Number Of Community Health Workers Research Articles

Examining The Care Pathways Patients Experience When Accessing Outpatient Psychiatric Care in British Columbia

The British Columbia (BC) mental health roadmap prioritizes equitable access to care. This study investigates the equity of care pathways experienced by BC residents accessing outpatient psychiatric care for the first time. Community-based care pathways are paramount as they indicate timely access to care and are less expensive for the health system. We analyzed linked administrative BC health data spanning April 1st 2013, to March 31st 2022, to study how sociodemographic factors relate to accessing psychiatric care pathways. Pathways to outpatient psychiatric care include a community-based pathway, hospitalization to primary care to outpatient psychiatry, and hospitalization directly to outpatient psychiatry. Sociodemographic factors considered were administrative sex, immigration recency and status, neighbourhood income quintile and being a recipient of a low-income drug plan. These relationships were analyzed using multinomial logistic regression, adjusting for age, location, fiscal year, and stratifying by mental disorder diagnoses. Being male, a low-income drug plan recipient, living in a lower income neighbourhood, or being a recent economic immigrant or permit holder was associated with increased odds of accessing outpatient psychiatric care via either hospitalization pathway. Having a diagnosis of schizophrenia/bipolar disorder was independently associated with both hospitalization pathways, and this diagnosis exacerbated the magnitude of the estimates for the sociodemographic characteristics. We find clear disparities in pathways to accessing outpatient psychiatric care. These disparities indicate health system failures in addressing specific population needs, highlighting the importance of targeted interventions, such as increasing the number of community health workers, to achieve equitable mental health care in BC.

Análise temporal de indicadores da Estratégia Saúde da Família sob o olhar da Política Nacional da Atenção Básica

Throughout the three editions of the Brazilian National Primary Health Care Policy (PNAB), changes were made in relation to the structure of the Family Health Strategy (FHS), with emphasis on modifications concerning the priority nature of the FHS as an organization and care strategy in primary health care. The objective was to analyze temporal trends in indicators related to the FHS from the perspective of the three PNAB editions: 2006, 2011, and 2017. This is a descriptive study of the temporal trend of indicators selected from a logical model constructed by components related to the FHS in the three editions of the PNAB. The logical model was developed based on the components Territory/Enrollment, Teams, Work Process, Territory Planning and Management, and Care for Priority Groups by Family Health Teams, each one being represented by selected indicators. The construction of the national and regional time series between 2007 and 2020 was carried out using the Joinpoint software. Most of the indicators showed an upward trend in the first time segments identified by the models, followed by segments of stability or decrease, especially after the year 2017. The indicator Number of community health workers stands out, which decreased after 2017 in most geographical regions and in Brazil. The 2017 PNAB may have discouraged the continuation and expansion of the FHS as the priority model of primary health care, by allowing and financing new teamwork arrangements and processes.

Temporal analysis of Family Health Strategy indicators from the perspective of the Brazilian National Primary Health Care Policy.

Throughout the three editions of the Brazilian National Primary Health Care Policy (PNAB), changes were made in relation to the structure of the Family Health Strategy (FHS), with emphasis on modifications concerning the priority nature of the FHS as an organization and care strategy in primary health care. The objective was to analyze temporal trends in indicators related to the FHS from the perspective of the three PNAB editions: 2006, 2011, and 2017. This is a descriptive study of the temporal trend of indicators selected from a logical model constructed by components related to the FHS in the three editions of the PNAB. The logical model was developed based on the components Territory/Enrollment, Teams, Work Process, Territory Planning and Management, and Care for Priority Groups by Family Health Teams, each one being represented by selected indicators. The construction of the national and regional time series between 2007 and 2020 was carried out using the Joinpoint software. Most of the indicators showed an upward trend in the first time segments identified by the models, followed by segments of stability or decrease, especially after the year 2017. The indicator Number of community health workers stands out, which decreased after 2017 in most geographical regions and in Brazil. The 2017 PNAB may have discouraged the continuation and expansion of the FHS as the priority model of primary health care, by allowing and financing new teamwork arrangements and processes.

