit (21%), district (4%) and national (2%) level. The most important costs drivers were training of CHWs (59% of total costs) and salaries (including stipends of the CHWs) of human resources (15%). Barriers included sustainable financing of human resources, internet connectivity, as well as limited trainings and supportive supervision, and unsupported transportation costs for CHWs and peer supervisors (PS). CHWs and community members reported that communities are more willing to share information about health issues compared to the pre-CBS implementation period.ConclusionsThe similarity between CBS and IDSR reports support the possibility that CBS increases the sensitivity of disease surveillance to the level of the community, which would enable local authorities to take early prevention measures when and where impact will be the greatest. Qualitative interviews suggest that CBS has improved the interface between the community and primary level of the health system. However if the barriers to sustainability are left unaddressed, opportunities for CBS to prevent disease outbreaks will go unrealized.

Addressing Hypertension and Diabetes through Community-Engaged Systems (ANDES) in Puno, Peru: rationale and study protocol for a hybrid type 2 effectiveness and implementation randomized controlled trial

BackgroundHypertension is the most common cardiovascular disease in Peru despite the availability of cost-effective, evidence-based treatment. Here we describe the rationale and study design for a hybrid type 2 randomized controlled trial to test the implementation and effectiveness of a community health worker (CHW)-led hypertension control program within the national primary care system in Puno, Peru.MethodsWe will recruit 1068 adult participants with hypertension aged ≥ 18 years in Puno, Peru, via facility-based enrollment and community health fairs. Participants will be individually randomized (1:1) to either continue with usual care or participate in a 12-month CHW-led home-based hypertension control program consisting of blood pressure monitoring, medication adherence support, and healthy lifestyle counseling. Outcome development and reporting are guided by the Consolidated Framework for Implementation Research (CFIR), the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, and the Proctor et al. framework. Clinical effectiveness outcomes include mean change in systolic blood pressure (primary outcome), diastolic blood pressure, and HbA1C. Implementation outcomes include fidelity (i.e., CHW protocol adherence and dose), reach, adoption, sustainability, acceptability, and cost-effectiveness.DiscussionThe ANDES trial is testing the first CHW-led multicomponent strategy for hypertension and type 2 diabetes management in Peru. This type 2 hybrid trial will provide critical insights into the individual, community, and system-level factors necessary for successful implementation and effectiveness. These data can inform the future adaptation and scaling of the ANDES strategy in Peru and other LMICs, as well as influence policies at the system level to support this transition. Furthermore, by addressing both hypertension and diabetes, the ANDES strategy supports integrated care approaches advocated by the WHO HEARTS technical package, ultimately enhancing health outcomes and reducing morbidity and mortality in the region.Trial registrationClinicalTrials.gov, ID: NCT05524987, Addressing Hypertension and Diabetes through Community-Engaged Systems in Puno, Peru (ANDES study), prospectively registered on September 1, 2021.

Integrating Community Health Workers in Rhode Island — A Roadmap toward Health Equity

Integrating Community Health Workers in Rhode Island — A Roadmap toward Health Equity

Factors associated with perceived health of school-aged children in rural Rwanda: an opportunity to leverage community health workers to enhance school health promotion and primary healthcare systems linkages

