Perspectives Of Health Workers Research Articles

Determinants of community health workers effectiveness for delivery of maternal and child health in Sub Saharan Africa: A Systematic review protocol.

BackgroundCountries in sub-Sahara African continue to have the highest maternal and under- five child death occurrences in the world and this has become a key health challenge in the region and persists as global public health agenda. Although Community Health Workers (CHWs) are increasingly being acknowledged as crucial members of the healthcare workforce in reducing health disparity, evidence is limited on perspective of community health workers. The objective of this protocol is to outline the methodological process of a systematic review that will gather qualitative data to examine determinants of community health workers effectiveness for delivery of maternal and child health in Sub Saharan Africa. Synthesizing the perspectives of community health workers’ perceived experience is crucial to inform decision makers, policy makers, and practitioners to address barriers to and scaleup facilitators of CHWs program to ensure maternal and child health equity and a resilience community health system.MethodsThe protocol has been registered in the PROSPERO (CRD42020206874). We will systematically conduct a literature search from inception in MEDLINE complete, EMBASE, CINAHL complete and Global Health for relevant studies. Eligible studies will be reports of original research, peer reviewed articles having a qualitative component (i.e., qualitative, mixed, or multi-method studies) on empowerment of CHWs associated with maternal and child health in the sub-Saharan Africa. Eligibility will be restricted to studies published in English. Two reviewers will independently screen all included abstracts and full-text articles. The primary outcome will be CHWs’ perceived barriers to and facilitators of effectiveness of community health workers in maternal and child health in sub-Saharan Africa. Study methodological quality (or bias) will be appraised using appropriate tools. Narrative analysis will be conducted, and narrative summary of findings will be presented. We will use the ‘best fit’ framework method as a systematic approach to analyzing the qualitative data.DiscussionThis study will systematically and comprehensively search literature and integrate evidence on perceived barriers to and facilitators of effectiveness of community health workers led maternal and child health program in sub-Saharan Africa. Our findings will inform policy and practice on maternal and child health equity and a resilient communities health system. The resulting manuscript will be disseminated in a peer-reviewed journal and at international and national conferences.

Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: A mixed-methods systematic review.

Stigma and discrimination are fundamental causes of health inequities, and reflect privilege, power, and disadvantage within society. Experiences and impacts of stigma and discrimination are well-documented, but a critical gap remains on effective strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings. We aimed to address this gap by conducting a mixed-methods systematic review and narrative synthesis to describe strategy types and characteristics, assess effectiveness, and synthesize key stakeholder experiences. We searched MEDLINE, CINAHL, Global Health, and grey literature. We included quantitative and qualitative studies evaluating strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings. We used an implementation-focused narrative synthesis approach, with four steps: 1) preliminary descriptive synthesis, 2) exploration of relationships between and across studies, 3) thematic analysis of qualitative evidence, and 4) model creation to map strategy aims and outcomes. Of 8,262 articles screened, we included 12 articles from 10 studies. Nine articles contributed quantitative data, and all measured health worker-reported outcomes, typically about awareness of stigma or if they acted in a stigmatizing way. Six articles contributed qualitative data, five were health worker perspectives post-implementation and showed favorable experiences of strategies and beliefs that strategies encouraged introspection and cultural humility. We mapped studies to levels where stigma can exist and be confronted and identified critical differences between levels of stigma strategies aimed to intervene on and evaluation approaches used. Important foundational work has described stigma and discrimination in sexual and reproductive healthcare settings, but limited interventional work has been conducted. Healthcare and policy interventions aiming to improve equity should consider intervening on and measuring stigma and discrimination-related outcomes. Efforts to address mistreatment will not be effective when stigma and discrimination persist. Our analysis and recommendations can inform future intervention design and implementation research to promote respectful, person-centered care for all.