Previne Brasil Program: the apex of threats to Primary Health Care?

Since 2017, the Brazilian health system is facing a wave of counter-reforms in policies that have expanded coverage and access and intended to change the care model. Primary Health Care (PHC) has been substantially modified by synergistic and complementary federal official acts. The creation of federal autonomous social service for the provision of doctors; public consultation to institute basket of consumption in healthcare; the flexibility of the weekly workload of doctors and nurses, who may integrate more than one team; the non-setting of a minimum number of community health workers per team form the context in which the Previne Brasil Program was launched to be in force by 2020. The government's argument is to increase: flexibility and local autonomy to organize services, greater efficiency and valorization. of performance. Criticism from sanitarians, some state councils of municipal authorities and the National Health Council points to the privatizing, marketing, selective and focused character of the proposal that is moving towards universal health coverage. This paper analyzes the Previne Brazil Program which, among other things, alters funding and suggests increasing resources for PHC in a context of freezing social spending. Contradictions and alternatives are identified to minimize potential damage to existing policies.

Community health workers caring for dependent elderly people.

Community Health Workers (CHWs) are a link between Family Health Strategy (FHS) professionals and the community. This study aims to analyze health care professionals' perceptions and health management about CHWs' role in caring for dependent elderly people. A qualitative study was carried out, from a hermeneutic-dialectic perspective, with 38 professionals working in elderly people's health in cities in the five regions of Brazil. The results identified CHWs as facilitators of access to elderly people dependent on the health care network, gaps in continuing education and the reduced number of these professionals to meet the demand in primary care. Respondents attributed great importance to CHW's performance, valued their participation in FHS, but pointed out a lack of knowledge and difficulties to supply the adequate amount in health care services and in assistance of elderly people with dependence and family. It is concluded that health professionals and managers consider CHWs to be a great workforce and essential to the dependent elderly people and their caregivers. The number of CHWs is insufficient in relation to FHS, and there is a lack of training to deal with various types of dependence.

Community health worker home visiting in deeply rural South Africa: 12-month outcomes

ABSTRACT Home visiting by community health workers (CHW) improves child outcomes in efficacy trials, there is however limited evidence of impact evaluating CHW programmes when operating outside of a research project. A CHW programme, previously demonstrated efficacious in a peri-urban township, was evaluated in a deeply rural context in a non-randomised comparative cohort study. Two non-contiguous, rural areas in the Eastern Cape of South Africa of about equal size and density were identified and 1469 mother-infant pairs were recruited over 33 months. In one area, CHWs conducted perinatal home visits (intervention group). Mothers in the comparison group received standard clinic care. Maternal and child outcomes were compared between the groups at one year. Mothers in the intervention group had significantly fewer depressive symptoms than mothers in the comparison group. Children of intervention mothers attained a higher proportion of their developmental milestones, compared to children in the comparison group. There were no other significant differences between mothers and children in the two groups. It is important to establish key parameters for implementing efficacious CHW programmes, especially as the numbers of CHWs are rapidly increased and are becoming critical components of task-shifting strategies of health departments in low and middle income countries (LMIC).

The study of utilization pattern of antenatal care services in Urban field practice area, Kims, Koppal, Karnataka

