Majority Of Community Health Workers Research Articles

Labour conditions in dual-cadre community health worker programmes: a systematic review

Health care delivered by community health workers reduces morbidity and mortality while providing a considerable return on investment. Despite growing consensus that community health workers, a predominantly female workforce, should receive a salary, many community health worker programmes take the form of dual-cadre systems, where a salaried cadre of community health workers works alongside a cadre of unsalaried community health workers. We aimed to determine the presence, prevalence, and magnitude of exploitation in national dual-cadre programmes. We did a systematic review of available evidence from peer-reviewed databases and grey literature from database inception to Aug 2, 2021, for studies on unsalaried community health worker cadres in dual-cadre systems. Editorials, protocols, guidelines, or conference reports were excluded in addition to studies about single-tier community health worker programmes and those reporting on only salaried cadres of community health workers in a dual-cadre system. We extracted data on remuneration, workload, task complexity, and self-reported experiences of community health workers. Three models were created: a minimum model with the shortest time and frequency per task documented in the literature, a maximum model with the longest time, and a median model. Labour exploitation was defined as being engaged in work below the country's minimum wage together with excessive work hours or complex tasks. The study was registered with PROSPERO, CRD42021271500. We included 117 reports from 112 studies describing community health workers in dual-cadre programmes across 19 countries. The majority of community health workers were female. 13 (59%) of 22 unsalaried community health worker cadres and one (10%) of ten salaried cadres experienced labour exploitation. Three (17%) of 18 unsalaried community health workers would need to work more than 40 h per week to fulfil their assigned responsibilities. Unsalaried community health worker cadres frequently reported non-payment, inadequate or inconsistent payment of incentives, and an overburdensome workload. Unsalaried community health workers in dual-cadre programmes often face labour exploitation, potentially leading to inadequate health-care provision. Labour laws must be upheld and the creation of professional community health worker cadres with fair contracts prioritised, international funding allocated to programmes that rely on unsalaried workers should be transparently reported, the workloads of community health workers should be modelled a priori and actual time use routinely assessed, community health workers should have input in policies that affect them, and volunteers should not be responsible for the delivery of essential health services. None.

Community Health Workers Engagement in Prevention of Mother-to-Child Transmission of HIV (PMTCT): A Cross-Sectional Study from Selected Fishing Communities in Tanzania

The prevalence of HIV infection is reported to be higher in fishing communities of Lake Victoria compared to non fishing neighboring communities. Besides, access to HIV/AIDS related services has been reported to be either inadequate or unavailable to some of these fishing communities particularly for those residing in islands. This study explored the engagement of Community Health Workers (CHWs) in provision of PMTCT services among the fishing communities of Sengerema and Musoma District Councils (DCs) in the Lake Zone of Tanzania. This was a cross sectional study using qualitative approach. Intrinsic and extrinsic motives were found to influence community members to be engaged as CHWs. The majority of CHWs were involved in Antenatal Care (ANC) and Reproductive and Child Health (RCH) as well as in health promotion activities as a strategy to cope with the shortage of trained health staff. CHWs were found to assist in HIV/AIDS Counseling and Treatment Center (CTC), generally, CHWs were not directly engaged in provision of PMTCT services. On the other hand, the National Health Policy does not clearly set roles of the CHWs and their incentives. Nevertheless, there are potentials of people willingness to volunteer in community health works that need to be better leveraged. Deploying CHWs is critical to enabling accessible primary health care services including HIV/AIDS particularly PMTCT services in remote areas such as fishing communities where human resource for health is reported to be inadequate.

Performance of community health workers and associated factors in a rural community in Wakiso district, Uganda.

Community health workers (CHWs) continue to play a crucial role in supporting health service delivery globally. Several CHW programmes around the world face vast challenges which affect their performance. This study assessed the performance of CHWs and associated factors in a rural community in Wakiso district, Uganda. This was a cross-sectional study that employed a structured questionnaire to collect quantitative data from 201 CHWs in Wakiso district. The main study variable was CHW performance based on various roles carried out by CHWs. Multivariable logistic regression in STATA was used to establish the predictors of CHW performance. Only 40 (19.9%) of the CHWs had a high performance which was associated with having attended additional / refresher trainings [AOR=12.79 (95% CI: 1.02-159.26)], and having attained secondary level education and above [AOR=3.93 (95% CI: 1.17-13.24)]. CHWs who were married [AOR=0.29 (95% CI: 0.09-0.94)] were less likely to perform highly. Among CHWs who had received essential medicines for treatment of childhood illnesses, the majority 90.3% (112/124) had experienced stock-outs in the 6 months preceding the study. Despite the majority of CHWs, 198 (98.5%), stating that being motivated was very important in their work, only 91 (45%) said that they were motivated. Additional / refresher trainings are necessary to enhance performance of CHWs. In addition, level of education should be considered while selecting CHWs. The health system challenges of low motivation of CHWs as well as stock-out of medicines need to be addressed to support their work.