Feasibility, acceptability, and appropriateness of a mobile health stroke intervention among Ghanaian health workers

BackgroundmHealth interventions can improve care delivery in settings with limited resources. The Phone-based Interventions under Nurse Guidance after Stroke (PINGS) is a nurse-led, mHealth-centered approach to blood pressure (BP) control among recent stroke survivors with hypertension in Ghana. It has 4 key components: (1) home blood pressure monitoring, (2) nurse-coordinated mhealth consults, (3) phone alerts as medication reminders, and (4) patient motivational messages delivered as interactive voice recordings. ObjectiveTo assess the feasibility, acceptability, and appropriateness for scale up of the PINGS intervention in Ghana, from the perspective of health workers. MethodsBetween July and August 2021, we deployed an online questionnaire describing the components of PINGS to a cross-section of health workers in Ghana. The questionnaire used an adaptation of psychometrically validated Likert scale measures to elicit agreement or disagreement with attributes of the intervention. The questionnaire was distributed online to approximately 4000 healthcare workers via email and social media platforms. A summary of descriptive statistics was obtained; summed composite scores were then calculated, dichotomized, and binary logistic regression performed using R programming software. ResultsOf 653 health workers who completed the survey, 57.2% were male; 73.2% clinicians; median age was 33 years (IQR 29, 37). Respondents' primary workplaces were public (64.4%), quasi-government (9.4%), and private, including mission-based (26.2%) facilities. PINGS was deemed feasible, acceptable, and appropriate by 93.9%, 94.8%, and 95.1% of respondents respectively. Clinical staff had higher odds of finding PINGS feasible (OR 4.10; C.I. 2.15, 8.0; p < 0.001), acceptable (OR 3.76, C.I. 1.87, 7.69; p < 0.001), or appropriate (OR 2.91, C.I. 1.41, 5.95; p = 0.004) compared to non-clinical staff. There was no statistically significant difference in the rating of each measure when analyzed by age, sex, years of health work experience, geographic location, type, or level of health facility. ConclusionAn overwhelming majority of health workers (particularly clinical staff) considered PINGS to be a feasible, acceptable, and appropriate for BP control among stroke survivors in Ghana.

Health workers’ values and preferences regarding contraceptive methods globally: A systematic review

ObjectiveWe sought to systematically review the literature on health workers’ values and preferences related to contraceptive methods. Study designAs part of a larger review, we searched ten electronic databases for published articles from January 1, 2005 through July 27, 2020. We included studies that reported qualitative or quantitative data from the perspective of health workers providing family planning services globally. ResultsForty-one studies met our inclusion criteria. These studies included 12,643 health workers and were conducted in 27 countries. Health worker values and preferences for contraceptive methods were affected by factors related to contraceptive method characteristics (e.g., bleeding pattern and convenience), the contraceptive user (e.g., medical history, parity), and the health worker themselves (e.g., training, environment). Differences were also noted between various professions/specialties (e.g., comfort level with contraceptive methods, depth of experience). While contraceptive counseling and provision were influenced by health worker values and preferences, they were also affected by health worker misconceptions and biases. ConclusionHealth worker values and preferences for contraception are affected by the client's history, medical eligibility, and the health worker context. Provision of contraception that is affected by harmful bias towards certain populations or about certain methods can negatively affect patient-centered care. Future work should address knowledge gaps and health worker biases by improving and standardizing education and training globally, to ensure high-quality, rights-based, and patient-centered contraceptive services.

Perspectives of frontline health workers on transition from development assistance for health in Ghana: A qualitative study.