Introduction: Health Care Utilization overall, and for maternal health specifically has improved in India. The progress has been attributed to NRHM, that has increased the number of community health workers and resulted in more institutional deliveries. Motherhood is the basis of family life. Antenatal Care (ANC) is a pivotal factor for safe motherhood. Mothers who had not received good ANC were found to be more at risk of having Low birth weight babies. Aims 1. To assess the utilization pattern of ANC services 2. Association between the socio demographic factors and the utilization pattern Methods: A cross sectional study was conducted in Urban Field Practice area, KIMS, Koppal. 327 women who delivered in one year were interviewed between 1st October 2018 to 30st September 2019 by using pre designed and semi structured questionnaire. House to house visit was done to obtain information about the antenatal care utilization and socio demographic factors. The data was entered in excel Results: Out of 328 study participants, majority 282(86%) had their ANC Checkup at Urban Health Centre, 273 (83.3%) had early antenatal registration during first trimester, 267 (81.7%) received IFA tablets. Conclusions: Due to the implementation of NRHM and the frequent monitoring of ANM and ASHA workers, our results have shown better ANC services utilization pattern in our study area.

Tracking progress on the health status and service delivery outcomes for neonates and children in the Metro West geographic service area of the Cape Metropole, 2010 - 2015

Background. Monitoring the health status of populations of children is one of the building blocks of the health system. The provision of an indicator dashboard with disaggregated data that are collected over time can be used to gauge the performance of the health system, guide the allocation of resources and prioritise health interventions within districts. Objectives. To determine neonatal and child mortality, morbidity and health service outcomes over a 6-year period in the Metro West geographic service area (GSA) of the Cape Town metropole. Methods. A dashboard with key indicators was developed using existing data. Results. From 2010 to 2015, there was a decrease in the perinatal mortality rate from 31.7 to 24.8 per 1 000 deliveries, and the early neonatal and neonatal mortality rates from 7.8 and 8.6 to 7.0 and 8.2 per 1 000 live births, respectively. The main obstetric causes of early neonatal deaths were antepartum haemorrhage (22 - 24%) and unexplained intrauterine death (13 - 16%); the main neonatal causes were immaturity (17 - 34%), congenital abnormalities (23 - 29%) and hypoxia (23 - 26%). Under-five mortality decreased in 2013 from 25 to 22 per 1 000 live births, with the main causes being neonatal conditions (32%), pneumonia (25%), congenital abnormalities (9%), injuries (8%) and diarrhoea (8%). Fifty percent of child deaths were out of hospital, with pneumonia and diarrhoea accounting for more than half of these. There was an improvement in health service coverage rates in 2015: immunisation <1 year old (99%); measles second dose (85%), pneumococcal third dose (100%) and rotavirus second dose (100%); maternal antiretroviral coverage (90%); HIV testing in mothers (93%); HIV DNA polymerase chain reaction testing in babies (97%); and a decrease in HIV transmission (2%). Exclusive breastfeeding coverage rates at 14 weeks, and vitamin A supplementation at 12 - 59 months, were only 30% and 44%, respectively, across the GSA. Conclusion. There was a decrease in perinatal, early neonatal, infant and under-five mortality in Metro West over the 6 years. Further reductions in under-five mortality will require focusing on interventions to reduce neonatal and out-of-hospital deaths across the service delivery platform. Home visits to at-risk mothers and infants by community health workers could prevent out-of-hospital deaths and improve exclusive breastfeeding and vitamin A coverage. This will require increasing the number of community health workers and broadening their scope of practice.

HRH dimensions of community health workers: a case study of rural Afghanistan

IntroductionThere is ample evidence to indicate that community health workers (CHW) are valuable human resources for health in many countries across the globe, helping to fill the gap created by a chronic health workforce shortage. This shortage is not only in number but also in workforce distribution and skill mix. There remains a lack of evidence, however, concerning the size and distribution of CHWs and their relationship to the professionally regulated and recognized health workforce, such as physicians and nurses, and the unregulated and unrecognized health workforce, such as traditional birth attendants and traditional healers. This is particularly the case in low-income, under-resourced countries, such as Afghanistan.MethodWe conducted a descriptive qualitative analysis involving fieldwork in Afghanistan between 2013 and 2014. We undertook participant observation and in-depth interviews with community members, CHWs, health managers, and policymakers, in an attempt to add more depth to our knowledge of how CHWs function, or could function better, as a recognized health worker.ResultsWe found that the number of CHWs has increased dramatically in recent years and that CHWs play a variety of roles, including work generally associated with professional providers, such as referral, education, and counseling. Although not a replacement for professional health providers, CHWs, in places where the number of and access to such providers is low, become the only option to meet basic health needs of the population. In places where professional providers are available, CHWs have the potential to extend the services to marginalized populations, provide community health services, and become a recognized member of the health provider team. A limitation of their role in health system strengthening is their lack of integration and a clear career path including into more recognized professional roles.ConclusionCHWs provide a critical human resources for health role in Afghanistan, but there are opportunities for improved integration with other providers which can increase their potential to improve service delivery.

