Trained Health Workers Research Articles

Appraisal of Health Sector Responses to Covid-19 at National and Sub-National Levels: Case Study of States with Highest Prevalence of Cases-Lagos, Kaduna and FCT Assessment of Health Sector Responses to Covid-19 at Selected States with Highest Prevalence of Cases

The Covid-19 pandemic is the largest and longest outbreak in modern times, with socio-economic, political, and educational disruptions. This study was to appraise the level of efforts and the impact of these interventions in the health sector. A mixed methodology approach involving quantitative research techniques. The study revealed that there was generally a high level of awareness and good compliance to government policies and guidelines on Covid-19 regulations being highest in Lagos state compared to FCT and Kaduna state. The public perception of the use of facemask and its enforcement and handwashing practices by health facilities was rated high across the three states. Client education and public perception of Covid-19 counselling was different across the three states, being highest in Lagos in comparison to FCT and Kaduna. Hence the study recommended refreshers training of health workers on awareness creation and counselling of clients at all levels of care. Keywords: Assessment, Covid-19, Health system strengthening.

FAKTOR DETERMINAN PENGETAHUAN, SIKAP, DAN PRAKTIK PASIEN DIABETES TERHADAP DIABETIK NEUROPATI, NEFROPATI DAN RETINOPATI

Background: The contribution of potential knowledge, attitudes and practices related to microvascular complications of diabetes is a determinant factor to consider. Objectives: Research is projected to determine the prevalence of DM characteristics and microrvascular complications, the potential for KAP to complications, health-seeking behaviors, follow-up problems, stigma and sources of information. Method: The cross-sectional approach is the main choice of research design in this study. This study took place in February – November 2021 which succeeded in recruiting the research subjects of 375 patients in Makassar City with diabetes observed. Results: The characteristics of DM type in this study included 3 types (DM type 1, DM type 2 and gestational DM), which were dominated by DM type 2, 310 (82.23%), followed by DM type 1, 59 (15.65%) and the smallest was Gestational diabetes 6 (2.12%) from 375 patients. The correlation of significance between quality of life and DM was shown to have positive values in aspects of knowledge and practice (r = 0.1; p = 0.002 ; r = 0.3; p=0.02), only the negative attitude aspect (r=-0.2; p=0.002). The correlation of knowledge of DM patients is directly proportional to the absence of: microvascular complications of diabetes (5.10 ± 2.64 versus 1.12 ± 0.33; P<0.001), coronary artery disease (3.69 ± 2.65 versus 2.08 ± 2.25; P<0.001), dyslipidemia (2.85 ± 2.58 versus 1.89 ± 2.07; p<0.001), hypertension (2.86 ± 2.62 versus 1.98 ± 2.11; p<0.001). Conclusion: This study provides invaluable information in helping to design and develop a supporting program model to educate and train DM patients and health workers professionally, especially in health service facilities in Makassar City in order to minimize the development of microvascular complications of diabetes

Supporting the helpers: what do peer deliverers of HIV interventions need to sustain their implementation efforts?

Peer-led HIV interventions are an increasingly common and low-cost strategy to address shortages of professionally trained health workers for implementing evidence-based HIV prevention and treatment interventions to populations who experience health disparities. There is a need to understand the experiences and unmet needs of this essential workforce responsible for implementing and delivering HIV interventions to ensure their implementation efforts are sustainable. This commentary provides a brief overview of barriers to peer deliverers' sustained engagement in the HIV workforce and potential implementation strategies to promote the sustainment of peer deliverers' implementation efforts.

Beyond Empathy to System Change: Four Poems on Health by Bertolt Brecht.

