Male Community Health Workers Research Articles

Gender and Violence in the Daily Routine of Community Health Workers in Fortaleza, Brazil.

Community Health Workers (CHWs) are the link between the Brazilian primary health care system and the community. Since CHWs live in the same neighborhoods they work, they are involved in what happens in the community, including observants and or potential targets of violence. However, it is not known if female and male CHWs perceive and suffer violence similarly. This study aimed to investigate the violence to which CHWs are exposed and if female CHWs experience and or perceive violence the same way as male CHWs. A structured questionnaire was used to collect information from CHWs. Two periods (2019 [n=1402] and 2021 [n=364]) were compared. The data show that more than 80% of CHWs were exposed to violence, either as victims or witnesses within the community they served. In general, while the occurrence of violence towards CHWs decreased, their perception of community violence increased. Over time, the perception of urban/community violence remained constant among male CHWs, but increased among female CHWs, as shown by the significant rise between 2019 and 2021 in the percentage of female CHWs reporting witnessing or hearing about manifestations of violence (e.g., physical aggression; assault; stabbing; lethal gunshot; non-lethal gunshot; and gang violence). Among male CHWs, perception only increased with regard to the item assault. Given the complexity of violence and its repercussions on the daily routines of CHWs, intersectoral and interdisciplinary partnerships between health workers and other stakeholders are needed to create strategies capable of dealing with expressions of violence in the territories served.

How Gender Influenced the Experience of Using a mHealth Intervention in Rural Mozambique: Secondary Qualitative Analysis of Community Health Worker Survey Data

BackgroundThe mixed-gender community health worker (CHW) program in Mozambique is a window into the different experiences that male and female CHWs may face in their work. The objective of this study is to investigate how gender influenced the experiences of community health workers using the PIERS on the Move (POM) mHealth app in Mozambique.MethodsThis is a secondary analysis by gender of health care workers involved in the Mozambique Community Level Intervention for Pre-eclampsia (CLIP) cluster randomized trial (NCT01911494). A structured survey with 10 open-ended questions was used to elicit CHW experiences using the POM app. Data collection took place in 2017 after completion of the CLIP trial. This analysis examined emergent themes to consider how experiences may have been shaped by health worker gender.ResultsOf the 43 CHWs who used the POM app, there were 31 (72%) women and 12 (28%) men. Gender differences emerged in descriptions of how using POM increased their value and respect by pregnant women and community members. Fifty-eight percent of female CHWs (18/31) said that POM positively influenced their status in the community in comparison to 33% of their male counterparts (4/12). While the small sample sizes, particularly of male CHWs who used POM, preclude conclusions, these findings were supported by qualitative results. Female CHWs tended to elaborate more about community perceptions of their increased value and status as health care providers than male CHWs.ConclusionCHWs work within existing gender norms. While gender norms are perceived to support the comfort of women to speak to another woman about their maternal and child health issues, gender norms also work against female CHWs as their professionalism may be questioned more than for their male counterparts. CHW's narratives suggested that the mHealth intervention was valued beyond the technology itself because it also added symbolic clinical value and demonstrated a tangible investment in their professional capacities, which may have been especially appreciated by the female CHWs.

Extent and causes of increased domestic violence during the COVID-19 pandemic: community health worker perspectives from Kenya, Bangladesh, and Haiti

# Background Emerging data, media reports, and anecdotal evidence suggest that domestic violence (DV) has increased during the COVID-19 pandemic. However, more detailed data are needed on the magnitude, forms, and causes of DV during COVID-19 in different contexts worldwide. We sought to contribute such evidence from the perspective of community health workers (CHWs) in low-middle income countries in three different regions of the world. # Methods We conducted phone surveys with female and male CHWs from September-December 2020 in Kenya (n=1,385), Bangladesh (n=370), and Haiti (n=261). Descriptive and selected bivariate analyses were performed. # Results In total, 56%, 32% and 12% perceived increased DV in their communities during COVID-19 in Kenya, Bangladesh and Haiti, respectively. This included violence against both intimate partners and children. Key reasons reported for DV increases were increased stress/tension due to loss of employment/income (\>80%) and children being home/misbehaving (\>50%). In Kenya CHWs also cited partners spending more time together (59%), increased alcohol/substance use (38%), and conflict over childcare/housework responsibilities (33%). In bivariate analyses, in Kenya and Bangladesh, reporting a greater number of reasons for increased DV was associated with reporting co-occurring violence against both intimate partners and children (vs. just partners; *P*\<0.001). # Conclusions Over half of CHWs in Kenya and one-third in Bangladesh perceived increased DV during COVID-19, largely due to increased stress/tension related to economic hardship and childcare. Fewer perceived increased DV in Haiti, where lockdowns have been less severe. Preventing and responding to DV must be central to COVID-19 response and recovery plans, and should include meeting families’ economic and childcare/schooling needs.