Many Low-income countries depend on development assistance for health (DAH) to finance the health sector. The transition of these countries to middle-income status has led to reduction in effective aid from development partners while these countries are expected to graduate from global funding agencies such as Gavi the vaccine alliance, with implications for service delivery. The aim of this study was to explore the perspectives of frontline health workers regarding the implications of Ghana's transition to middle-income status on service delivery, the likely impact and opportunities it presents to the country. This exploratory qualitative study employed in-depth interviews to collect data from 16 health workers at three hospitals in the Greater Accra Region; one at the regional level and two at the district level. The study was conducted from December 2019 to July 2020. Data from interviews were transcribed, coded and analysed using thematic analysis in NVivo Qualitative Analysis Software version 12. The level of awareness among frontline workers about the transition and decline in DAH was generally low. Nonetheless, frontline health workers perceived that the country seems inadequately prepared for transition as donors continue to be major financiers for the sector and even for emergencies such as the current COVID-19 global pandemic. Potential challenges facilities would face due to transition may include difficulty in funding health programs, human resource challenges and delays in logistics and medicines. The implications for these will be poor health outcomes, defective monitoring and evaluation, and lapses in training programs. In addition, the perceived barriers to transition identified were poor management of resources, political interference and lack of technical expertise. While opportunities such as improvement of the health sector prioritization and efficiency, private sector involvement and autonomy could be gained. Gaps in the health intervention monitoring resulting from DAH transition could pose affect health outcomes, particularly in respect of HIV, tuberculosis and malaria. The country's preparedness to transition from DAH could be better improved with development of a clear transition plan agreed by stakeholders, including government and in-country development partners. For the health sector, the eligibility for DAH transition should not simply be based on economic growth, but importantly on a country's ability to sustain ongoing and upcoming health programs.

Community Health Worker Perspectives on Engaging Unhoused Peer Ambassadors for COVID-19 Vaccine Outreach in Homeless Encampments and Shelters

BackgroundCOVID-19 vaccination is a priority for people experiencing homelessness. However, there are barriers to vaccine access driven in part by mistrust towards clinicians and healthcare. Community health workers (CHWs) and Peer Ambassadors (PAs) may be able to overcome mistrust in COVID-19 vaccine outreach. An unhoused PA program for COVID-19 vaccine outreach by CHWs was implemented in Los Angeles using a participatory academic-community partnership.ObjectiveThe purpose of this study was to evaluate CHW perspectives on an unhoused PA COVID-19 vaccine outreach program in Los Angeles.DesignThis study used a participatory community conference and qualitative focus groups to understand CHW perspectives on the PA program. The one-day conference was held in November 2021.ParticipantsOf the 42 conference participants, 19 CHWs participated in focus groups for two-way knowledge exchange between CHWs and researchers.ApproachFour focus groups were held during the conference, with 4-6 CHWs per group. Each group had a facilitator and two notetakers. Focus group notes were then analyzed using content analysis to derive categories of findings. CHWs reviewed the qualitative analysis to ensure that findings represented their experiences with the PA program.Key ResultsThe five categories of findings from focus groups were as follows: (1) PAs were effective liaisons to their peers to promote COVID-19 vaccines; (2) CHWs recognized the importance of establishing genuine trust and equitable working relationships within CHW/PA teams; (3) there were tradeoffs of integrating unhoused PAs into the existing CHW workflow; (4) CHWs had initial misgivings about the research process; and (5) there were lingering questions about the ethics of “exploiting” the invaluable trust unhoused PAs have with unhoused communities.ConclusionsCHWs were in a unique position to empower unhoused PAs to take a leadership role in reaching their peers with COVID-19 vaccines and advocate for long-term employment and housing needs.

Awareness Regarding Gestational Diabetes Mellitus among Antenatal Women of Rural West Bengal: A Mixed-method Study