Integrating a nationally scaled workforce of community health workers in primary care: a modelling study.

To model cost and benefit of a national community health worker workforce. Modelling exercise based on all general practices in England. United Kingdom National Health Service Primary Care. Not applicable. Publicly available data on general practice demographics, population density, household size, salary scales and screening and immunisation uptake. We estimated numbers of community health workers needed, anticipated workload and likely benefits to patients. Conservative modelling suggests that 110,585 community health workers would be needed to cover the general practice registered population in England, costing £2.22bn annually. Assuming community health workerss could engage with and successfully refer 20% of eligible unscreened or unimmunised individuals, an additional 753,592 cervical cancer screenings, 365,166 breast cancer screenings and 482,924 bowel cancer screenings could be expected within respective review periods. A total of 16,398 additional children annually could receive their MMR1 at 12 months and 24,716 their MMR2 at five years of age. Community health workerss would also provide home-based health promotion and lifestyle support to patients with chronic disease. A scaled community health worker workforce integrated into primary care may be a valuable policy alternative. Pilot studies are required to establish feasibility and impact in NHS primary care.

Mobility and Vitality Lifestyle Program (MOVE UP): A Community Health Worker Intervention for Older Adults With Obesity to Improve Weight, Health, and Physical Function.

Background and ObjectivesObesity rates in adults ≥65 years have increased more than other age groups in the last decade, elevating risk for chronic disease and poor physical function, particularly in underserved racial and ethnic minorities. Effective, sustainable lifestyle interventions are needed to help community-based older adults prevent or delay mobility disability. Design, baseline recruitment, and implementation features of the Mobility and Vitality Lifestyle Program (MOVE UP) study are reported.Research Design and MethodsMOVE UP aimed to recruit 26 intervention sites in underserved areas around Allegheny County, Pennsylvania and train a similar number of community health workers to deliver a manualized intervention to groups of approximately 12 participants in each location. We adapted a 13-month healthy aging/weight management intervention aligned with several evidence-based lifestyle modification programs. A nonrandomized, pre–post design was used to measure intervention impact on physical function performance, the primary study endpoint. Secondary outcomes included weight, self-reported physical activity and dietary changes, exercise self-efficacy, health status, health-related quality of life, and accelerometry in a subsample.ResultsOf 58 community-based organizations approached, nearly half engaged with MOVE UP. Facilities included neighborhood community centers (25%), YMCAs (25%), senior service centers (20%), libraries (18%), senior living residences (6%), and churches (6%). Of 24 site-based cohorts with baseline data completed through November 2017, 21 community health workers were recruited and trained to implement the standardized intervention, and 287 participants were enrolled (mean age 68 years, 89% female, 33% African American, other, or more than one race).Discussion and ImplicationsThe MOVE UP translational recruitment, training, and intervention approach is feasible and could be generalizable to diverse aging individuals with obesity and a variety of baseline medical conditions. Additional data regarding strategies for program sustainability considering program cost, organizational capacity, and other adaptations will inform public health dissemination efforts.

Overview, methods and results of multi-country community-based maternal and newborn care economic analysis.