BackgroundIn many low-income countries, enhancing the health of school-aged children is often impeded by insufficient or limited knowledge regarding their health status. Further, hands-on health promotion interventions are nearly non-existent due to the lack of designated health workers. The disconnection between schools and primary care facilities further exacerbates this issue. To address these challenges, the World Health Organization has introduced the Health Promoting School (HPS) framework, a comprehensive model designed to integrate health into all aspects of school life and promote physical, mental, and social well-being. We sought to assess the perceived health status of school-aged children, identify associated factors, and explore the role of community health workers (CHWs) in public schools in rural Rwanda.MethodsWe carried out a convergent mixed methods study among teachers and community members in rural areas of Musanze, Rwanda. Data collection instruments were adapted from the World Health Organization’s HPS framework and the literature. We conducted six in-depth interviews and three focus group discussions. We performed a logistic regression analysis to examine the factors associated with perceived health. Thematic analysis was used to analyze the qualitative data.ResultsA total of 479 individuals participated in this survey. Of these, 425 (89%) were community members, while 54 (11%) were employed as teachers at Nyabirehe or Rwinzovu public schools. Almost half of respondents 221 (46%) described the children’s health as poor. Many factors were associated with perceived children’s health, including having an established leadership team for school-based health promotion (OR = 1.97, 95%CI: 1.01,3,84), and being familiar with school-based health promotion (OR = 4.77, 95%CI: 2.27,10.0). Qualitative results described the CHW as a bridge between communities, schools, and primary healthcare centers.ConclusionThis study revealed that the health of schoolchildren needs particular attention. In resource-limited settings, HPS presents a promising opportunity to address the health and well-being of children at rural public schools. However, adapted policies, the establishment of health promotion teams, and hands-on orientation for teachers and community members are necessary to ensure an effective implementation of HPS. In Rwanda and other low-income countries where public schools lack nursing staff, CHWs could play a vital role in enhancing HPS and the linkage between schools and primary healthcare facilities.

Prevalence and Factors Associated with the Fourth Standard Antenatal Care Utilization among Pregnant Women Attending Ruli District Hospital, Rwanda

Purpose: The purpose of this research is to identify the prevalence of adherence to the recommended four antenatal care (ANC) visits and to analyze factors associated with achieving the fourth ANC visit among pregnant women attending Ruli District Hospital in Gakenke District, Rwanda. The study aims to address gaps in ANC attendance, focusing on improving maternal and fetal health. Methodology: A cross-sectional study design was used, with a sample size of 421 women, determined through Fisher et al.'s (1998) formula. Systematic sampling was employed to select participants between November 20, 2023, and January 20, 2023. Data collection included informing participants about the study and obtaining consent. Confidentiality was maintained by anonymizing participant data. Analysis was conducted using SPSS version 25, applying descriptive statistics such as percentages, means, and frequencies. Bivariate and multivariate regression analyses were used to identify relationships between independent and dependent variables, with significance assessed at p < 0.05. Findings: The study found that 57.5% of respondents adhered to the four recommended ANC visits, while 42.5% attended fewer than four. Factors significantly associated with increased ANC attendance included higher educational attainment, abstinence from alcohol by both the mother (AOR=1.953, CI: 1.202-3.174, P<0.007) and husband (AOR=2.041, CI: 1.112-3.747, P<0.002), planned pregnancies (AOR=4.159, CI: 1.975-10.326, P<0.001), and absence of mistreatment toward women (AOR=3.040, CI: 1.367-6.762, P=0.006). Unique Contribution to Theory, Practice and Policy: The study recommends enhanced supportive supervision and mentorship of Community Health Workers for home visits to pregnant women. Additionally, improving customer care and the quality of ANC services is advised. These insights are expected to guide policymakers in Rwanda, including the Ministry of Health, Ruli District Hospital, and other stakeholders, in enhancing ANC adherence and improving maternal health outcomes.

Perception of Health Professionals on Brain Drain in Nepalese Health Sector

Health workers are professionals who are engaged in the delivery of healthcare services to individuals. They include a wide range of roles such as doctors, nurses, midwives, paramedics, and support staff who provide clinical services to patients. They also encompass community health workers and public health professionals who work on disease prevention, health education, and improving access to healthcare. Health workers are essential for the functioning of health systems and play a critical role in ensuring the health and well-being of the population. Brain drain is increasing in Nepal day by day due to the many reasons, including the desire for better pay, work conditions, quality of life, high opportunities, more working hours, personal growth that make health workers leave. This situation is creating problem for Nepal’s health services. The main purpose of this study is to explore the perceptions of health professionals regarding brain drain in Nepal’s health sector. Through in-depth interviews and focused group discussions with various stakeholders, including doctors, nurses, pharmacist, health informatics, front line manager, the research aims to uncover the underlying factors contributing to emigration of skilled health workers. This study also examines the impact on Nepal’s healthcare system and suggest strategies to mitigate the loss of talent. This research contributes the deeper understanding of brain drain and provides insights for policy development to strengthen Nepal’s health sector.