Changes in knowledge and beliefs of community health workers following an oral health intervention training program

Greater acknowledgement of the ways in which social determinants influence health has led to increased engagement of Community Health Workers (CHWs) in health promotion activities. This study sought to evaluate changes in CHW knowledge and beliefs via pre-/post-training surveys immediately following a four-day (∼20 hour) oral health intervention training and to gather CHW feedback on training. Significant increases in summary scores for 19 knowledge (t(9) = −6.715, p < .001) and four belief (t(9) = −2.994, p = .015) measures, using four-point Likert scales, were observed post-training. Feedback was overwhelmingly positive, with the majority of CHWs reporting confidence in understanding the material and study purpose. Findings support the effectiveness and acceptability of a brief training program to prepare CHWs to deliver an oral health intervention. CHWs hold promise to effectively engage populations in which the impact of interventions delivered by traditional oral healthcare team members has shown limited success.

Sickle cell disease in southwestern Nigeria: assessment of knowledge of primary health care workers and available facilities.

Patients with sickle cell disease (SCD) benefit optimally from comprehensive care. In Nigeria, despite the huge burden, involvement of community health workers (CHWs) in the management of SCD is poor. This community-based study assessed SCD-related knowledge of 182 CHWs from the 46 primary health care (PHC) centres in Ilesa, southwestern Nigeria. Available facilities and management practices for SCD care at these centres were also evaluated using pretested self-administered questionnaires and observational checklists. The majority of CHWs (167/182 [91.8%]) knew that SCD is an inheritable blood disorder. However, only 32.4% and 26.4% knew that SCD can be diagnosed in the prenatal and neonatal periods, respectively. Also 37.4%, 49.5% and 67.6% knew about the role of chemoprophylaxis (folic acid/penicillin), adequate fluids and malaria prevention, respectively, in SCD care. Overall, 37.9% had good knowledge on the nature and care of the disease. Just 2/46 (4.3%) PHC centres treat patients with SCD. SCD-targeted nutritional counselling and referral to secondary/tertiary hospitals were poor and unorganized. No centre offered SCD screening, home visits or recordkeeping. The level of SCD care and knowledge of CHWs at PHC centres in southwestern Nigeria of early SCD diagnosis and crisis prevention is poor. CHWs should be regularly trained and equipped for basic SCD management, including early detection, crisis prevention, prompt referral and provision of basic genetic counselling, to dispel associated myths and stigma.

“He Can’t Say a Man’s Stuff to a Woman…”: Perspectives on the Preferences of Men Living with HIV for Gender-Concordant Care Workers in Cape Town, South Africa

Community health workers (CHWs) play a central role in the provision of HIV care in South Africa, and people receiving such community-based adherence support have considerably better health outcomes. As with other forms of care work, the majority of CHWs are women. HIV vulnerability is also gendered, with women being more likely to contract HIV, while men living with HIV are more likely to die of AIDS-related illness. This article explores the relational gender dynamics of eight Cape Town–based CHWs and their male clients. Derived from multiple semistructured interviews, it engages the perspectives of CHWs, men living with HIV, and HIV and masculinities activists to explore HIV-positive men’s gender preferences for CHWs, and how these pairings may support their health and well-being. Reasons cited for gender-concordant preferences include gendered power dynamics, comfort in sharing intimate health information of someone of the same gender, and, in some cases, negative associations of women as untrustworthy gossips.

Perfil sociodemográfico, ocupacional e avaliação das condições de saúde mental dos trabalhadores da Estratégia Saúde da Família em um município do Rio Grande do Sul, RS

