Worker Program Research Articles

Arbeitsplatzbezogenes Belastungserleben und psychische Gesundheit der Beschäftigten im Gesundheitswesen während der COVID-19-Pandemie: Risiko- und Schutzfaktoren aus der VOICE-Studie

ZusammenfassungHintergrundBeschäftigte im Gesundheitswesen haben ein erhöhtes Risiko für Depressionen und Angstsymptome und insbesondere während der COVID-19-Pandemie war medizinisches Personal vielseitig gefordert. Ziel der VOICE-Studie war es, Risiko- und Schutzfaktoren für arbeitsplatzbezogenes Belastungserleben und psychische Gesundheit zu untersuchen.MethodeIm Verbund von 5 psychosomatischen Universitätskliniken (Erlangen, Ulm, Bonn, Köln und Dresden) wurde ab Frühjahr 2020 eine multizentrische, webbasierte und prospektive Befragung (VOICE-Studie) initiiert. An der Studie nahmen zu 5 Messzeitpunkten mehr als 25.000 Personen teil.ErgebnisseVon 3678 während der ersten Pandemiewelle untersuchten Mitarbeitenden im Krankenhaussetting waren 17,4 % bzw. 17,8 % der Ärztinnen und Ärzte, 21,6 % bzw. 19,0 % der Pflegekräfte und 23,0 % bzw. 20,1 % der medizinisch-technischen Assistenteninnen und Assistenten (MTA) von Depressions- und Angstsymptomen in klinisch relevantem Ausmaß betroffen. Die wichtigsten Risikofaktoren für eine depressive bzw. Angstsymptomatik waren unzureichende Erholung in der Freizeit, erhöhter Alkoholkonsum, geringeres Vertrauen in die Kolleginnen und Kollegen in schwierigen Arbeitssituationen sowie erhöhte Angst, sich mit COVID-19 zu infizieren. Prädiktoren für eine erhöhte posttraumatische Symptomatik waren erhöhte generalisierte Angst und Depressivität sowie erhöhte Angst vor Ansteckung der Angehörigen. Als protektive Faktoren fungierten Kohärenzgefühl, soziale Unterstützung, Optimismus und Belohnungsniveau.DiskussionDie psychischen Auswirkungen arbeitsplatzbezogener Belastung in der Pandemie stellten sich als bedeutsam dar. Daher sind regelmäßige Screening- und Präventionsprogramme zur psychischen Gesundheit für Beschäftigte im Gesundheitswesen angezeigt.

Motivations and Impact of Training of Home Care Workers for Older Adults in Nigeria

Background: The aging population in Nigeria presents a significant challenge to the healthcare system, particularly in providing adequate home care. This study addresses the urgent need for well-trained home care workers as traditional family-based care models become increasingly unsustainable due to urbanization and economic pressures. Objectives: The study explored the motivations and impacts of a two-week training program for home care workers, aimed at equipping participants with essential skills for caring for older adults in Nigeria. Methods: Using a descriptive qualitative approach, including semi-structured interviews with 20 participants, this study investigates the motivations for joining the training program and its impact on professional development and competency in elder care. Results: The findings reveal diverse motivations for participation, including aspirations for career advancement, personal growth, and a strong commitment to providing quality care. The training program significantly enhanced participants' skills, knowledge, and confidence, enabling them to manage complex caregiving situations more effectively and improve the overall quality of care. Conclusions: This research highlights the critical role of specialized training in improving the quality of life for older adults in Nigeria. It emphasizes the need for policy interventions to standardize training for home care workers, ensuring consistent quality of care for Nigeria's aging population and recognizing the profession's essential contribution to the healthcare system.