Bertolt Brecht's poem "A Worker's Speech to a Doctor" is frequently cited as a means to raise awareness among health workers of the health effects of living and working conditions. Less cited is his Call to Arms trilogy of poems, which calls for class-based action to transform the capitalist economic system that sickens and kills so many. In this article, we show how "A Worker's Speech to a Doctor," with its plea for empathy for the ill, contrasts with the more activist and often militant tone of the Call to Arms trilogy: "Call to a Sick Communist," "The Sick Communist's Answer to the Comrades," and "Call to the Doctors and Nurses."We also show that, while "A Worker's Speech to a Doctor" has been applied in the training of health workers, its accusatorial tone towards health workers' complicity in the system the poem is critiquing risks alienating such workers. In contrast, the Call to Arms trilogy seeks common ground, inviting these same workers into the broader political and social fight against injustice. While we contend that the description of the sick worker as a "Communist" risks estranging these health workers, our analysis of the Call to Arms poems nevertheless indicates thattheir use can contribute to moving health workers' educational discourse beyond a laudable but fleeting elicitation of empathy for the ill towards a structural critique and deeper systemic understanding in order to prompt action by health workers to reform or even replace the capitalist economic system that sickens and kills so many.

Evaluation of an Online Training Program on COVID-19 for Health Workers in Papua New Guinea.

Health worker training is an important component of a holistic outbreak response, and travel restrictions resulting from the COVID-19 pandemic have highlighted the potential of virtual training. Evaluation of training activities is essential for understanding the effectiveness of a training program on knowledge and clinical practice. We conducted an evaluation of the online COVID-19 Healthcare E-Learning Platform (CoHELP) in Papua New Guinea (PNG) to assess its effectiveness, measure engagement and completion rates, and determine barriers and enablers to implementation, in order to inform policy and practice for future training in resource-limited settings. The evaluation team conducted a mixed methods evaluation consisting of pre- and post-knowledge quizzes; quantification of engagement with the online platform; post-training surveys; qualitative interviews with training participants, non-participants, and key informants; and audits of six health facilities. A total of 364 participants from PNG signed up to participate in the CoHELP online training platform, with 41% (147/360) completing at least one module. Of the 24 participants who completed the post-training survey, 92% (22/24) would recommend the program to others and 79% (19/24) had used the knowledge or skills gained through CoHELP in their clinical practice. Qualitative interviews found that a lack of time and infrastructural challenges were common barriers to accessing online training, and participants appreciated the flexibility of online, self-paced learning. Initially high registration numbers did not translate to ongoing engagement with the CoHELP online platform, particularly for completion of evaluation activities. Overall, the CoHELP program received positive feedback from participants involved in the evaluation, highlighting the potential for further online training courses in PNG.

Evaluating the availability and quality of services for lymphatic filariasis morbidity in Ghana.

In districts where lymphatic filariasis (LF) is endemic, the goal is to provide 100% geographical coverage of the essential package of care. Additionally, countries seeking elimination status must document the availability of services for lymphoedema and hydrocele in all endemic areas. To do this, the WHO recommends conducting assessments of the readiness and quality of services provided to identify service delivery and quality gaps. This study used the recommended WHO Direct Inspection Protocol (DIP), which consists of 14 core indicators related to LF case management, medicine and commodities, staff knowledge and patient tracking. The survey was administered in 156 health facilities across Ghana designated and trained to provide LF morbidity management services. Patient and health provider interviews were also conducted to assess challenges and feedback. The highest performing indicators across the 156 surveyed facilities were related to staff knowledge; 96.6% of health workers correctly identified two or more signs and symptoms. The lowest scoring indicators concerned medication availability, with the two lowest scoring indicators in the survey being availability of antifungals (26.28%) and antiseptics (31.41%). Hospitals performed best with an overall score of 79.9%, followed by health centers (73%), clinics (67.1%) and CHPS compounds (66.8%). The most commonly reported challenge from health worker interviews was lack of medications and supplies, followed by a lack of training or poor motivation. The findings from this study can help the Ghana NTD Program identify areas of improvement as they seek to achieve LF elimination targets and continue to improve access to care for those with LF-related morbidity as part of overall health systems strengthening. Key recommendations include prioritizing refresher and MMDP training for health workers, ensuring reliable patient tracking systems, and integrating lymphatic filariasis morbidity management into the routine healthcare system to ensure medicine and commodity availably.

The feasibility of establishing parent support groups for children with congenital Zika syndrome and their families: a mixed-methods study.