Community Health Worker Videoconferencing Interventions for Disease Management and Health Promotion: Protocol for a Scoping Review

Background Public health interventions delivered by community health workers (CHWs) have been proven effective in improving health outcomes across multiple fields, particularly in populations that are underserved by traditional health care systems. To date, little research is available about how CHW-led interventions could be successfully delivered virtually, despite many other health care services being offered via telehealth. Objective This paper details a scoping review protocol that aims to assess the existing literature on CHW-led interventions using videoconferencing technology. Methods The scoping review protocol was developed using the Joanna Briggs Institute’s guidelines on conduct of scoping reviews. Included papers will describe a direct intervention to manage disease or improve health, delivered by CHWs via videoconferencing. Multiple literature databases and gray literature will be searched. Abstracts and then full texts will be reviewed to determine inclusion by 2 independent reviewers; conflicts at each stage will be resolved by a third reviewer. A data extraction tool will be used by reviewers to independently chart data from included studies; results will be reviewed for accuracy by a second reviewer. Included papers will be analyzed to identify the breadth of the available evidence, including barriers, facilitators, effectiveness, and best practices described in the literature. Data will be summarized in a narrative review. Results This study commenced in April 2022, and the study protocol was finalized in November 2022. A preliminary search of the published literature (excluding gray literature) in July 2024 revealed 276 reports after removal of duplicates. The formal literature search will commence in August 2024, with results available by December 2024. We intend to publish results in the academic literature as well as creating a report accessible to nonacademic and community audiences. Conclusions This review will illuminate the breadth of the evidence available on CHW videoconferencing interventions, with specific focus on strategies for implementation success and equity of access. and will be of great value to organizations that offer CHW services. International Registered Report Identifier (IRRID) DERR1-10.2196/55160

Experience of Health System Personnel in the Implementation of Mass Distribution Campaigns for the Control of Lymphatic Filariasis in Rural Guinea in 2022

This study documents the experiences of health system personnel in the implementation of mass distribution campaigns for the control of lymphatic filariasis in rural Guinea. This was an exploratory qualitative study using data collected from implementing actors of mass distribution campaigns in the Boké health district. The results showed four main facilitators of mass distribution campaign rollout in the Boké health district: (i) support to the district teams in the organization of the campaigns; (ii) involvement of community-based associations in social mobilization; (iii) strong adherence of the communities to the different mass distribution campaigns, facilitated through the involvement of community relays, who are members of these communities, in the distribution of drugs; and (iv) transparency in the allocation of incentives to drug dispensers and supervisors. However, the frequent shortages of medicines, the difficulty of access to rural areas, and the lack of logistical means for the supervision of activities were the main obstacles to the success of the various mass distribution campaigns in Boké. The provision of buffer stocks for special areas such as Boké by national programme actors and partners, joint planning of campaign activities with local managers of health systems and services, and improvement of existing mechanisms for motivating health workers, including community health workers, during future campaigns should help to achieve national objectives in the fight against NTDs in Guinea.

Maternal Continuum of Care among Homeless Women: Does Community Health Workers and Non-Government Organisation Involvements Matter?

Maternal Continuum of Care among Homeless Women: Does Community Health Workers and Non-Government Organisation Involvements Matter?

A critical review of literature and a conceptual framework for organising and researching urban health and community health services in low- and middle-income countries.

Low- and middle-income countries (LMIC) are rapidly urbanizing, and in response to this, there is an expansion in the body of scholarship and significant policy interest in urban healthcare provision. The idea and the reality of 'urban advantage' has meant that health research in low- and middle-income countries (LMICs) has disproportionately focused on health and healthcare provision in rural contexts and is yet to sufficiently engage with urban health as actively. We contend that this research and practice can benefit from a more explicit engagement with the rich conceptual understandings that have emerged in other disciplines around the urban condition. Our critical review included publications from four databases (MEDLINE, EMBASE, CINAHL and Social Sciences Citation Index) and two CHW resource hubs. We draw upon scholarship anchored in sociology to unpack the nature and features of the urban condition; we use these theoretical insights to critically review the literature on urban community health worker programs, as a case to reflect on community health practice and urban health research in LMIC contexts. Through this analysis, we delineate key features of the urban - such as heterogeneity, secondary spaces and ties, size and density, visibility and anonymity, precarious work and living conditions, crime, and insecurity, and specifically the social location of the urban CHWs and present their implications for community health practice. We propose a conceptual framework for a distinct imagination of the urban to guide health research and practice in urban health and community health programs in the LMIC context. The framework will enable researchers and practitioners to better engage with what entails a 'community' and a 'community health program' in urban contexts.