Training on Radiation Protection in Diagnostic Radiology: Role of the Regulatory Body to Ensure the Safe Use of Ionizing Radiation in Bangladesh

Radiation has been used since its invention in various sectors like medicine, agriculture, industry, research & education, power production, and so on, for the benefit of mankind. With this trend, Bangladesh is also using radiation to achieve economic development through the application of radiation in all possible ways. Proper education, knowledge, training, and awareness are a mandatory part of using radiation to ensure safe use of it against its harmful effects. Concerning the control of the safe use of radiation, an extensive regulatory system: “Bangladesh Atomic Energy Regulatory Authority (BAERA)” was set up in 2013 in Bangladesh consisting of acts, rules, and guidance. The primary objective of the regulatory body is to protect the workers, the public, and the environment from the possible adverse effects of radiation use. To deal with its objective, it is a core activity of the regulatory body to create radiation awareness among radiation workers and related personnel all over the country through the provision of the existing act and rules regarding radiation protection training. The current study is done to have an overview of the role of the regulatory body in this regard and their present status related to the radiation protection training program for radiation workers in the field of diagnostic radiology in the country.

Improving possible serious bacterial infection (PSBI) management in young infants when referral is not feasible: lessons from embedded implementation research in Ethiopia and Kenya

BackgroundSepsis is a leading cause of neonatal mortality, despite the availability of effective treatment of possible serious bacterial illness (PSBI), including when referral to a hospital is not feasible. Gaps in access and delivery worsened during COVID-19. We conducted embedded implementation research in Ethiopia and Kenya aimed at mitigating the impact of COVID-19 and addressing various implementation challenges to improve PSBI management.MethodsThe implementation research projects were implemented at the subnational level in Ethiopia and Kenya between November 2020-June 2022 (Ethiopia) and December 2020-August 2022 (Kenya). Guided by the implementation research frameworks, both projects conducted mixed formative quantitative and exploratory research from April to May 2021, followed by summative evaluations conducted between June and July 2022. Frameworks encompassed Consolidated Framework for Implementation Research (CFIR), Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM), as well as health systems framework that incorporates cascades of care and World Health Organization Health Systems Building Blocks. Results were synthesized across the projects through document review and sharing cross-project measures and strategies through a project community of practice.ResultsDespite differences in settings across the projects, cross-cutting facilitators included community health worker program and support, and existence of guidelines for PSBI management at primary care levels. Barriers included community attitudes towards seeking care for sick newborns, COVID-19 risks and fear, and lack of health care worker competence. Country-specific contextual barriers included supply chain issues, civil conflict (Ethiopia), and labor strikes (Kenya). Strategies chosen to mitigate barriers and support implementation and sustainability in both settings included leveraging community health workers to address resistance to care-seeking, health workers’ training, COVID-19 infection prevention measures, stakeholder engagement, and advocacy to integrate PSBI management into existing programs, policies, and training. Other strategies addressing emerging project-specific barriers, included improving follow-up through a community health desk and PSBI mobile app (Kenya) and supply chain strengthening (Ethiopia). Both projects improved PSBI management coverage, increased adoption and uptake, and informed national policy changes supporting potential for sustainability.ConclusionsPragmatic embedded implementation research effectively supports the identification of barriers and mapping to strategies designed to increase effective coverage of PSBI management when referral is not feasible during the COVID-19 pandemic. Despite differences in context, cross-cutting strategies identified could inform broader scale-up in the region, including during future health system shocks.

Reinforcing community health workers program in africa for universal health coverage and global health security: A call for concerted efforts.

Reinforcing community health workers program in africa for universal health coverage and global health security: A call for concerted efforts.

Innovative Approaches to the Training of Social Workers for Work with Psychoactive Substance Dependence: An Interdisciplinary Strategy

The article analyzes the need for implementing an interdisciplinary approach in the education of social workers specializing in assisting individuals, including those dependent on psychoactive substances and those living with HIV. The main focus is on integrating knowledge from medicine, psychology, law, and social work to improve the quality of training and enhance the professional competencies of these specialists. The study highlights existing deficiencies in the educational programs for social workers in the Kyrgyz Republic, particularly in addressing the specific needs of individuals dependent on psychoactive substances. The article proposes an educational module (a teaching and methodological complex) designed to fill the gaps in the education of social workers in the field of addiction services. The pilot testing of this educational module showed its relevance and effectiveness in raising the level of knowledge on issues related to addiction, methods of providing social support, and social accompaniment. It is important to note that the interdisciplinary approach, which combines theoretical knowledge with practical training, helps in understanding the complexities of the issue and improves the outcomes of social adaptation for individuals with psychoactive substance dependence. The main conclusion of the article is that the use of innovative educational models (teaching modules) significantly enhances the quality of social work within the continuum of addiction services. The author stresses the importance of further developing and implementing such educational programs/modules for social workers, as this will overall improve the rehabilitation and socialization process for individuals with psychoactive substance dependence.