Objetivo: Descrever os fatores sociodemográficos e ocupacionais e avaliar a prevalência de transtornos mentais comuns em trabalhadores das Estratégias de Saúde da Família (ESF) em Santa Cruz do Sul, RS. Métodos: Estudo com abordagem epidemiológica, de corte transversal e quantitativo, realizado no período de junho a agosto de 2013. Foram avaliados 83 trabalhadores, entre médicos, enfermeiros, técnicos/auxiliares de enfermagem e agentes comunitários de saúde, atuantes nas 11 unidades de saúde da família do município. O instrumento de pesquisa constituiu-se em um questionário autoaplicável, englobando aspectos sociodemográficos, ocupacionais e questões pertencentes ao Self-Reporting Questionnaire. Resultados: A idade média dos participantes foi de 37,1±8,9 anos, sendo a maioria agentes comunitários de saúde, do sexo feminino, casadas, com filhos, renda per capita de até 2 salários mínimos e ensino médio completo. A prevalência geral de transtorno mental comum foi de 19,7%, estando presente em todas as categorias profissionais, e mais frequente entre os enfermeiros (25%), porém sem diferenças estatísticas. Conclusão: O presente estudo, além de caracterizar a população de trabalhadores das ESF de Santa Cruz do Sul, RS, em seus aspectos sociodemográficos e ocupacionais, identificou que o sofrimento psíquico está presente, embora em graus variados, em todas as categorias profissionais avaliadas. Frente a esses achados relevantes, sugerem-se providências que visem à prevenção e promoção da saúde mental desses profissionais

Perception of Beneficiaries and Stakeholders about the Services Offered by Health Huts Put in Place by the Health Project—Community Health of USAID in the Goudomp Health District (Senegal)

The Health Project—Community Health USAID is a community-based intervention that has been implemented by a group of NGOs, among which there is Africare, for a period of 5 years (2006-2011). It seeks to strengthen the community health system through a package of basic services offered at the health center, and as well as to improve the skills and knowledge of community actors. The main objective of this study is to capture the perceptions of beneficiaries and stakeholders about the services offered at the PSSC health posts located in the health district Goudomp. A qualitative cross-sectional study on the perception of the community of the USAID PSSC and quality of services offered by the health huts was conducted from the 2nd to 5th of May 2009 in the Goudomp health district. To achieve the objectives of this study, we conducted focus group discussions with all the community leaders and had individual interviews with the community health workers (CHWs) and the supervisor of the NGO Africare. From most of the discussions, it can be concluded that the activities of the health hut are not well known by the populations. The best known activities are those performed by the nurse: immunization and prenatal care. The existence of health huts at the community level was considered beneficial by all the community leaders. For the majority of the participants to the focus group discussions, the health huts “provided access to basic care”. Some participants, however, pointed out the “frequent drugs shortages” which, according to them, would explain the low attendance of the health huts in favor of the health post. The majority of CHWs and matrons felt that supervision activities were done on a regular basis. During the interviews, they mentioned many difficulties. However, the most common problem is the fact that the CHWs and the matron “who have no other source of income” were not salaried workers. This assessment has identified some difficulties in the implementation of the PSSC in the Goudomp health district. In order to solve the problems one would necessarily have to initiate a dialogue between the community and other stakeholders (health district, Africare, Local Government and CHWs).

Relação entre a presença da equipe de saúde bucal na Estratégia Saúde da Família com o nível de conhecimento dos agentes comunitários de saúde

Objetivo: identificar a relação entre o nível de conhecimento dos agentes comunitários de saúde sobre saúde bucal e a presença da Equipe de Saúde Bucal na Estratégia Saúde da Família. Métodos: uma pesquisa tipo inquérito foi realizada com 173 agentes comunitários de saúde alocados na rede pública de saúde em cinco municípios da região noroeste do estado de São Paulo, Brasil, por meio de um questionário autoaplicável, estruturado. O instrumento da pesquisa contemplava perguntas referentes à presença da Equipe de Saúde Bucal na Estratégia Saúde da Família e questões sobre saúde bucal. Resultados: a maioria dos agentes comunitários de saúde estava inserida em estratégias com a presença de Equipes de Saúde Bucal (60,1%). Verificou-se que o conhecimento em saúde bucal da maioria dos participantes foi bom (48%). Conclusão: existe relação entre o nível de conhecimento dos agentes comunitários de saúde e a presença da Equipe de Saúde Bucal na Estratégia Saúde da Família.

Community health workers: who they are and what they do.

Community health workers (CHWs) are community members who serve as frontline health care professionals. They generally work with the underserved and are indigenous to the community in which they work-ethnically, linguistically, socioeconomically, and experientially. This article presents the results of a survey of 197 systematically selected health care providers in eight Bay Area counties. The authors found that 25% of the health care providers in these eight counties hire CHWs. The hiring projections indicate that opportunities are expanding for these frontline professionals; the majority of growth is in public health departments and community-based organizations. The majority of CHWs are women (66%) of color (77%) with a high school degree or less (58%). A total of 44% earn an annual salary of $20,00 to $25,000; 30% make more than $25,001. AIDS and maternal and child health are the two major content foci of CHW work.