Home visits for pregnancy and postnatal care were endorsed by the WHO and partners as a complementary strategy to facility-based care to reduce newborn and maternal mortality. This article aims to synthesise findings and implications from the economic analyses of community-based maternal and newborn care (CBMNC) evaluations in seven countries. The evaluations included five cluster randomized trials (Ethiopia, Ghana, South Africa, Tanzania, Uganda) and programmatic before/after assessments (Bolivia, Malawi). The economic analyses were undertaken using a standardized, comparable methodology the 'Cost of Integrated Newborn Care' Tool, developed by the South African Medical Research Council, with Saving Newborn Lives and a network of African economists. The main driver of costs is the number of community health workers (CHWs), determined by their time availability, as fixed costs per CHW (equipment, training, salary/stipend, supervision and management), independent from the level of activity (number of mothers visited) represented over 96% of economic and financial costs in five of the countries. Unpaid volunteers are not necessarily a cheap option. An integrated programme with multi-purpose paid workers usually has lower costs per visit but requires innovative management, including supervision to ensure that coverage, or quality of care are not compromised since these workers have many other responsibilities apart from maternal and newborn health. If CHWs reach 95% of pregnant women in a standardized 100 000 population, the additional financial cost in all cases would be under USD1 per capita. In five of the six countries, the programme would be highly cost-effective (cost per DALY averted < GDP/capita) by WHO threshold even if they only achieved a reduction of 1 neonatal death per 1000 live births. These results contribute useful information for implementation planning and sustainability of CBMNC programmes.

Malaria case management by community health workers in the Central African Republic from 2009\u20132014: overcoming challenges of access and instability due to conflict

BackgroundIn the Central African Republic (CAR), decades of armed conflict have crippled the public health system. This has left the population without timely access to life-saving services and therefore vulnerable to the numerous consequences of infectious diseases, including malaria. As a response, in 2008 an international non-governmental organization started a network of community health workers (CHWs) in the highly malaria-endemic region of northwest CAR. The area has experienced years of violent clashes between rebel groups and seen hundreds of thousands of people displaced.MethodsData from routine patient registers from 80 CHWs working in Paoua and Markounda sub-prefectures were entered and retrospectively reviewed. The time period covered December 2009–April 2014 and hence different stages of conflict and unrest. Several indicators were measured over time, including malaria rapid diagnostic test (RDT) positivity rates, CHW reporting rates, and malnutrition indicators.ResultsAmong nearly 200,000 people who consulted a CHW during this period, 81% were found to be positive for malaria parasites by RDT. In total, 98.9% of these positive cases were appropriately treated with artemisinin-based combination therapy (ACT). Only 1.2% of RDT negative cases were incorrectly treated with an ACT. Monthly data from each CHW were regularly reported, with more than 96% of CHWs reporting each month in the first 3 years of the project. However, since the coup d’état in March 2013, the number of CHWs reporting each month decreased as the programme battled the additional constraints of civil war.ConclusionsAlthough the political crisis affected the CHWs, the programme showed that it could reach those most vulnerable and continue some level of care at all times. In addition, this programme revealed that surveillance could be maintained in conflict zones. This paper fills a significant gap in the knowledge of malaria control in CAR and this is especially important for agencies which must often decide in a short space of time how to respond effectively to complex emergencies.

Independent Evaluation of the Rapid Scale-Up Program to Reduce Under-Five Mortality in Burkina Faso.