Background: The 2015 - 2016 Zika epidemic highlighted gaps in health and social care services for parents of children with developmental disabilities. In response, we developed the 'Juntos' intervention, a 10 week community-based early intervention support group for parents of children with congenital Zika syndrome (CZS). The intervention's components include participatory learning sessions, practical skill acquisition, peer support, and psychological support, aiming to improve caregiver's knowledge and confidence in caring for their children. This study aimed to evaluate the feasibility of implementing 'Juntos' in Colombia. Methods: Two facilitators delivered 'Juntos' to four groups of 8-10 caregivers between 2017 and 2018. One researcher observed each group. Data were collected from: observation notes from 40 sessions, focus group discussions held after each session, pre- post intervention questionnaires with 34 caregivers, and semi-structured interviews conducted with four facilitators, 12 caregivers and three stakeholders. We used the Bowen framework in data analysis. Results:The feasibility evaluation revealed that 'Juntos' was highly acceptable and in demand among the target population. The intervention was predominantly delivered with fidelity. Practicality was facilitated by providing transport costs and selecting convenient locations. Additional organisational and social media support was required for successful implementation. Community health worker training may support integration and the established groups could facilitate programme expansion. However, participants perceived lack of prioritisation as a limitation within existing health systems. Participants' knowledge and confidence to care for their child improved after programme enrolment. Conclusion:The 'Juntos' intervention demonstrated high acceptability, demand, and practicality in supporting parents of children with CZS in Colombia. However, its implementation faces challenges due to existing gaps in health system support for children with CZS.

In low-and middle-income countries, does training health workers in clinical breast examination (CBE) increase early detection of breast cancer?

In low-and middle-income countries, does training health workers in clinical breast examination (CBE) increase early detection of breast cancer?

Cervical cancer screening aided by artificial intelligence, China.

To implement and evaluate a large-scale online cervical cancer screening programme in Hubei Province, China, supported by artificial intelligence and delivered by trained health workers. The screening programme, which started in 2017, used four types of health worker: sampling health workers, slide preparation technicians, diagnostic health workers and cytopathologists. Sampling health workers took samples from the women on site; slide preparation technicians prepared slides for liquid-based cytology; diagnostic health workers identified negative samples and classified positive samples based on the Bethesda System after cytological assessment using online artificial intelligence; and cytopathologists reviewed positive samples and signed reports of the results online. The programme used fully automated scanners, online artificial intelligence, an online screening management platform, and mobile telephone devices to provide screening services. We evaluated the sustainability, performance and cost of the programme. From 2017 to 2021, 1 518 972 women in 16 cities in Hubei Province participated in the programme, of whom 1 474 788 (97.09%) had valid samples for the screening. Of the 86 648 women whose samples were positive, 30 486 required a biopsy but only 19 495 had one. The biopsy showed that 2785 women had precancerous lesions and 191 had invasive cancers. The cost of screening was 6.31 United States dollars (US$) per woman for the public payer: US$1.03 administrative costs and US$ 5.28 online screening costs. Cervical cancer screening using artificial intelligence in Hubei Province provided a low-cost, accessible and effective service, which will contribute to achieving universal cervical cancer screening coverage in China.

Gender and caste inequalities in primary healthcare usage by under-5 children in rural Nepal: an iterative qualitative study into provider perspectives and the potential role of implicit bias

ObjectiveThis study explored provider perspectives on: (1) why inequalities in health service usage persist; and (2) their knowledge and understanding of the role of patient experience and implicit bias (also...

Addressing Training Gaps: A Competency-Based, Telehealth Training Initiative for Community Health Workers.