Community Capacity Building for HIV and Addiction Service Integration: An Intervention Trial in Vietnam

Scientific findings and policy guidelines recommend integrating HIV and drug addiction prevention and care into community-based settings. Systematic capacity-building efforts are warranted to provide technical support for community health workers and improve their confidence in the integrated service provision. An intervention trial was conducted between 2018 and 2019 with 120 community health workers (CHW) from 60 communes in Vietnam’s four provinces. The 60 intervention CHW received in-person training to enhance their HIV/addiction-related service knowledge and skills. Online support groups were established between trained CHW and local HIV and addiction specialists. The intervention outcomes were assessed using mixed-effects regression models with the data collected at baseline and every 3 months for 1 year. Adjusted analyses showed that intervention CHW reported a significant increase in the interaction with other treatment providers than the control group at 6 months and remained at the 12-month follow-up. The difference in the improvement of confidence in HIV/addiction-related service delivery between the intervention and control groups was significant at 6-month but became insignificant at the 12-month. Male CHW were more confident in providing services than female CHW at baseline, and gender differences in the changing patterns were observed over time. This capacity-building intervention demonstrated promising outcomes on CHW inter-agency collaborations and confidence in service delivery. Gender divides in healthcare professionals should be attended to in future studies.

Redressing the gender imbalance: a qualitative analysis of recruitment and retention in Mozambique\u2019s community health workforce

BackgroundMozambique’s community health programme has a disproportionate number of male community health workers (known as Agentes Polivalentes Elementares (APEs)). The Government of Mozambique is aiming to increase the proportion of females to constitute 60% to improve maternal and child health outcomes. To understand the imbalance, this study explored the current recruitment processes for APEs and how these are shaped by gender norms, roles and relations, as well as how they influence the experience and retention of APEs in Maputo Province, Mozambique.MethodsWe employed qualitative methods with APEs, APE supervisors, community leaders and a government official in two districts within Maputo Province. Interviews were recorded, transcribed and translated. A coding framework was developed in accordance with thematic analysis to synthesise the findings.FindingsIn-depth interviews (n = 30), key informant interviews (n = 1) and focus group discussions (n = 3) captured experiences and perceptions of employment processes. Intra-household decision-making structures mean women may experience additional barriers to join the APE programme, often requiring their husband’s consent. Training programmes outside of the community were viewed positively as an opportunity to build a cohort. However, women reported difficulty leaving family responsibilities behind, and men reported challenges in providing for their families during training as other income-generating opportunities were not available to them. These dynamics were particularly acute in the case of single mothers, serving both a provider and primary carer role. Differences in attrition by gender were reported: women are likely to leave the programme when they marry, whereas men tend to leave when offered another job with a higher salary. Age and geographic location were also important intersecting factors: younger male and female APEs seek employment opportunities in neighbouring South Africa, whereas older APEs are more content to remain.ConclusionGender norms, roles and power dynamics intersect with other axes of inequity such as marital status, age and geographic location to impact recruitment and retention of APEs in Maputo Province, Mozambique. Responsive policies to support gender equity within APE recruitment processes are required to support and retain a gender-equitable APE cadre.

Promotores' perspectives on a male-to-male peer network.