We conducted a prospective evaluation of the “Rapid Scale-Up” (RSU) program in Burkina Faso, focusing on the integrated community case management (iCCM) component of the program. We used a quasi-experimental design in which nine RSU districts were compared with seven districts without the program. The evaluation included documentation of program implementation, assessments of implementation and quality of care, baseline and endline coverage surveys, and estimation of mortality changes using the Lives Saved Tool. Although the program trained large numbers of community health workers, there were implementation shortcomings related to training, supervision, and drug stockouts. The quality of care provided to sick children was poor, and utilization of community health workers was low. Changes in intervention coverage were comparable in RSU and comparison areas. Estimated under-five mortality declined by 6.2% (from 110 to 103 deaths per 1,000 live births) in the RSU area and 4.2% (from 114 to 109 per 1,000 live births) in the comparison area. The RSU did not result in coverage increases or mortality reductions in Burkina Faso, but we cannot draw conclusions about the effectiveness of the iCCM strategy, given implementation shortcomings. The evaluation results highlight the need for greater attention to implementation of iCCM programs.

Strategies to Improve the Integration of Community Health Workers Into Health Care Teams: “A Little Fish in a Big Pond”

IntroductionThe Patient Protection and Affordable Care Act acknowledges the value of community health workers (CHWs) as frontline public health workers. Consequently, growing attention has been placed on promoting CHWs as legitimate partners to provide support to health care teams and patients in the prevention, management, and control of chronic disease, particularly among diverse populations and high-need individuals.MethodsUsing a mixed-methods research approach, we investigated the integration of CHWs into health care teams from the CHW perspective. We conducted a survey of 265 CHWs and interviews with 23 CHWs to better understand and describe their experience and their perceived opportunities and challenges regarding their integration within the context of health care reform.ResultsFeelings of organizational support were positively correlated with the number of CHWs in the organization. CHWs reported the following facilitators to integration: having team meetings (73.7%), training inside (70.4%) and outside of the organization (81.6%), access to electronic health records, and ability for CHWs to stay connected to the community.ConclusionThe perspectives of CHWs on their positive and negative experiences offer useful and innovative insight into ways of maximizing their impact on the health care team, patients, and their role as key emissaries between clinical services and community resources.

Equidade na Estratégia Saúde da Família (ESF)

Objective: To associate the implementation of the Family Health Strategy (FHS) between 2001 and 2010 with the variables of the Municipal Human Development Index (MHDI) and socioeconomic indicators. Methods: Ecological study collected information on the MHDI, socioeconomic indicators, and the FHS, regarding the number of Community Health Workers (CHW), Family Health Teams (FHT), Oral Health Teams (OHT), and population and relative (%) coverage in 645 municipalities in the state of Sao Paulo, Brazil, in the period from 2001 to 2010. Descriptive analysis was conducted by means of absolute and relative frequencies for evaluation of each indicator. Non-parametric tests were used: Spearman’s correlation coefficient for the FHS variables and the socioeconomic indicators, and Wilcoxon test (p<0.05) for comparison between the two dates. Results: There was positive correlation between the increase in FHS and OHT teams, and the MHDI (p<0.01). Social data (access to water, waste collection percentage, and average income presented positive correlation with FHS and population coverage. A negative correlation was found between population coverage (%) and all the social variables except illiteracy. Conclusion: The evolution of the FHS in the state of Sao Paulo during the studied period was positive in fighting the health inequalities.

Bangladesh Health System and the Millennium Development Goals: Strategic Policy Options for Sustained Progress in Maternal and Child Health

The timeline set by the United Nations in achieving the Millennium Development Goals (MDGs) pronounced in the year 2000 is coming to end in 2015. While the United Nations has already came up with a new set of 17 Sustainable Development Goals (SDGs) to follow the MDGs, efforts are underway to assess the success and failures of countries in achieving the MDGs. Bangladesh has made tremendous progress in achieving most of the MDGs including those related to maternal and child health. The maternal mortality ratio and the infant mortality rate in Bangladesh declined from 507 and 149 in 1990 to 209 and 53 in 2010 respectively. However, district level review suggests that numerous constraints and challenges confront the health system in sustaining these achievements. Moreover, desegregated data strongly indicate that the progress is even across different regions of the country. Most importantly, significant gaps still persist between the rich and the poor. For example, while the overall IMR is 43 per 1,000 live births among the highest income quintile, the figure is 84 among the lowest income quintile. In other words, Bangladesh must forcefully address regional disparity and rich-poor gap to ensure sustainable and equitable development in all aspects of health. The study identified a few strategic policy directions for this purpose including aggressive pro-poor and sub-national development planning. To ensure availability of and accessibility to primary health care for all, the study strongly argues for the establishment of community clinics throughout the country equipped with skilled midwives and adequate number of community health workers.