To overcome vast variations in Community Health Worker (CHW) training, investigators for the CHW Core Consensus Project (CCCP) derived three types of CHW (Category 1, 2, 3) and established competencies for each category. However, studies are needed that implement these competencies in real-world settings. Using the six competency domains of the CCCP as a theoretical backbone, we developed and evaluated a training for Category 1 CHWs, individuals whose focus is on community outreach and advocacy. We developed five telehealth-based, bilingual (Spanish/English) training sessions and implemented them among Category 1 Latino(a) CHWs. We measured the number of CHWs who achieved ≥70% correct on a domain-based posttest, attendance, and qualitative feedback. All (18/18) CHWs achieved at least 70% on the posttest (mean: 93.7%; range 73.3-100%). Training attendance was 98.9%. Using a six-point scale, CHWs reported high levels of satisfaction overall (5.72 ± 0.57/6.0), with telehealth (5.72 ± 0.58/6.0), effectiveness of teaching strategies/methods (5.89 ± 0.32/6.0), achieving training objectives (5.96 ± 0.15/6.0), knowledge improvement (5.72 ± 0.57/6.0), and interest (5.78 ± 0.43/6.0). We successfully developed and evaluated a bilingual training program for Category 1 CHWs to address core competency gaps. High CHW attendance reinforces the value of telehealth modalities and their potential to increase the reach for CHW training. To overcome gaps in chronic disease training, investigations are needed to address additional CHW trainings. NCT04835493.

Rectal artesunate for severe malaria, implementation research, Zambia.

To determine whether the positive results of a single-district pilot project focused on rectal artesunate administration at the community level in Zambia could be replicated on a larger scale. In partnership with government, in 10 rural districts during 2018-2021 we: (i)trained community health volunteers to administer rectal artesunate to children with suspected severe malaria and refer them to a health facility; (ii)supported communities to establish emergency transport, food banks and emergency savings to reduce referral delays; (iii)ensured adequate drug supplies; (iv)trained health workers to treat severe malaria with injectable artesunate; and (v)monitored severe malaria cases and associated deaths via surveys, health facility data and a community monitoring system. Intervention communities accessed quality-assured rectal artesunate from trained community health volunteers, and follow-on treatment for severe malaria from health workers. Based on formal data from the health management information system, reported deaths from severe malaria reduced significantly from 3.1% (22/699; 95% confidence interval, CI: 2.0-4.2) to 0.5% (2/365; 95% CI: 0.0-1.1) in two demonstration districts, and from 6.2% (14/225; 95% CI: 3.6-8.8) to 0.6% (2/321; 95% CI: 0.0-1.3) in eight scale-up districts. Despite the effects of the coronavirus disease, our results confirmed that pre-referral rectal artesunate administered by community health volunteers can be an effective intervention for severe malaria among young children. Our results strengthen the case for wider expansion of the pre-referral treatment in Zambia and elsewhere when combined with supporting interventions.

Embedding Care in Communities: Mixed-Methods Evaluation of a Community Health Worker Training Initiative in Rural Haiti.

Community Health Workers (CHWs) are valuable members within the communities they serve and increase access to health care by garnering the trust of their fellow neighbors, providing services including facilitating access to care, and improving the quality and cultural competence of service delivery. In Southern Haiti, there is a health care provider shortage with one doctor or nurse per 3,000 persons. CHWs are critical to help close the gap of the lack of access to care and facilitate the provision of basic health care. To describe the CHW training initiative at capra-care, a community-based health care provider in rural Haiti, using survey and focus groups results highlighting key findings and implications for the CHW initiative. A mixed-method approach was used to evaluate capracare's CHW Training program. Focus groups were conducted that documented the lived experience of CHWs following the training program; examined barriers and facilitators to translating the training skills to practice in the community. Pretest and post-test data assessed change in knowledge post the Community Health Worker Training (CHWT) program. Findings included 51 (57%) of the graduates. A significant increase was observed in mean test scores from baseline (n = 51; m = 61.48 ± 1.80) to post-test (m = 76.93 ± 1.73; t-7.69; P < 0.001), indicating that the CHW training was successful in increasing participants' knowledge. Themes that emerged from the qualitative analysis were comprehension of skills learned, community benefit, and empowerment. Results from this CHWT program has implications to increase the health care workforce thus facilitating access to care among community residents in under-resourced regions.

Embedding Care in Communities: Mixed-Methods Evaluation of a Community Health Worker Training Initiative in Rural Haiti.

Embedding Care in Communities: Mixed-Methods Evaluation of a Community Health Worker Training Initiative in Rural Haiti.