Perspectives on improving wound care for Aboriginal health workers in rural and remote communities in Queensland, Australia

BackgroundThe care of wounds is an ongoing issue for Indigenous people worldwide, yet culturally safe Indigenous wound care training programs for rural and remote Australian Aboriginal Health Workers are largely unavailable. The higher prevalence of chronic disease, lower socioeconomic status and poorer access to services experienced by Aboriginal and Torres Strait Islanders compared to non-Indigenous people, leads to a greater incidence of chronic wounds in Aboriginal and Torres Strait Islander people. Identifying the barriers and enablers for delivering wound care will establish areas of need for facilitating the development of a specific wound care program for Aboriginal Health Workers and Aboriginal Health Practitioners. This paper reports the first phase of a larger project directly aligned to the Indigenous Australians’ Health Program’s objective of supporting the delivery and access to high quality, culturally appropriate health care and services to Aboriginal and Torres Strait Islander Australians. This study aimed to examine experiences of Aboriginal Health Workers, Aboriginal Health Practitioners, and nurses for managing chronic wounds within rural and remote Aboriginal Medical Services in Queensland, Australia.MethodsYarning facilitated by two Aboriginal researchers among Aboriginal Health Workers, Aboriginal Health Practitioners, and nurses currently employed within four Aboriginal Medical Services located in rural and remote areas of Queensland, Australia.ResultsTwo themes were developed through rigorous data analysis of yarning information and responses: participants’ experiences of managing wounds and barriers and enablers to effective wound care.ConclusionsThis study contributes an insight into the experiences of Aboriginal Health Workers on the current barriers and enablers to timely treatment of chronic wounds. Results from this study indicate a significant barrier to obtaining timely and effective wound care in regional and remote settings is access to an appropriately skilled, culturally competent, and resourced health work force. A lack of education and professional development for Aboriginal Health Workers can compromise their ability to maximise patient outcomes and delay wound healing. Findings have informed the development of an evidence based, culturally competent open access chronic wound care education program for Aboriginal Health Workers.

Primary healthcare providers' knowledge, practices and beliefs relating to preventive sexual and reproductive health care for women from refugee and asylum-seeking backgrounds in Australia: a national cross-sectional survey.

Background Many refugee women and women seeking asylum arrive in high-income countries with unmet preventive sexual and reproductive health (SRH) care needs. Primary healthcare providers (HCPs) are usually refugee and asylum seekers' first point of care. This study aimed to identify HCP characteristics associated with initiating conversations and discussing SRH opportunistically during other health interactions. Methods An anonymous online survey was distributed nationally to representatives of health professional organisations and Primary Health Networks. Hierarchical logistic regression analysed factors including HCP demographics, knowledge and awareness, perceived need for training and professional experience with refugee women were included in the models. Results Among 163 HCPs, those initiating conversations ranged from 27.3% (contraceptive care) to 35.2% (cervical screening). Opportunistic discussions ranged from 26.9% (breast screening) to 40.3% (contraceptive care). Positively associated factors included offering care to refugee women or women seeking asylum at least once every 2months 7.64 (95% CI 2.41;24.22, P P P P P P Conclusions Direct professional experience, frequency of service provision, years of practice, and part time work positively influence HCPs' SRH care practices. Enhancing bilingual health worker programs, outreach, education, and support for SRH and cultural competency training are essential to improving the preventive SRH care of refugee women and women seeking asylum.