Abstract C11: Factors impacting implementation of a community coalition-driven evidence-based intervention: Results from a cluster randomized controlled trial

Abstract Background: For the past two decades there has been increased emphasis on implementing community coalition-driven, evidence-based interventions. However, little information is available to determine which elements of coalition infrastructure and partnerships are most supportive of successful intervention implementation. The Educational Program to Increase Colorectal Cancer Screening (EPICS) is a cluster randomized controlled trial (cRCT) currently underway in 20 communities located in 12 US states. The objective of this paper is to describe the role of three elements important in EPICS implementation by community coalitions: organizational infrastructure, facilitator selection and partnership formation. We hypothesized that more experienced community coalitions with larger, formal structures will train more facilitators and establish more partnerships when compared to smaller, less formal coalitions. Methods: National Black Leadership Initiative on Cancer (NBLIC) community coalitions were charged with recruiting facilitators and community partners for EPICS delivery. The role of the facilitators was to deliver the educational intervention to small groups of participants. Facilitators selected were either community health educators (CHEs) – persons with a health professions degree - or community health workers (CHWs). Partnerships were formed with churches, clinics and other community sites to serve as settings and to assist in participant recruitment. Data were collected using a mixed method approach: two self-administered surveys (Organizational Assessment and Facilitator Baseline, Knowledge, Attitudes and Confidence Survey) and telephone key informant interviews. Descriptive analyses of the three groups of study participants (e.g., community coalitions, facilitators and partners) and correlational analysis was also performed within each community coalition to test for differences in facilitator and partnership type. Results: A total of 20 community coalitions, 204 facilitators and 61 community institutions formed partnerships for EPICS implementation. Organizational Structure: All but one community coalition targets primarily African American populations (95.24%). Facilitator Selection: CHEs and CHWs were demographically similar (e.g., gender, race, age, language of preference, marital status, religious preference, and insurance coverage). While the association between community coalition size and the number of CHEs was not significant, there was a significant difference between community coalition size and the number of CHWs. Smaller and medium-sized coalitions engaged more CHWs as facilitators (p=0.0071). Partnership Formation: Community coalition size did not correlate with partnership type or number. Community coalitions indicating partnerships with clinics were more likely to select CHEs than CHWs (p=0.0338). Conclusions: We examined multiple organizational characteristics to determine their relationship to facilitators and partners implementing EPICS. Although demographically similar, CHWs were selected more often by smaller and medium-sized community coalitions to train as EPICS facilitators. This finding suggests that smaller community coalitions, with a less formal structure were more likely to engage individuals with limited health backgrounds to facilitate the intervention. As a community-driven intervention, EPICS facilitation does not require a health professional for delivery. Interestingly, for community coalitions planning to implement EPICS in clinical settings, CHEs were selected over CHWs as facilitators. Citation Format: Selina A. Smith, Sandra J. Hamilton, Rene D. Jackson, Mechelle D. Claridy, Ernest Alemah-Mensah, Joyce Q. Sheats, Joyce Q. Sheats. Factors impacting implementation of a community coalition-driven evidence-based intervention: Results from a cluster randomized controlled trial. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C11.

Reproductive health indicators and outcomes among refugee and internally displaced persons in postemergency phase camps.