Introduction: Awareness regarding Gestational Diabetes Mellitus (GDM) among antenatal women is necessary for early diagnosis and management of the disease for ensuring a safe motherhood and a healthy child. Objective: This study envisaged to assess the awareness regarding GDM and its determinants among antenatal women attending healthcare facilities in a rural area of West Bengaland to explore the perspectives of health workers with regard to gaps in proper awareness generation activities among antenatal women. Method: This mixed-method study was conducted from April 2021 to July 2021 at 4 health facilities in Singur, West Bengal. Quantitative data were collected from 195 antenatal women using a pretested questionnaire which were analysed using SPSS software. Qualitative data were collected via in-depth interviews among 6 health workers working in the health facilities and were analysed thematically. Results: Overall, 75.4% of participants were not aware of GDM. Multivariable logistic regression analysis showed that secondary education and below (AOR=3.48, 95% CI=1.63-7.42), no history of GDM among family &amp; relatives (AOR=7.24,95% CI=2.12-24.66), lesser number of antenatal visits (AOR=3.48, 95% CI=1.63-7.42) and non-receipt of counselling regarding GDM during antenatal visits (AOR= 3.09, 95% CI =1.45–6.58) had a significant association with poor awareness. From health workers’ perspectives, lack of reorientation training, shortage of supplies for testing, and overburdening with other responsibilities were the major gaps identified in proper awareness generation activities. Conclusion: Present study revealed majority of study participants possessed poor knowledge regarding GDM. Reorientation training of health workers, organizing awareness campaigns at the community level, and relevant counselling regarding GDM during each antenatal visit should be given utmost priority for improving knowledge about the disease.

Health workers\u2019 and hospital administrators\u2019 perspectives on mistreatment of women during facility-based childbirth: a multicenter qualitative study in Ghana

BackgroundGlobally, mistreatment of women during facility-based childbirth continues to impact negatively on the quality of maternal healthcare provision and utilization. The views of health workers are vital in achieving comprehensive understanding of mistreatment of women, and to design evidence-based interventions to prevent it. We explored the perspectives of health workers and hospital administrators on mistreatment of women during childbirth to identify opportunity for improvement in the quality of maternal care in health facilities.MethodsA qualitative study comprising in-depth interviews (IDIs) with 24 health workers and hospital administrators was conducted in two major towns (Koforidua and Nsawam) in the Eastern region of Ghana. The study was part of a formative mixed-methods project to develop an evidence-based definition, identification criteria and two tools for measuring mistreatment of women in facilities during childbirth. Data analysis was undertaken based on thematic content via the inductive analytic framework approach, using Nvivo version 12.6.0.ResultHealth workers and hospital administrators reported mixed feelings regarding the quality of care women receive. Almost all respondents were aware of mistreatment occurring during childbirth, describing physical and verbal abuse and denial of preferred birthing positions and companionship. Rationalizations for mistreatment included limited staff capacity, high workload, perceptions of women’s non-compliance and their attitudes towards staff. Health workers had mixed responses regarding the acceptability of mistreatment of women, although most argued against it. Increasing staff strength, number of health facilities, refresher training for health workers and adequate education of women about pregnancy and childbirth were suggestions to minimize such mistreatment.ConclusionHealth workers indicated that some women are mistreated during birth in the study sites and provided various rationalizations for why this occurred. There is urgent need to motivate, retrain or otherwise encourage health workers to prevent mistreatment of women and promote respectful maternity care. Further research on implementation of evidence-based interventions could help mitigate mistreatment of women in health facilities.

FEASIBILITY, ACCEPTABILITY, AND APPROPRIATENESS OF THE PHONE BASED INTERVENTIONS UNDER NURSE GUIDANCE AFTER STROKE (PINGS) IN GHANA