Little documentation exists about male community health workers (promotores) networks. The experiences of promotores can provide input on how to attract, train, supervise and maintain male promotores in CHW programs. We present the experience and perspectives of promotores who participated in a male promotores network assisting Latino immigrant men in an emerging Latino community. All promotores in this community-based participatory study received payment for work 10 hours a week. We conducted qualitative interviews with all promotores starting the program, after 5 and 13 months. Three main themes emerged: 1) Men decided to become promotores to help others, yet appreciated being paid. 2) Promotores' learning experience was ongoing and was facilitated by a cooperative dynamic among them. Learning how to listen was crucial for promotores 3) Promotores experienced difficulty separating their personal lives form their role as a promotor We conclude that paying promotores facilitates the fulfillment of their drive to serve the community. Enhancing listening abilities needs to be part of promotores' training curricula. Finally, it is advisable to build a project with many opportunities for promotores and project staff to share professional and non-professional time and discuss their challenges.

Abstract C15: Using grounded theory to develop a model of prostate cancer care and survivorship for black men: The Florida CaPCaS study

Abstract The purpose of this study is to explore the experience of screening, diagnosis, treatment and survivorship of black men with prostate cancer using qualitative ground theory methodology. A sample of black men diagnosed with prostate cancer in 2010 was recruited via telephone screening from the Florida Department of Health cancer registry. The individuals recruited were purposively sampled for variation in country of origin (African, Caribbean, and US born) and other demographics. An open-ended interview guide about their prostate cancer experience, developed by our Community Advisory Board and revised by the scientific team, was used to conduct in-depth, face-to-face interviews of 2-3 hours in length. The interviews were scheduled at the convenience of the participant and conducted by a black male Community Health Worker in a private location in the community chosen by the participant. These steps were taken to assure maximum comfort for the participants to share their experiences fully. To date 14 interviews have been completed, with the goal of 60 interviews completed by the end of September, 2015. Data analysis consists of line-by-line coding of interview transcripts for themes that emerge from the interviews, followed by in-depth coding of constructs to be included in a grounded theory model of the prostate cancer experience for black men. Preliminary findings indicate emerging themes of trust of the health care providers, the impact of health literacy, views of active surveillance and watchful waiting, the importance of family support, and decisional regrets. Understanding the prostate cancer experience from the perspective of black prostate cancers survivors will help us to reduce the impact of the disease in this population. Citation Format: Mary Ellen Young, Folakemi T. Odedina, Christopher Williams, Deidre Pereira, Getachew Dagne, Eva Egensteiner, Lauren Gilbert, Kenneth Stokes, Christopher Hill, Esther Piervil. Using grounded theory to develop a model of prostate cancer care and survivorship for black men: The Florida CaPCaS study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C15.

Reproductive, Maternal, Newborn, and Child Health in the Community: Task-sharing Between Male and Female Health Workers in an Indian Rural Context.

Background:Male community health workers (CHWs) have rarely been studied as an addition to the female community health workforce to improve access and care for reproductive, maternal, newborn, and child health (RMNCH).Objective:To examine how male health activists (MHAs) coordinated RMNCH responsibilities with existing female health workers in an Indian context.Materials and Methods:Interviews from male and female CHWs were coded around community-based engagement, outreach services, and links to facility-based care.Results:Community-based engagement: MHAs completed tasks both dependent and independent of their gender, such as informing couples on safe RMNCH care in the antenatal and postnatal periods. MHAs motivated males on appropriate family planning methods, demonstrating clear gendered responsibility. Outreach services: MHAs were most valuable traveling to remote areas to inform about and bring mothers and children to community health events, with this division of labor appreciated by female health workers. Link to facility-based services: MHAs were recognized as a welcome addition accompanying women to health facilities for delivery, particularly in nighttime.Conclusion:This study demonstrates the importance of gendered CHW roles and male-female task-sharing to improve access to community health events, outreach services, and facility-based RMNCH care.

Equally able, but unequally accepted: Gender differentials and experiences of community health volunteers promoting maternal, newborn, and child health in Morogoro Region, Tanzania.