Early Hearing Detection and Intervention programmes for neonates, infants and children in non-Asian low-income and middle-income countries: a systematic review.

Early Hearing Detection and Intervention (EHDI) programmes were established to reduce the impact of hearing loss on children. High-income countries (HICs) have resources and knowledge to execute these programmes. However, financial and other resource constraints limit the availability of these programmes to low-income and middle-income countries (LMICs). Yet, LMICs have explored strategies to implement EHDI programmes in their context; the outcomes are still largely unknown.The aim of this study is to identify the various models of the EHDI program implemented in non-Asian LMICs. METHOD: Studies published between 2010 and 2023 reporting EHDI programmes in non-Asian LMICs for children were considered. The primary databases searched were PubMed, Scopus, Web of Science, EBSCOHost, EBSCO-CINAHL and ProQuest dissertations. The search results are summarised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses chart. Quality appraisal and risk-of-bias assessment were assessed. Using the retrieved data, a narrative synthesis of the identified methods and forest plots for the prevalence estimate was created. Fifty-six studies from 16 LMICs were included. They were grouped into 29 hearing screening programmes for neonates and infants and 26 programmes for older children. Predominantly hospital-based screening was employed for neonates and infants and school-based screening for older children. Two-stage otoacoustic emissions screening was employed for neonates and infants, while single-stage pure tone audiometry with otoscopy screening was used for older children. Predominantly, audiologists performed screening and diagnostics for neonates/infants while community health workers performed screening for the older children. Screening aspects were reported predominantly and not diagnostic evaluation/intervention outcomes. Overall, the economics of EHDI was reported only anecdotally in a few studies. The screening strategies were not uniform among non-Asian LMICs. The protocols used were similar to HICs, yet few developed protocols adapting the Joint Committee of Infant Hearing. However, long-term outcomes such as rate of identification, suitable intervention and their outcomes are not known. EHDI programmes with successful outcomes of early intervention must be studied and reported with economic evaluations.

Integrating community health workers into HIV care clinics: a qualitative study with health system leaders and clinicians in the Southern United States

BackgroundCommunity health workers (CHWs) can support patient engagement in care for a variety of health conditions, including HIV. This paper reports on the experiences of HIV clinics and health departments that integrated CHWs into their health systems as part of a capacity-building initiative to address HIV-related disparities in the United States.MethodsSemi-structured interviews were conducted with key informants (n = 14) in two Ryan White HIV/AIDS program jurisdictions: Mississippi (jurisdiction covers the entire state) and the city of New Orleans, Louisiana. This work was part of a larger evaluation of an initiative that used a Learning Collaborative model to facilitate the implementation of evidence-informed interventions to address HIV care continuum gaps in four jurisdictions. The two jurisdictions that focused on integrating CHWs into HIV care clinics and support service agencies were selected for this sub-analysis. Interview participants included HIV clinic leaders and staff, health department leaders, and other Learning Collaborative leaders. Interview transcripts were coded and analyzed for themes related to the acceptability, feasibility, and perceived impact of CHW integration.ResultsOverall, participants expressed interest in having support from CHWs at HIV clinics and service agencies to assist with patient retention and engagement efforts. However, there were challenges integrating CHWs into existing systems (e.g., gaining access to electronic health records, changing policies to conduct home visits, and clarifying roles and scope of work). Negotiating contracts and accessing funding for CHW positions presented major challenges that often contributed to turnover and conflicts around scope of practice. When health departments leveraged existing funding streams to support CHW positions, the clinics and agencies where the CHWs worked had limited flexibility over the hiring process.ConclusionsOur findings reinforce the value and acceptability of CHWs as part of the workforce in HIV clinical and support service settings; however, integrating CHWs into clinics and service agencies required effort. Training the CHWs was not sufficient; other staff and clinicians had to understand the role of CHWs to facilitate their integration into health systems. Resources are needed to support organizations in incorporating CHWs effectively, and long-term, flexible sources of funding are necessary for these positions.