Implementation of Boarding Training as an Effort to Improve the Capabilities of Public Health Services for Health Workers at Puskesmas

Purpose: The perpuse of this research is to improve the ability of public health services through boarding training for health workers at the Mojokerto Health Office. Theoretical framework: The key to the success of public health lies in services designed in the management of health services which involve all health workers who study good public health services with professional knowledge and skills through boarding training with a structured process, authentic activities carefully designed through boarding training design. Thus, the boarding school training method is very suitable for public health services. Method/design/approach: This study uses qualitative methods, and uses a case study research design. Subjects in this study are 10 respondents who came from participants in the training of health workers' dormitories. In this study using in-depth interview instruments, and observation. Results and conclusion: The results of the study show that forming a team of education and training providers as an efficient team work at the Mojokerto Health Office, and how to train competent and empowered health workers. Research implications: With this training, health workers in Mojokerto can provide good public health services at the puskesmas, and increase their professional knowledge and skills that have been obtained during the training.

Breast Cancer Literacy: Status of Peripheral Health Workers in Lucknow

Background: Every woman needs to know the facts, and the fact is, when it comes to breast cancer, every woman is at risk. India accounts for 7.2% of global cancer incidence, but in terms of mortality, the country accounts for 8.3% of global mortality. India faces a high burden of cancer with the late-stage presentation being a common feature. Early detection of cancer is an important strategy for improved survival and simple cost-effective treatment. Low levels of cancer awareness are a significant factor for delay in seeking treatment by women.Objective: The present study was conducted among Peripheral Health Workers (PHWs) in the Lucknow district to assess their perception of risk factors of breast cancer, knowledge of symptoms, early detection methods, and their availability in the district. Methods: The study was conducted from September 2017 to August 2018, among 450 female PHWs working in rural and urban areas of Lucknow. A semi-structured questionnaire was used to collect information about the awareness of PHWs regarding breast cancer. The awareness score was calculated based on their responses. Data were analyzed using SPSS version 24.0 (IBM Corporation).Results: The mean score for overall knowledge of breast cancer was statistically significantly high in BHWs in comparison to ASHAs (Accredited Social Health Activist). The mean knowledge score of signs and symptoms was significantly high among BHWs (Basic Health Workers). PHWs that had undergone training for breast cancer had about 5 times higher chances of having an above-median score. Conclusion: Current low awareness levels, scarcity of resources, and screening programs call for training and refresher pieces of training for peripheral level health workers to empower them to provide preventive health education and screening at the community level. Breastfeeding counseling sessions during home visits and VHNDs could be utilized as an opportunity to create awareness about breast cancer, especially its protective effect on breast cancer.

Hambatan Pelaksanaan Program Directly Observed Treatment Short-Course (DOTS) Di Negara Berkembang: Sebuah Tinjauan Sistematik

Tuberculosis is a global burden with most cases occurring in developing countries. After the implementation of Directly Observed Treatment Short-course (DOTS), the incidence of tuberculosis decreased. Despite, studies reported constraints in implementing this program. This study aims to describe the challenges of DOTS implementation in developing countries narratively. Methods: a search strategy through PUBMED was used to identify relevant articles. 10 relevant articles were included from 349 records. The studies were conducted in 8 developing countries namely South Africa, Sub-Saharan Africa, Brazil, Ethiopia, Indonesia, Angola and Nigeria. All articles included was extracted and categorized in ten main points regarding the challenges of the implementation of DOTS program. Results: There were 10 main points of challenges in implementing the DOTS strategy in developing countries : lack of access to health centres, managerial and organizational service problems, lack of health education-related tuberculosis, lack of supervision, TB co-infection, lack of trained health workers, smoking, alcohol, and drug abuse during treatment, patient-health professional relationship, lack of food availability and interruption during treatment. Conclusion: The implementation of the DOTS strategy encounters many challenges in developing countries where lack of health facilities, managerial and organizational service problems and lack of education-related TB are the main challenges to implement the program

Hambatan Pelaksanaan Program Directly Observed Treatment Short - Course (DOTS) di Negara Berkembang : Sebuah Tinjauan Sistematik