BackgroundDespite emerging qualitative evidence of gendered community health worker (CHW) experience, few quantitative studies examine CHW gender differentials. The launch of a maternal, newborn, and child health (MNCH) CHW cadre in Morogoro Region, Tanzania enlisting both males and females as CHWs, provides an opportunity to examine potential gender differences in CHW knowledge, health promotion activities and client acceptability.MethodsAll CHWs who received training from the Integrated MNCH Program between December 2012 and July 2013 in five districts were surveyed and information on health promotion activities undertaken drawn from their registers. CHW socio-demographic characteristics, knowledge, and health promotion activities were analyzed through bi- and multivariate analyses. Composite scores generated across ten knowledge domains were used in ordered logistic regression models to estimate relationships between knowledge scores and predictor variables. Thematic analysis was also undertaken on 60 purposively sampled semi-structured interviews with CHWs, their supervisors, community leaders, and health committee members in 12 villages from three districts.ResultsOf all CHWs trained, 97 % were interviewed (n = 228): 55 % male and 45 % female. No significant differences were observed in knowledge by gender after controlling for age, education, date of training, marital status, and assets. Differences in number of home visits and community health education meetings were also not significant by gender. With regards to acceptability, women were more likely to disclose pregnancies earlier to female CHWs, than male CHWs. Men were more comfortable discussing sexual and reproductive concerns with male, than female CHWs. In some cases, CHW home visits were viewed as potentially being for ulterior or adulterous motives, so trust by families had to be built. Respondents reported that working as female–male pairs helped to address some of these dynamics.ConclusionsMale and female CHWs in this study have largely similar knowledge and health promotion outputs, but challenges in acceptance of CHW counseling for reproductive health and home visits by unaccompanied CHWs varied by gender. Programs that pair male and female CHWs may potentially overcome gender issues in CHW acceptance, especially if they change gender norms rather than solely accommodate gender preferences.

Male engagement as a strategy to improve utilization and community-based delivery of maternal, newborn and child health services: evidence from an intervention in Odisha, India.

BackgroundIn response to persistently poor levels of maternal, newborn and child health (MNCH) in rural India, the National Rural Health Mission (NRHM) was launched to support the provision of accessible, affordable and quality health care in deprived and underserved communities. The Accredited Social Health Activists (ASHAs), local women, are trained as health promoters to generate demand for, and facilitate access to MNCH care in their communities. While they are also expected to provide husbands of expectant women with information on MNCH care and family planning, their reach to the husbands is limited. The aim of this study is to describe the influence of a male engagement project on the utilization and community-based delivery of MNCH care in a rural district of the country.MethodsWe used qualitative data from the evaluation of a project which recruited and trained male Community Health Workers (CHWs) known as Male Health Activists (MHAs) to complement the work of ASHAs and target outreach to men. This paper uses data from in-depth interviews (IDIs) with ASHAs (n=11), Anganwadi Workers (AWWs) (n=4) and Auxiliary Nurse Midwives (ANMs) (n=2); with women who had delivered at home, community health center or district hospital in the few months preceding the date of the interview (n=11); and with husbands of these women (n=7).ResultsParticipants’ responses are broadly organized around the facilitation of ASHAs’ work by MHAs, and male engagement activities undertaken by MHAs. More specifically, the narratives reflected gender-based divisions of work and space in three core areas of delivery and use of MNCH services: escorting women to health centers for facility-based deliveries; mobilizing women and children to attend Village Health and Nutrition Days and Immunization Days; and raising awareness among men on MNCH and family planning.ConclusionThis study sheds light on male engagement as a strategy to improve the delivery, access and uptake of maternal, newborn and child health in the context of prevailing gender norms and gendered roles in rural India. Ultimately, it unveils the complementarity of male and female CHWs in the community-based delivery of, and increased demand for, MNCH services.

Male engagement as a strategy to improve the delivery and use of maternal, newborn, and child health services