Background PINGS is a clinical trial to evaluate a nurse-led mHealth technology - centered approach to maintaining BP control among recent stroke survivors with hypertension in Ghana. PINGS involves domiciliary BP self-monitoring, mobile phone consultations, phone alerts as reminders, and patient education via text messages. We assessed the feasibility, acceptability, and appropriateness of PINGS from the perspective of health workers in general - not necessarily working in stroke rehabilitation. Methods Using an adaptation of psychometrically validated Likert-scale measures for feasibility, acceptability, and appropriateness of interventions, we deployed an online survey among health workers. Summed composite scores were obtained, dichotomized, and binary logistic regression performed using R programming software. Results There were 665 respondents; males (57%), females (43%); clinical staff (75%) and non-clinical staff (25%); and median age was 33 years (IQR 29, 37). PINGS was feasible, acceptable, and appropriate to 93%, 93% and 94% of respondents respectively. Clinical staff found PINGS feasible (OR 9.28; C.I. 4.86, 18.7; p<0.001), acceptable (OR 7.41, C.I. 3.95, 14.5; p<0.001), or appropriate (OR 7.59, C.I. 3.9, 15.5; p<0.001) compared to non-clinical staff. The measures were not significantly affected by type (including public or private), level (including tertiary or district), or regional location of the facility. Conclusion PINGS was overwhelmingly perceived as feasible, acceptable, and appropriate, with these perspectives not being significantly different across different types of facilities, levels of health care, or geographic locations in Ghana. Clinical staff however found PINGS much more feasible, acceptable, and appropriate than their non-clinical counterparts. PINGS is a clinical trial to evaluate a nurse-led mHealth technology - centered approach to maintaining BP control among recent stroke survivors with hypertension in Ghana. PINGS involves domiciliary BP self-monitoring, mobile phone consultations, phone alerts as reminders, and patient education via text messages. We assessed the feasibility, acceptability, and appropriateness of PINGS from the perspective of health workers in general - not necessarily working in stroke rehabilitation. Using an adaptation of psychometrically validated Likert-scale measures for feasibility, acceptability, and appropriateness of interventions, we deployed an online survey among health workers. Summed composite scores were obtained, dichotomized, and binary logistic regression performed using R programming software. There were 665 respondents; males (57%), females (43%); clinical staff (75%) and non-clinical staff (25%); and median age was 33 years (IQR 29, 37). PINGS was feasible, acceptable, and appropriate to 93%, 93% and 94% of respondents respectively. Clinical staff found PINGS feasible (OR 9.28; C.I. 4.86, 18.7; p<0.001), acceptable (OR 7.41, C.I. 3.95, 14.5; p<0.001), or appropriate (OR 7.59, C.I. 3.9, 15.5; p<0.001) compared to non-clinical staff. The measures were not significantly affected by type (including public or private), level (including tertiary or district), or regional location of the facility. PINGS was overwhelmingly perceived as feasible, acceptable, and appropriate, with these perspectives not being significantly different across different types of facilities, levels of health care, or geographic locations in Ghana. Clinical staff however found PINGS much more feasible, acceptable, and appropriate than their non-clinical counterparts.

Addressing childhood obesity in Queensland: Aboriginal and Torres Strait Islander Health Worker perspectives and practices.

Obesity disproportionately impacts Aboriginal and Torres Strait Islander children compared to non-Indigenous children. Aboriginal and Torres Strait Islander Health Workers (AHWs) in Queensland support the health of Aboriginal and Torres Strait Islander peoples. However, little is known about their perspectives and practices on addressing childhood obesity. The aim of this study was to investigate AHW perspectives and clinical practice behaviours with Aboriginal and Torres Strait Islander children and their families. In a cross-sectional mixed-methods approach, a purpose-developed online survey (25 items) was distributed to the AHW workforce in Queensland (~100 AHWs). The survey explored [1] role characteristics, [2] current attitudes and beliefs about childhood obesity, [3] barriers to discussing weight management, [4] clinical practice behaviours and [5] demographic characteristics. Eight AHWs responding to the survey also participated in semi-structured telephone interviews to discuss their survey responses. Fifty-five AHWs responded and 45 completed the survey. While the majority of respondents (91%) agreed that addressing childhood obesity was an important part of their role, fewer (67%) agreed that obesity was an issue in Aboriginal and Torres Strait Islander peoples. Over half (55%) found it difficult to discuss overweight and obesity with children and families and only 22.5% reported measuring height and weight often. Key themes included a willingness to address childhood obesity, with experience and training being key enablers to discussing the issue. There was a perceived lack of culturally appropriate programs to support AHWs working with families. AHWs report a willingness to address childhood obesity within their roles, however many find it difficult to raise the issue with families, with even fewer routinely undertaking obesity assessment practices. SO WHAT?: These findings could inform training initiatives for AHWs to optimise screening, identification, referral, and treatment of childhood obesity in Aboriginal and Torres Strait Islander communities.