The Surge in Human Papillomavirus Vaccine Rejection in Nigeria.

In October 2023, Nigeria integrated the single-dose human papillomavirus (HPV) vaccine into its routine immunization program, aiming to protect 7.7 million girls aged 9 to 14 years. This milestone in the fight against HPV-related cancers, especially cervical cancer, faces significant challenges due to high vaccine rejection rates driven by misinformation and cultural barriers. Despite the vaccine's proven safety and efficacy, uptake remains low. This communication highlights the urgent need for a comprehensive public health education campaign to address these barriers. Proposed strategies include leveraging digital health technologies, integrating HPV education into school curricula, training community health workers, engaging religious and cultural leaders, and launching media campaigns featuring personal narratives. Implementing these evidence-based interventions is crucial for dispelling myths, misconceptions, and skepticism surrounding HPV vaccines. This will enhance acceptance and uptake, ultimately reducing cervical cancer mortality in Nigeria.

Healthy Drinks, Healthy Teeth – Ciunerkaq Tanqigtuq (The Future is Bright): A study protocol for a community-based, non-randomized sociobehavioral trial to reduce added sugar intake in Alaska Native Yup'ik children in the Yukon-Kuskokwim Delta

BackgroundThis study protocol describes a community-based intervention that will seek to reduce added sugar intake in Yup'ik Alaska Native children by targeting reductions in sugar-sweetened fruit drinks. MethodsA two-group non-randomized design will be used to evaluate the intervention in three Yup'ik communities in Alaska focusing on children age 1 to less than age 12 years with a minimum enrollment target of 192 children. Families in the intervention arm will participate in a program consisting of five sessions plus four brief check-ins, all delivered by a Yup'ik Community Health Worker. Modifications to the local store environment will be made to give families a place to purchase sugar-free water enhancers. Families in the delayed treatment control arm will receive no intervention during the main study period. There will be five data collection visits (baseline, 1-month, 3-months, 6-months, and 12-months) that will include collection of survey and dietary data, and a hair and plaque sample from each participating child. The outcomes will be change, from baseline to 6 months, in added sugar intake based on a validated hair biomarker (grams of added sugar/day). We hypothesize children in the intervention arm will have greater reductions in added sugar intake compared to children in the control arm as measured by the hair biomarker. DiscussionThis is one of the first known community-based sociobehavioral interventions aimed specifically at reducing added sugar intake in Alaska Native communities by targeting sugar-sweetened fruit drinks. Trial registrationClinicalTrials.govNCT05219448 (first posted on February 2, 2022).

A One Health approach to pastoral (im)mobility, health, and disease: A qualitative participatory study in Plateau State, Nigeria.

In Plateau State, pastoralism has historically been a cost effective and resilient economic system well-suited to the ecological context. However, changes in land use and conflict have increasingly changed patterns of mobility. Pastoralist movement is now often associated with zoonotic disease transmission, environmental degradation and conflict, increasingly resulting in forced sedentarisation. Rather than a direct outcome of population movement however, animal, human and zoonotic disease drivers are complex and influenced by a range of socio-economic and environmental factors. The interlinkages of (im)mobility and health requires better understanding of underlying vulnerabilities to disease, which we aim to address in this study. Using a multisite case study methodology we investigated pastoralists' animal and human health concerns and priorities in Plateau State, Nigeria. We deployed participatory tools, including open-ended Focus Group Discussions, transect walks, mapping exercises, calendars and matrices. Data were analysed using a One Health conceptual framework. We interviewed 105 participants, from transhumance, migratory and sedentary households, dependent on livestock and small-scale crops. While transhumance was often preferred, participants had become sedentary as a result of insecurity, loss in livestock, and household characteristics. Humans and animals suffered from several endemic diseases, including zoonoses, however veterinary and human health services are only available in larger towns, and people mostly rely on community (animal) health workers and self-medication. Both transhumance and sedentary livestock keepers face challenges around forage grazing, regularly blocked by landowners, sometimes escalating into conflict. While conflict and changes in land use affected animal and human disease patterns, underlying political, social and economic risk factors were important determinants of health. There is a need for more inclusive, transdisciplinary, multilevel approaches to address animal and human disease, based on better contextualization of the challenges, through the participation of affected communities.