Abstract Background In response to persistently poor maternal and child health in rural India, the National Rural Health Mission (NRHM) was launched in 2005 as a framework for the provision of accessible, affordable, and quality health care in deprived and underserved communities. At the centre of the programme are the accredited social health activists—local women trained as health educators and promoters to generate demand for, and facilitate access to, maternal, newborn, and child health (MNCH) services in their communities. In this study, we aimed to examine the effect of a male community health worker project on the delivery and uptake of MNCH care in a rural district of India. The specific research questions are: did male community health workers complement the work of the accredited social health activists and fill important gaps in community MNCH service delivery? Further, what is the perceived effect of male community health workers' engagement with men? Methods We recruited and trained male community health workers, referred to as male health activists, to complement the work of the female social health activists and extend community-based delivery of MNCH services. The project was implemented between February, 2011, and March, 2013, in Keonjhar district in the state of Odisha, which is one of the six states in India with high rates of maternal and child deaths. We conducted in-depth interviews with 11 social health activists, 11 women who had recently delivered in a health facility, and seven husbands of women who had recently delivered. The interviews were conducted by locally based interviewers in the local language. Responses were audio-recorded, transcribed verbatim and translated to English, then coded manually. Findings From the interview responses, we identified three main gender-based divisions of work and space in three areas of delivery and use of MNCH services: the escorting of women to health facilities for MNCH care; awareness raising among men on MNCH and family planning; and mobilisation of parents and children to attend village health and nutrition days and immunisation days. The narratives from virtually all respondents pointed to the crucial roles played by male health activists around and during delivery, especially at night when they facilitate transport and provide security, a role that female community health workers would rarely assume. Women and social health activist respondents were appreciative of the increased engagement of male health activists with men, which they reported resulted in some positive behaviour changes, including on family planning. Finally, the accredited social health activists identified tangible constraints, such as the cost of transport, to the implementation of village health and nutrition days and immunisation days that could only be addressed by male health activists. Interpretation These findings highlight the potential for trained and equipped male community health workers to improve outcomes in maternal, newborn, and child health. Funding The project and its evaluation and data analysis for this study were funded by a grant from the Bill and Melinda Gates Foundation.

Health Posts in Afghanistan

Said Habib Arwal* Community Based Health Care (CBHC), Afghanistan *Corresponding author: Said Habib Arwal, Founder and National Coordinator for Community Based Health Care (CBHC), Afghanistan, Tel: 93700605071, Email: saidhabiba@gmail.com Rec date: Oct 28, 2015, Acc date: Dec 08, 2015, Pub date: Dec 15, 2015 Copyright: © 2015 Arwal SH. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Afghan Health System have a national Strategy that is Basic Package of the Health Service (BPHS), Health Post is the first step for providing of Primary Health Care Services. Community-based basic health care services are provided by community health workers (CHWs) at their own homes recognized as community Health Post. Usually, a Health Post is staffed by a female and a male community health worker. If two (male and female) CHWs could not be available, one CHW may provide Health care services, but every effort should be made to provide two CHWs (a male and female) for every Health Post. A Health Post will cover a catchment area of 1,000 to 1,500 people, which is equivalent to 100 or 150 families. In case of need, the coverage level of the Health Post can be changed. Health education and promotion of health habits in the community is the first and most important responsibility of the Health Post. In addition, the Health Post provides preventive care such as drug distribution and birth spacing devices, mothers’ health care and limited curative services like diagnosis and treatment of common disease in children and adults. The main responsibilities of a Health Posts are as follows: Health education and changing of health habits of the community; Referral of patients to health facilities; Provision of first aid; Treatment of common illnesses; Community mobilization. The Community Health Worker is an important member of the health system, provides basic health care services from his/her home, which is recognized as a health post. The CHW is from the same area he/she is supposed to serve (familiar with the culture and language of the people), train for foursix months to deliver Basic Health Services. The CHWs are selected by the community they serve and supervised and monitored by the Community Health Supervisor from the nearest health facility. Now there are about 15000 Health Posts, serving for rural population in Afghanistan, but there are still many un-served areas. Health posts through trained CHWs providing health care services to 45% sick children and covering 69% family planning, but some concerns are there about quality of the care they provide. CHWs workload is also a matter of concern, but not a major problem yet. CHWs motivation needs to be taken very seriously because they are volunteers. Recognition of their role in the health system, respect, honor, update of knowledge, and supportive supervision are important types of compensation. It is also very important to be specific about the different types of “incentives”, including reimbursement of expenses, rewards for good performance or performance based financing to keep them in their volunteer role. Urban CBHC program for poor urban populations, which is focusing on female CHWs, started in Kabul city, but other big cities are not covered yet. Nomad CBHC program for Nomad populations started but needs to have more CHWs for many un-served areas of Nomad populations For establishment of a health post, in view of the following points a CHW should be identified and introduced by the community: Be a resident of the locality; Be 20 to 50 years of age; Be volunteer, active and interested to serve as CHW; Be respectable in his/her locality and enjoy the support of his/her community members; Women should be encouraged to volunteer for being provided with training as CHWs (According to the guideline of the Ministry of Public Health, at least 50% of CHWs to be trained should be female.); Basic literacy is preferable. Job Description of CHWs The community health worker (CHW) is a person (male or female) selected by the community according to selection criteria mentioned above. The CHW promotes healthy lifestyles in the community, encourages appropriate use of health services, and treats and refers common illnesses. The CHW is accountable to the community Health Shura for performance and community satisfaction and is technically accountable to the community health supervisor (CHS). The CHW has the following responsibilities: A. Community Collaboration and Health Promotion

