Presence Of Community Health Workers Research Articles

Structural barriers and facilitators to accessing HIV services for marginalized working populations: Insights from farm workers in South Africa.

Farm workers are a vulnerable working population that face significant inequalities in accessing health services, including those for HIV prevention, treatment, and care. This descriptive phenomenological study aimed to explore farm workers' experiences when accessing HIV services, and was conducted in Limpopo province, South Africa. Eighteen in-depth interviews (IDIs) were conducted in four health facilities from two districts, and two focus group discussions (FDGs) were conducted in one of the farms within the province. Purposive and systematic random sampling were used to select study participants. A deductive thematic approach was used to analyze data, informed by the social-ecological model of health. The results reveal that farm workers perceive multiple interdependent factors that inhibit or enable their access to HIV healthcare services. Key barriers to HIV healthcare were transport affordability, health worker attitudes, stigma and discrimination, models of HIV healthcare delivery, geographic location of health facilities, and difficult working conditions. Key facilitators to HIV healthcare included the availability of mobile health services, the presence of community health workers, and a supportive work environment. The findings suggest disparities in farm workers' access to HIV services, with work being the main determinant of access. We, therefore, recommend a review of HIV policies and programs for the agricultural sector, and models of HIV healthcare delivery that address the unique needs of farm workers.

Strengthening Health Systems in Conflict: Evidence-Based Policies for Quality Care in Yemen

Yemen’s health system has faced formidable obstacles due to the enduring conflict since 2014, resulting in compromised infrastructure, disrupted services, and exacerbated vulnerabilities. This discourse meticulously analyzes the primary health system challenges in Yemen within the framework of the World Health Organization’s six pillars. It subsequently presents evidence-based policy recommendations to enhance Yemen’s health system and ensure the provision of high-quality and equitable care. In terms of service delivery, it suggests augmenting the presence of community health workers, leveraging mobile health technology, rehabilitating facilities, and improving emergency obstetric care. Regarding the health workforce, it proposes financing mechanisms for adequate remuneration, task-shifting strategies, embracing telemedicine, and fostering partnerships with universities. To strengthen information systems, it advocates for the enhancement of facility reporting, the implementation of national surveys, the utilization of mobile phone surveys, and the adoption of robust health information software. Regarding essential medicines, it recommends reorganizing regulations pertaining to selection, procurement, storage, and distribution. For health financing, it highlights the importance of increasing domestic budget allocation, implementing user fee exemptions, adopting performance-based financing mechanisms, and strengthening financial management systems. Last, in terms of governance, it emphasizes the need for transparent and accountable leadership, effective coordination mechanisms, and inclusive policy-making processes. Yemen requires sustained political commitment and adequate resources to facilitate the comprehensive reconstruction of its health system.

Barriers and Enablers of KMC Implementation in Health Facility and Community of Tigray Region, Northern Ethiopia: Formative Research.

BackgroundKangaroo mother care (KMC) is an evidence-based approach to reducing morbidity and mortality in low-birth-weight and preterm newborns. Barriers for KMC and its effective practice at a larger scale are highly affected by contextual factors. The purpose of this study is to explore barriers and enablers in the community and health facilities for implementation and continuation of KMC.MethodsThis formative study employed a qualitative exploratory approach using focus group discussions and in-depth interviews in five zones of Tigray region, Northern Ethiopia. A total of 16 focus group discussions and 46 in-depth interviews were conducted with health workers and community members. The whole process of data collection took an iterative approach. An inductive thematic analysis was done by going through the transcribed data using ATLAS.ti software.ResultsThe current study found that problems of infrastructure and equipment for KMC practice, shortage of staff, and absence of trained health workers as the most frequently mentioned barriers by health workers. Low level of awareness, lack of support, mother being responsible for the rest of the family, holding babies in the front being traditionally unacceptable, and preference of incubators for better care of small babies were among the barriers identified in the community. Presence of community health workers and the positive attitude of the community towards them, as well as antenatal and postnatal care were among the favorable conditions for the implementation of KMC at health facilities and continuation of KMC at home.ConclusionEmpowering health workers through training to identify preterm and low-birth-weight babies, to do follow-ups after discharge, and creating awareness in the community to change the perception of kangaroo mother care are necessary.