Suicide amongst young Inuit males: The perspectives of Inuit health and wellness workers in Nunavik

The rate of suicide amongst Inuit boys and men in Nunavik has risen since the 1980s. Despite this, little is known about the strengths and protective factors, and the unique risks, that contribute to suicidality amongst Inuit males. This article presents the findings of a qualitative interview study conducted with Inuit health and wellness workers in Nunavik to better understand the gendered nature of suicide for young Inuit males. Discussed within a critical masculinities framework, findings highlight the need to consider the gendered nature of intergenerational trauma, the changing nature of the Northern economy and its impact on gender dynamics, and the inequities that some men face within institutional structures. Also offered are culturally meaningful and strength-based strategies for attracting and engaging young males to mental health services. Findings provide important insights into the social determinants of Inuit males' mental health, and advocate for targeted suicide prevention programs for Inuit boys and young men.

Experiencias de salud mapuche en Atención Primaria de Salud desde trabajadores sanitarios y usuarios/as en zona urbana de Chile

Abstract This study describes experiences and perceptions on interculturality in Primary Health Care (PHC) from the perspective of health workers and Mapuche health users. For this purpose, a qualitative systematization of these experiences was carried out in a PHC Intercultural Health Program at an urban commune in Chile. Data were collected by means of individual and group interviews, respectively, with 19 users and 13 professionals. The semantic content analysis was performed. While service users perceive Mapuche health positively, assimilating it to the concept of interculturality, health workers reported that Mapuche health is respected but no integrated work is promoted. As barriers, participants cited administrative aspects, lack of integration, and scientific issues. In conclusion, recognition of indigenous health and greater occupational training on indigenous health and interculturality is necessary.

Early Perinatal Workforce Adaptations to the COVID-19 Pandemic.

The objective of this study was to describe the system's initial pandemic response from the perspectives of perinatal health workers and to identify opportunities for improved future preparedness. An exploratory survey was designed to identify perinatal practice changes and workforce challenges during the initial weeks of the COVID-19 pandemic. The survey included baseline data collection and weekly surveys. A total of 181 nurses, midwives, and physicians completed the baseline survey; 84% completed at least 1 weekly survey. Multiple practice changes were reported. About half of respondents (50.8%) felt the changes protected patients, but fewer (33.7%) felt the changes protected themselves. Most respondents providing out-of-hospital birth services (91.4%) reported increased requests for transfer to out-of-hospital birth. Reports of shortages of personnel and supplies occurred as early as the week ending March 23 and were reported by at least 10% of respondents through April 27. Shortages were reported by as many as 38.7% (personal protective equipment), 36.8% (supplies), and 18.5% (personnel) of respondents. This study identified several opportunities to improve the pandemic response. Evaluation of practice changes and timing of supply shortages reported during this emergency can be used to prepare evidence-based recommendations for the next pandemic.

‘We have a plan for that’: a qualitative study of health system resilience through the perspective of health workers managing antenatal and childbirth services during floods in Cambodia

ObjectiveHealth system resilience can increase a system’s ability to deal with shocks like floods. Studying health systems that currently exhibit the capacity for resilience when shocked could enhance our understanding...

Understanding Health Worker Perspectives on Risk Screening for HIV Testing—A Qualitative Study from Zimbabwe