“…considered ‘essential workers’, so we report to work and serve the community”: experiences of community health workers during COVID-19 pandemic in the Eastern Cape, South Africa

BackgroundCommunity health workers (CHWs) played an essential part in providing health services to the communities they served prior to and during the COVID-19 pandemic, and they had some positive impact on community/household health service promotion and delivery. Nonetheless, restricted movement and social isolation made it challenging for community members to access CHW services, which are normally provided in person. We explore community health workers’ opinions on the impact of COVID-19 on their responsibilities, clients, and communities in South Africa’s Eastern Cape.MethodsUsing a semi-structured interview guide, we conducted individual (n = 10) and focus group discussions (n = 13) with 23 community health workers. Participants were community health workers servicing three Black township communities in Buffalo Municipality District, Eastern Cape, South Africa. Transcripts from audiotaped and transcribed verbatim interviews were analysed thematically using Atlas.ti.ResultsThe COVID-19 had an impact on the CHWs’ job-related activities, the clients’ health, and caused disruptions in community social and economic activities, all of these had a negative impact on population health. COVID-19 had detrimental effects on the clients’ health in various ways, including restricted movement and fear of contracting the virus, isolation and deaths created anxiety and terror, or refusal to attend clinics for routine medical check-ups and treatment. Furthermore, CHWs claimed that COVID-19 affected community livelihoods, exacerbating food insecurity and job insecurity. The vast majority of CHWs, who were predominantly women, had to balance their employment workload tasks with domestic responsibilities, which added extra pressure and burden. In addition, many individuals experienced personal loss and bereavement. However, the clients and the community exhibited remarkable resilience and perseverance despite the multifaceted obstacles faced by the COVID-19 pandemic.ConclusionFinancial hardships, unemployment, and work disruptions or changes created by the COVID-19 pandemic triggered stress, sadness, worry, and terror among the CHWs. The client’s health conditions were adversely affected, as some clients refrained from visiting clinics for their medications and treatment because of restricted movements, concerns about contracting the virus, and isolation, all of which contributed to their anxiety and fear. The social isolation and quarantine, as well as food and job insecurity, all had an impact on the community’s social and economic life. Despite the COVID-19 risks and stressors, CHWs demonstrated resilience during the COVID-19 pandemic burden and emphasising their importance as “essential workers” in community health care which further underscores the need to provide CHWs with adequate resources and training in preparation for future pandemics.

Innovative healthcare solutions for resource-limited settings expanding pharmaceutical care to remote populations

Access to essential healthcare and pharmaceutical services remains a significant challenge in resource-limited settings. This paper explores innovative strategies for expanding pharmaceutical care to remote populations, focusing on the integration of mobile health technologies and community-based interventions. Mobile health (mHealth) technologies, including telemedicine and mobile pharmacies, offer a cost-effective means of delivering healthcare services, enhancing access, and improving real-time monitoring. Community-based interventions, such as the deployment of community health workers, health education campaigns, and peer support groups, play a critical role in addressing healthcare disparities and improving health literacy and medication adherence. The paper also discusses the integration of pharmaceutical care models, emphasizing the importance of collaboration among healthcare providers, pharmacists, and community health workers. Future directions highlight emerging innovations like AI and blockchain technology, while policy recommendations emphasize the need for investment in healthcare infrastructure, professional training, and regulatory support. By leveraging these strategies and innovations, healthcare outcomes and equity in resource-limited settings can significantly improve.