Can a community health worker and a trained traditional birth attendant work as a team to deliver child health interventions in rural Zambia?

BackgroundTeaming is an accepted approach in health care settings but rarely practiced at the community level in developing countries. Save the Children trained and deployed teams of volunteer community health workers (CHWs) and trained traditional birth attendants (TBAs) to provide essential newborn and curative care for children aged 0–59 months in rural Zambia. This paper assessed whether CHWs and trained TBAs can work as teams to deliver interventions and ensure a continuum of care for all children under-five, including newborns.MethodsWe trained CHW-TBA teams in teaming concepts and assessed their level of teaming prospectively every six months for two years. The overall score was a function of both teamwork and taskwork. We also assessed personal, community and service factors likely to influence the level of teaming.ResultsWe created forty-seven teams of predominantly younger, male CHWs and older, female trained TBAs. After two years of deployment, twenty-one teams scored “high”, twelve scored “low,” and fourteen were inactive. Teamwork was high for mutual trust, team cohesion, comprehension of team goals and objectives, and communication, but not for decision making/planning. Taskwork was high for joint behavior change communication and outreach services with local health workers, but not for intra-team referral. Teams with members residing within one hour’s walking distance were more likely to score high.ConclusionIt is feasible for a CHW and a trained TBA to work as a team. This may be an approach to provide a continuum of care for children under-five including newborns.

Determinants of Skilled Birth Attendant Utilization in Afghanistan: A Cross-Sectional Study

We sought to identify characteristics associated with use of skilled birth attendants where health services exist in Afghanistan. We conducted a cross-sectional study in all 33 provinces in 2004, yielding data from 617 health facilities and 9917 women who lived near the facilities and had given birth in the past 2 years. Only 13% of respondents had used skilled birth attendants. Women from the wealthiest quintile (vs the poorest quintile) had higher odds of use (odds ratio [OR] = 6.3; 95% confidence interval [CI] = 4.4, 8.9). Literacy was strongly associated with use (OR = 2.5; 95% CI = 2.0, 3.2), as was living less than 60 minutes from the facility (OR = 1.5; 95% CI = 1.1, 2.0) and residing near a facility with a female midwife or doctor (OR = 1.4; 95% CI = 1.1, 1.8). Women living near facilities that charged user fees (OR = 0.8; 95% CI = 0.6, 1.0) and that had male community health workers (OR = 0.6; 95% CI = 0.5, 0.9) had lower odds of use. In Afghanistan, the rate of use of safe delivery care must be improved. The financial barriers of poor and uneducated women should be reduced and culturally acceptable alternatives must be considered.

Correlates of Dietary Intake Among Men Involved in the MAN for Health Study

The clustering of diet and other lifestyle behaviors and their psychosocial correlates were examined among 455 Latino and African American men in the U.S. Southeast. Men were recruited by male community health workers and surveys were self-administered in a group format. Latino men were younger, less educated, and more likely to be employed than African American men and reported a lower household income and larger household size. Fruit and vegetable consumption was associated with physical activity (p < or = .001). A more positive attitude toward health was associated with meeting vegetable dietary guidelines (p < or = .05) and consuming fast food less frequently (p < or = .01). Active coping was associated with meeting fruit and vegetable dietary guidelines (p < or = .01 and p < or = .001, respectively), and avoidant coping was associated with greater fast-food consumption (p < or = .001). Latino fast-food consumption was associated with binge drinking (p < or = .001). This research provides evidence for tailoring dietary intervention for men of color.