Background: Zimbabwe recorded a 55% increase in HIV testing from 2011 to 2018 but with decreasing HIV-testing yields from 20% to 6% respectively as we aim to identify the narrowing gap of undiagnosed people living with HIV. As such adoption of screening tools during targeted HIV testing services improves efficiency by identifying individuals who are likely to test positive. Effective utilization of screening tools requires an understanding of health care worker perception and willingness to use the tools. Methods: We conducted a qualitative study among healthcare workers at 8 selected primary healthcare facilities in Zimbabwe. Interviewer-guided, in-depth interviews were conducted with healthcare workers and their immediate supervisors. Thematic analysis was performed following a framework built around the grounded theory model to describe perspectives that influence the utilization of HIV screening tools and suggestions for improved eligibility screening. Results: Behavioural factors facilitating the utilisation of the screening tool included motivation to adhere to standard practice, awareness of screening in targeting testing, and its ability to manage workload through screening out ineligible clients. This was evident across service delivery levels. Barriers included limited healthcare capacity, confidentiality space, multiple screening tools and opaque screening in/out criteria and the potential of clients not responding to screening questions truthfully. Conclusions: Across geographical and service delivery levels, placing screening tools at HIV testing entry points, healthcare worker knowledge on screening in/out criteria emerged as enablers for correct and consistent utilization. Further, standardizing the tools and adopting a decision aid algorithm would improve the accurate utilisation of screening tools.

Barriers to managing elder abuse in primary care services: experiences of healthcare providers in Mexico City

ABSTRACT The purpose of this study was to analyze the barriers to managing elder abuse from the perspective of primary care health workers in Mexico City. We performed an ethnographic qualitative-descriptive study. Thirty semi-structured interviews were conducted with healthcare providers associated with three health centers located in areas with medium and high levels of poverty. A phenomenological approach was used to identify themes, subthemes and codes. Three main types of barriers were found: 1) institutional framework; 2) professional competency limitations and the dominance of a biomedical vision; and 3) the invisibilization of elder abuse. These barriers, described by healthcare workers, highlight the complexity involved in integrating the treatment of elder abuse into primary care health services. It is necessary to develop public educational and preventive public policies for elder abuse that are coordinated both with support services to treat such cases as well as with programs to strengthen healthcare providers professional competency.

Familiar but neglected: identification of gaps and recommendations to close them on exclusive breastfeeding support in health facilities in Malawi

BackgroundExclusive breastfeeding is widely accepted as a key intervention with proven efficacy for improving newborn survival. Despite international commitments and targets to support and promote breastfeeding, there are still gaps in meeting and maintain coverage in many sub-Saharan African countries. This paper aimed to triangulate the perspectives of health workers, mothers, and their family members with facility assessments to identify gaps to improve breastfeeding support in in Malawi.MethodsThe study on breastfeeding barriers and facilitators was conducted in 2019 at one tertiary hospital and three secondary-level hospitals in Malawi. We conducted 61 semi-structured interviews with health workers, postnatal mothers, grandmothers, aunts, and fathers. In 2017, we carried out a neonatal care facility assessment using the World Health Organization (WHO) Integrated Maternal, Neonatal, and Child Quality of Care Assessment and Improvement Tool. Qualitative data were analysed using a thematic analysis approach within the Systems Framework for Health Policy.ResultsThe district-level hospitals rated high with an average score of 4.8 out of 5 across the three facilities indicating that only minor improvements are needed to meet standards of care for early and exclusive breastfeeding. However, the score fell to an average of 3.5 out of 5 for feeding needs with sick neonates indicating that several improvements are needed in this area. The qualitative data demonstrated that breastfeeding was normalized as part of routine newborn care. However, the focus on routine practice and reliance on breastfeeding knowledge from prenatal counselling highlights inequities and neglect in specialized care and counselling among vulnerable mothers and newborns. Revitalisation of breastfeeding in Malawian facilities will require a systems approach that reinforces policies and guidelines; contextualises knowledge; engagement and empowerment of other relatives to the baby and task-sharing among health workers.ConclusionsBreastfeeding is accepted as a social norm among health workers, mothers, grandmothers, aunts, and fathers in Malawi, yet vulnerable groups are underserved. Neglect in breastfeeding support among vulnerable populations exacerbates health inequities. Health systems strengthening related to breastfeeding requires a concerted effort among health workers, mothers, grandmothers, aunts, and fathers while remaining grounded in contexts to support family-centered hospital care.