Enablers and barriers of community health programs for improved equity and universal coverage of primary health care services: A scoping review

BackgroundCommunity health programs (CHPs) are integral components of primary health care (PHC) systems and support the delivery of primary care and allied health and nursing care services. CHPs are necessary platforms for delivering health services toward universal health coverage (UHC). There are limited prior studies on comprehensive evidence synthesis on how CHPs strengthen community health systems for the demand and supply of PHC services. Therefore, this scoping review synthesized existing evidence on the interlinkage between CHPs and the community health system and beyond for delivering and utilising PHC services toward UHC.MethodsWe conducted a scoping review of research articles on CHPs. We identified research articles in six databases (PubMed/Medline, CINAHL, Scopus, Cochrane, Web of Science, and Embase) and Google Scholar using search terms under three concepts: CHPs, PHC, and UHC. Of the 3836 records identified, 1407 duplicates were removed, and 2346 were removed based on titles and abstracts. A total of 83 articles were eligible for the full-text review; of them, 18 articles were removed with reasons, and the other 16 were included through hand search. Themes were identified and explained using Sacks and colleagues’ “Beyond the Building Block” framework.ResultsA total of 81 studies were included in the final review. Studies described CHPs as foundations for community health system readiness for PHC services, including decentralization in the health sector, community-controlled governance, resource mobilization, ensuring health commodities (e.g., through community pharmacies), and information evidence. These foundational inputs mediate the actions of CHPs by partnership with community organizations and health workforces (e.g., community health workers). CHPs contributed to improved access to health services by providing health services in public health emergencies, affordable and comprehensive care, and modifying social determinants of health.ConclusionsCHPs are platforms for implementing and delivering PHC services close to communities. They help to modify social determinants of health, promote health and wellbeing, reduce care costs, prevent disease progression, and reduce hospitalisation rates. CHPs are integral parts of community health systems and require investment to improve access to PHC services. Gaps and challenges of CHPs include inadequate funding, limited engagement of the private sector, poor quality of health services, and limited focus on non-communicable diseases (NCDs). Further implementation research is needed to mitigate the burden of NCDs. Health systems efforts focus on increasing resources (e.g., financial and human) required in CHPs to ensure the quality of PHC services provided through CHPs toward better service access, and reaching the unreached and achieve equity and universality of PHC services.

Community Health Worker Service: addressing the needs of Gypsy/Travellers in Scotland

Abstract Background Members of the Gypsy/Traveller community in the United Kingdom face significant health inequalities compared to the general population, including lower life expectancy, higher rates of morbidity and suicide and poorer infant and child outcomes. This study evaluated the implementation of community-based lay workers in Scotland - the Gypsy/Traveller Community Health Worker (CHW) service. Methods This multi-method qualitative study (December 2021 to August 2023) included 16 individual interviews, five focus groups, one workshop, two informal discussions, and one site visit. Participants were stakeholders, CHWs, and members of the Gypsy/Traveller community. Additionally, 116 documents were analysed. The framework method, Proctor’s implementation outcomes and thematic analysis were used for data analysis. Results CHWs reached approximately 1,000 individuals across six National Health Services (NHS) Boards. The implementation outcomes showed that the intervention was accepted and feasible. A third-sector organization (Black and Minority Ethnic Carers of People Project - MECOPP), played a crucial role in successfully delivering the CHW service. This innovative intervention employed members of the Gypsy/Traveller community as lay healthcare workers to break down barriers to accessing healthcare and other services (e.g., uptake of cervical screening, vaccination, housing, and sanitation). The CHWs were trusted, ensured healthcare information was culturally appropriate and successfully addressed discriminatory behaviours in health and social care. Limited resources pose challenges to the sustainability of the service. Conclusions The Gypsy/Traveller CHW service enhanced prevention, acted as a bridge between communities and health systems and addressed the wider determinants of health. The Gypsy/Traveller community still faces discriminatory, racist, and stigmatising behaviours, which further impede the quality, delivery, and accessibility of care. Key messages • The Community Health Worker service was acceptable and feasible in the Gypsy/Traveller community, acting as a bridge between community and health systems and increasing access to services. • Community Health Worker Service is an important strategy for delivering healthcare support through their sector organizations to address historical discrimination against minority ethnic groups.