Despite increasing awareness of the importance of reproductive health programs and services for refugee and internally displaced populations, there is a paucity of basic epidemiological data on reproductive health outcomes. To collect data on reproductive health outcomes among refugees and internally displaced persons in postemergency phase camps and compare these outcomes with those of host country and country-of-origin populations. To determine programmatic factors that may affect reproductive health outcomes. Retrospective study of data collected from August 1998 through March 2000 of 688,766 persons living in 52 postemergency phase camps in 7 countries. Reproductive health outcomes of refugee and internally displaced populations were compared with available data of reference populations within their respective host country and country of origin. Crude birth rate (CBR), neonatal mortality rate (NNMR), maternal mortality ratio (MMR), percentage of newborns with low birth weight (LBW), and incidence of complications of unsafe or spontaneous abortions. Six of 11 groups had lower CBRs than their country of origin and 5 of 9 groups had lower CBRs than their host country. Four of 5 had lower NNMRs than their country of origin and 6 of 9 had lower NNMRs than the host country. Four of 6 had lower MMRs than their country of origin, and 5 of 6 had lower MMRs than their host country. Seven of 9 had lower percentages of LBWs than in the country of origin and 5 of 9 had lower percentages of LBWs than the host country. Higher CBRs were associated with more recently established camps and higher numbers of local health staff per 1000 persons; and higher percentages of LBW newborns were associated with rainy season, more recently established camps, lower numbers of community health workers per 1000 persons, and camps without supplementary feeding programs. Refugees and internally displaced persons in most postemergency phase camps had better reproductive health outcomes than their respective host country and country-of-origin populations.

Perspectives on health economics. 3. Economics in action.

This paper describes 4 health care studies which illustrate the value of using economic analysis to evaluate health care choices. A Chamberlain undertook an applied health economics study of family planning service costs in a Scottish community. The study revealed that the cost of avoiding an unwanted birth was 320-490 pounds. Chamberlain also calculated the utilization cost for 1 woman/year of family planning services when the services were provided by a general practitioner (10.74 pounds), by a multipurpose health center (7.87 pounds), and by a family planning clinic (10.22 pounds). Information of this type can be used to develop rational health care policies. J.K. Wang'ombe assessed the costs and benefits of a project to decentralize access to primary health care in West Kenya. In order to increase health care contacts among the members of communities surrounding rural health posts, a number of community health workers were trained to diagnose and treat minor illness and to refer more serious cases on to the health posts. The project resulted in a marked increase in health care contact and a decline in the cost of each contact. Over a period of a year, the program provided 10 times as much value (contacts)/cost unit as the previous program, i.e., operating the health post without community health workers. The 3rd study was undertaken at a health maintenance organization in the US. It compared the cost of using a physician only with the cost of using a combined physician and nurse team to do the tasks outlined in the diagnosis and treatment protocals for 4 different medical conditions. For 3 of the 4 medical conditions the team approach was less expensive than the physician only approach, and for 2 of the conditions the team approach was significantly less expensive than the physician only approach. Medical outcomes were as good and sometimes better under the team system as under the physician only system. The 4th study was conducted in the Netherlands. It compared the treatment and referral behavior of general practitioners working in different practice setting, e.g., private offices and community health centers. The study revealed that savings expected to be associated with community health care centers, especially in referrals for secondary care, were not realized. The study raised serious questions as to whether the government should continue to provide subsidies to community health care centers. Despite the demonstrated applied value of health economic studies, economic analyses are rarely used in health planning and evaluation. In 1983, the National Health Service of the United Kingdom held a seminar to address this issue. The participants attributed the dearth of economic analysis in health planning to health professionals' lack of awareness of health economics and lack of concern with efficiency. Health professionals tend to believe that no price should be placed on saving a life. Other reasons were: 1) disagreements about whether equity should be be based on service access, quality, or utilization; 2) a lack of understanding between NHS and economists; and 3) the difficulties involved in attempting to do economic analyses in the context of poor health planning. These difficulties could be overcome by making planning less political, providing incentives for efficiency in the health care system, and educating health professionals about the value of efficiency.