Battle of Modern Heroes: Healthcare Provider’s Crisis Experiences During Covid-19 Pandemic

This paper aimed to describe the coronavirus experiences of the healthcare workers. Numerous studies showed the experiences of healthcare workers during the pandemic, but no information is available on the overall experience. The novelties of this study are the overall experiences and the perception of the healthcare workers during the COVID-19 pandemic. We used a screening tool to determine the suitable participants with an emphasis on the length of their work hours during the pandemic. The interview was conducted online, and the screening tool form was sent to the participant's online messaging account. The result showed the experiences and perspectives of health workers during the pandemic, especially the challenges, difficulties, and changes in work functioning and environment. They also noted the difficulties in their work and personal life. It also showed their weaknesses and threats to their personal life. There were also coping mechanisms and strategies to deal with the challenges. The practitioners during the pandemic have experienced significant difficulties during the pandemic and brought awareness and comprehension to the current situation. This study would not only help the present health response during the pandemic but also any future pandemic to protect the wellbeing of our health workers.

Delays, fears and training needs: Perspectives of health workers on clinical management of snakebite revealed by a qualitative study in Kitui County, Kenya.

Key aims of the WHO Strategy to halve snakebite morbidity and mortality include health system strengthening and training of health workers. This requires knowledge of local health system needs and capacity, health worker training needs, and factors influencing health worker decision-making in snakebite management. This study explored health worker experiences and perceptions of snakebite management, both individually and in the context of their local health system.We used a qualitative study design with semi-structured interviews (n = 14) and focus group discussions (n = 4). We employed a combination of sampling strategies aiming to achieve maximum variation among key informants within resource limitations. We recruited health workers (n = 33) of varying roles from purposively selected tier 2, 3 and 4 health facilities (n = 12) and the community (tier 1) in four sub-counties in Kitui County, Kenya. We conducted inductive thematic analysis of all transcripts.The results identified that health workers recognised snake envenoming as a time-critical emergency in which delay in care seeking, sometimes exacerbated by health system referral delays, was a major barrier to effective management of patients. Clinicians strongly voiced a need for training in snakebite management, diagnosis and antivenom administration. Unexpressed needs for training were demonstrated in traditional remedy ineffectiveness, syndromic management, and critical appraisal of treatment effectiveness. Under-resourcing in antivenom, other medication, equipment, infrastructure and staffing also challenged management. Fear of snakebite and fear of antivenom, both linked to past experiences, influenced clinical decision-making.Our findings clearly indicate a need in Kitui County for training programmes that equip health workers for clinical decision-making in snakebite management. We further identify community intervention needs to facilitate prompt presentation to healthcare, including practical affordable transport solutions, and systematic health system resourcing needs. In addition, we recommend supportive supervision and further research in response to the emotional stress resulting from managing difficult cases in under-resourced settings.

Fear, mistrust, and vaccine hesitancy: Narratives of the dengue vaccine controversy in the Philippines

This article applies a qualitative approach to the 2017 dengue vaccine controversy involving Sanofi Pasteur’s Dengvaxia to understand vaccine hesitancy and related anxieties in contemporary Philippines. Through a multisited project that investigated the health aspirations and lived experiences of low- and middle-income Filipinos across urban and rural Philippines, this article distills the perspectives of both ordinary community members and health workers in local and national capacities regarding the controversy—and how it altered their perceptions toward vaccines, health care, and government. Our study reveals widespread mistrust and fear in the communities toward both the state and health institutions following the controversy, with frontline health workers bearing the brunt of the communities’ apprehensions, and the media partly responsible in fomenting these fears. Given the repetitive nature of health and vaccine controversies, this article suggests the importance of responsible journalism, well-calibrated crisis communications, and a people-centered health paradigm that involves exploring local contexts of vaccine hesitancy and mining people’s lived experiences in tackling present and future health crises—especially now in the advent of COVID-19 vaccinations.