Illness recognition and care-seeking for maternal and newborn complications in rural eastern Uganda

BackgroundTo enhance understanding of the roles of community-based initiatives in poor rural societies, we describe and explore illness recognition, decision-making, and appropriate care-seeking for mothers and newborn illnesses in two districts in eastern Uganda where in one implementation district, a facility and community quality improvement approach was implemented.MethodsThis was a cross-sectional study using qualitative methods. We conducted 48 event narratives: eight maternal and newborn deaths and 16 maternal and newborn illnesses. Additionally, we conducted six FGDs with women’s saving groups and community leaders. Qualitative data were analyzed thematically using Atlas.ti software.ResultsWomen and caretakers reported that community initiatives including the presence of community health workers and women’s saving groups helped in enhancing illness recognition, decision-making, and care-seeking for maternal and newborn complications. Newborn illness seemed to be less well understood, and formal care was often delayed. Care-seeking was complicated by accessing several stations from primary to secondary care, and often, the hospital was reached too late.ConclusionsOur qualitative study suggests that community approaches may play a role in illness recognition, decision-making, and care-seeking for maternal and newborn illness. The role of primary facilities in providing care for maternal and newborn emergencies might need to be reviewed.

Residual Barriers for Utilization of Maternal and Child Health Services: Community Perceptions From Rural Pakistan

Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the main barriers reported, while cultural and religious restrictions were lesser reported. For preventive services including antenatal care (ANC), facility deliveries, postnatal care (PNC), childhood immunization and family planning, the main barrier was low awareness. Conversely, formidable distances and poorly functional services were the main reported constraints in the event of maternal complications and acute child illnesses. The study also found that clients residing in areas served by CHWs had better awareness only of ANC and family planning, while other MCH services were overlooked by the health worker program. The paper highlights that traditional policy emphasis on health facility infrastructure expansion is not likely to address poor utilization rates in remote rural areas. Preventive MCH services require concerted attention to building community awareness, task shifting from facility to community for services provision, and re-energization of CHW program. For maternal and child emergencies there is strong community demand to utilize health facilities, but this will require catalytic support for transport networks and functional health care centers.

Role and outcomes of community health workers in HIV care in sub‐Saharan Africa: a systematic review

IntroductionThe provision of HIV treatment and care in sub-Saharan Africa faces multiple challenges, including weak health systems and attrition of trained health workers. One potential response to overcome these challenges has been to engage community health workers (CHWs).MethodologyA systematic literature search for quantitative and qualitative studies describing the role and outcomes of CHWs in HIV care between inception and December 2012 in sub-Saharan Africa was performed in the following databases: PubMed, PsychINFO, Embase, Web of Science, JSTOR, WHOLIS, Google Scholar and SAGE journals online. Bibliographies of included articles were also searched. A narrative synthesis approach was used to analyze common emerging themes on the role and outcomes of CHWs in HIV care in sub-Saharan Africa.ResultsIn total, 21 studies met the inclusion criteria, documenting a range of tasks performed by CHWs. These included patient support (counselling, home-based care, education, adherence support and livelihood support) and health service support (screening, referral and health service organization and surveillance). CHWs were reported to enhance the reach, uptake and quality of HIV services, as well as the dignity, quality of life and retention in care of people living with HIV. The presence of CHWs in clinics was reported to reduce waiting times, streamline patient flow and reduce the workload of health workers. Clinical outcomes appeared not to be compromised, with no differences in virologic failure and mortality comparing patients under community-based and those under facility-based care. Despite these benefits, CHWs faced challenges related to lack of recognition, remuneration and involvement in decision making.ConclusionsCHWs can clearly contribute to HIV services delivery and strengthen human resource capacity in sub-Saharan Africa. For their contribution to be sustained, CHWs need to be recognized, remunerated and integrated in wider health systems. Further research focusing on comparative costs of CHW interventions and successful models for mainstreaming CHWs into wider health systems is needed.