Tuberculosis is a global burden with most cases occurring in developing countries. After the implementation of Directly Observed Treatment Short-course (DOTS), the incidence of tuberculosis decreased. Despite, studies reported constraints in implementing this program. This study aims to describe the challenges of DOTS implementation in developing countries narratively. Methods a search strategy through PUBMED was used to identify relevant articles. 10 relevant articles were included from 349 records. The studies were conducted in 8 developing countries namely South Africa, Sub-Saharan Africa, Brazil, Ethiopia, Indonesia, Angola and Nigeria. All articles included was extracted and categorized in ten main points regarding the challenges of the implementation of DOTS program. Results: There were 10 main points of challenges in implementing the DOTS strategy in developing countries : lack of access to health centres, managerial and organizational service problems, lack of health education-related tuberculosis, lack of supervision, TB co-infection, lack of trained health workers, smoking, alcohol, and drug abuse during treatment, patient-health professional relationship, lack of food availability and interruption during treatment. The Conclusion is the implementation of the DOTS strategy encounters many challenges in developing countries where lack of health facilities, managerial and organizational service problems and lack of education-related TB are the main challenges to implement the program.

The feasibility of establishing parent support groups for children with congenital Zika syndrome and their families: a mixed-methods study

Background: The 2015 – 2016 Zika epidemic highlighted gaps in health and social care services for parents of children with developmental disabilities. In response, we developed the ‘Juntos’ intervention, a 10 week community-based early intervention support group for parents of children with congenital Zika syndrome (CZS). The intervention's components include participatory learning sessions, practical skill acquisition, peer support, and psychological support, aiming to improve caregiver’s knowledge and confidence in caring for their children. This study aimed to evaluate the feasibility of implementing ‘Juntos’ in Colombia. Methods: Two facilitators delivered ‘Juntos’ to four groups of 8-10 caregivers between 2017 and 2018. One researcher observed each group. Data were collected from: observation notes from 40 sessions, focus group discussions held after each session, pre- post intervention questionnaires with 34 caregivers, and semi-structured interviews conducted with four facilitators, 12 caregivers and three stakeholders. We used the Bowen framework in data analysis. Results: The feasibility evaluation revealed that 'Juntos' was highly acceptable and in demand among the target population. The intervention was predominantly delivered with fidelity. Practicality was facilitated by providing transport costs and selecting convenient locations. Additional organisational and social media support was required for successful implementation. Community health worker training may support integration and the established groups could facilitate programme expansion. However, participants perceived lack of prioritisation as a limitation within existing health systems. Participants’ knowledge and confidence to care for their child improved after programme enrolment. Conclusion: The 'Juntos' intervention demonstrated high acceptability, demand, and practicality in supporting parents of children with CZS in Colombia. However, its implementation faces challenges due to existing gaps in health system support for children with CZS.

Faktor yang Memengaruhi Mutu Pelayanan Medik di RSUD Pidie Jaya

Health services are one's expectations of the quality obtained in accordance with the desired expectations, such as health services, there are services in hospitals that include customers, such as patients for treatment from doctors in hospitals where patients get the best service from the hospital. The aim of the study was to determine the factors that influence the quality of service at the Pidie Jaya Hospital, Pidie Jaya Regency. The research design uses a quantitative method which is carried out by an analytical survey with a Cross Sectional Study approach. The population in this study were all outpatients with a total of 6,685 patients. The sample used random sampling technique as many as 99 patients. Data analysis used univariate, bivariate and multivariate analysis. The results showed that there was an effect of technical competence p = 0.000, efficiency p = 0.000, effectiveness p = 0.000, satisfaction p = 0.000 and patient safety p = 0.000 on the quality of service in Pidie Jaya Hospital, Pidie Jaya Regency. While the most dominant factor is satisfaction p = 0.000 and 95% CI = 5,389-316,539 with OR = 41,154.The conclusion from this study is that there is an influence of technical competency, efficiency, effectiveness, satisfaction, and patient safety on service quality in Pidie Jaya Hospital, Pidie Jaya Regency. It is recommended for the hospital to adopt policies in order to improve the quality of hospital services in order to produce optimal performance such as conducting training for health workers in hospitals based on their competence and conducting supervision and monitoring so that implementation in the field can run optimally.