Scale-up of community action for health: lessons from a realistic evaluation of the Mitanin program in Chhattisgarh, India

Description of the problem It has long been argued that health for all is most effectively, democratically, and sustainably facilitated through the presence of community health workers at the grassroots. In India, among the few acknowledged successes in community programmes–the prototype for the National Rural Health Mission’s Accredited Social Health Activists – is Chhattisgarh’s Mitanin Programme, designed and maintained at the scale of the entire state. Typical evaluations of scaled-up interventions like this one examine population-level health outcomes, placing less emphasis on why programmes succeed or fail. Methods To fill this gap, we undertook a retrospective realistic evaluation, systematically characterising the contexts, mechanisms, and outcomes (C-M-O) of community action for health at scale through the Mitanin (female community health worker) programme in Chhattisgarh. Our research drew specifically upon the role of the Chhattisgarh State Health Resource Centre (SHRC) as a technical agency whose genesis and mandate is closely interlinked with the programme. We undertook observation, policy documentary review, in-depth interviews (N=79), and focus group discussions (N=51) with policy and programme developers, facilitators and trainers at various echelons of the health system, community health workers, and representatives of civil society. Iterative data analysis was undertaken by four researchers, following the framework method of qualitative data analysis. Based on an initial free list of themes, interview summaries were coded, and then grouped under meta-themes. Meta-themes were then organized into specific mechanism, context and outcome categories. Main findings Chhattisgarh’s new statehood in 2000 presented a context of strategic public sector system-building where health and community action were given priority. The creation of SHRC institutionalized a mechanism of plural governance requiring collaboration between a range of public and private stakeholders in funding, selecting, training, and supporting Mitanins. This included doctors, bureaucrats, activists, donors, and civil society leaders, combining “technical” or medical-public health competencies with “socio-political” empowerment and mobilization. And yet, community action in Chhattisgarh is also shaped by a larger context of tribal alienation and lack of women in statecraft. A key outcome of SHRC’s efforts is the decade-long sustenance of the programme “through four Directors, two Chief Ministers and three elections.” And while women have not yet occupied leadership positions at SHRC, Mitanins are pivotal in grassroots action and are in turn, demanding institutional recognition. SHRC has responded with mechanisms of career-building and the creation of additional spaces for local health action with Mitanin involvement. Another mechanism has been ‘recycling:’ SHRC functionaries rarely leave. Rather, they rotate across various roles at block, district, state and national levels. This retention contrasts against the waning involvement of established Non-Governmental Organisations, and growing linkages to local rights-based (tribal, food) campaigns. Discussion including recommendations The SHRC model offers lessons of how large-scale community action in health can be polycentrically governed. Whereas Chhattisgarh is an exception in that its state health agenda could be formulated anew, once in place, SHRC mechanisms were intentionally developed at scale, requiring both technical and social competencies. Mechanisms were further shaped by the demands of frontline community actors who, over time, gave the programme its unique identity. In the bargain, the engagement of a core group of elite and frontline stakeholders has remained (albeit in different roles and capacities), while relationships with existing community stakeholders in and beyond the health domain have changed. We therefore recommend that efforts to scale-up community action for health institutionalize broad stakeholdership. Community action efforts require the long-term commitment of leaders to the programme, in a framework of plural governance such that no one individual or group can completely change the course of the programme; rather interests and ideas can converge and diverge around mechanisms responsive to outcomes at the community level. We additionally recommend that the Mitanin programme engage in a more proactive effort to involve marginalized tribal communities in health action, and encourage women’s leadership at the state level. Conflict of Interest Statement All authors declare that they have no competing interests.

Can community health workers increase coverage of reproductive health services?

BackgroundHealth services were severely affected during the many years of instability and conflict in Afghanistan. In recent years, substantial increases in the coverage of reproductive health services have been achieved,...