Implementing and monitoring high-quality community health worker care in adult primary care at New York City Health + Hospitals

BackgroundThis study describes how New York City (NYC) Health + Hospitals implemented a large-scale Community Health Worker (CHW) program in adult primary care clinics between January 2022 and December 2023 and established metrics to monitor program implementation. This study is timely as healthcare systems consider how to scale high-quality CHW programs.MethodsWe collected metrics in the following areas: (1) Workforce demographics, team structure, and training; (2) Enrolled patient demographics; (3) Patient-centered metrics, such as patient counts (e.g. patients outreached and enrolled) and engagement (e.g. median time in program, caseloads per CHW), and goals (e.g. median number of goals identified and completed). Metrics are based on standard data elements captured through CHW documentation in the electronic health record collected during program implementation. Data cleaning is completed using SQL queries and R scripts.ResultsIn June 2023, there were a total of 97 CHW and 22 CHW Supervisor staff lines in adult primary care across 17 healthcare sites. There were 4.6 CHWs to 1 CHW supervisor on average though this ranged by facility from 1:1 to 1:6. Compared to the population that receives primary care at NYC H + H, CHWs served more African American/Black patients (40% vs. 32%) and an older patient population (35% older than 65 vs. 21% older than 65). From January 2022 to December 2023, 13,812 patients were outreached by CHWs. Of these, 9,069 (66%) were referred by clinicians, 7,331 (53%) were enrolled, and 5,044 (37%) successfully graduated. The median number of goals identified by patients was four, and the median number of goals completed with a CHW per patient was three. The top three goals were primary care engagement (47%), specialty care engagement (46%), and food insecurity (45%).ConclusionEstablishing clear implementation and process metrics helps to ensure that CHWs embedded in health systems can meaningfully engage adult patients in health care, address patient-centered goals, and connect patients to community and government services.

The Effectiveness of Group Interpersonal Therapy on Burnout Among Long-Term Care Workers.

Burnout syndrome can have a negative impact on people who work in occupations that require close interaction with others, contributing to a decline in their psychological well-being. This study aimed to examine the effectiveness of Group Interpersonal Therapy (IPT-G) in reducing burnout among care workers for older adults in a Turkish long-term care facility. The study employed a pretest-post-test randomised experimental design. Fifty care workers scoring 27 or above on emotional exhaustion and 10 or above on depersonalisation subscales of the Maslach Burnout Inventory (MBI) were randomly assigned to the intervention or control group for 8 weeks. The study utilised the World Health Organization (WHO) Group Interpersonal Therapy for Depression manual as a guide. The post-test was conducted immediately after the last session of the intervention. In comparing pre- and post-test scores of the intervention group, a statistically significant difference was found in overall burnout scores (pretest M = 74.10, post-test M = 63.08, p < 0.001; d = 1.12). Additionally, emotional exhaustion scores (pretest M = 30.99, post-test M = 24.89, p < 0.001; d = 1.11) and depersonalisation scores (pretest M = 12.76, post-test M = 8.53, p < 0.001; d = 1.69) exhibited significant differences. However, no significant difference was observed in personal accomplishment scores (p > 0.05). The control group had no significant differences concerning the overall burnout scores and all three subscales (p > 0.05). The IPT-G used in this study effectively decreased burnout among care workers in a long-term care facility in Türkiye. In addition, the participants reported high satisfaction with the IPT-G program. Our results support the usefulness of the IPT-G program for care workers in long-term care facilities considering adding it to their occupational health management. This research aimed to determine whether IPT-G successfully decreased care worker burnout. Future research focusing on various types of healthcare workers in long-term care facilities and examining factors such as burnout, job satisfaction and self-efficacy could provide more information on the effects of IPT-G.

The effect on HIV transmission and cost-effectiveness of programmes for female sex workers in East, Central, and Southern Africa: a modelling study

HIV prevalence and incidence has declined in East, Central, and Southern Africa (ECSA), but remains high among female sex workers (FSWs). Sex worker programmes have the potential to considerably increase access to HIV testing, prevention, and treatment. We aimed to quantify these improvements by modelling the potential effect of sex worker programmes at two different intensities on HIV incidence and key health outcomes, and assessed the programmes' potential cost-effectiveness in order to help inform HIV policy decisions. Using a model previously used to review policy decisions in ECSA, we assumed a low-intensity sex worker programme had run from 2010 until 2023; this resulted in care disadvantages among FSWs being reduced, and also increased testing, condom use, and willingness to take pre-exposure prophylaxis (PrEP). After 2023, three policy options were considered: discontinuation, continuation, and a scale-up of the programme to high-intensity, which would have a broader reach, and higher influences on condom use, antiretroviral therapy (ART) adherence, testing, and PrEP use. Outputs of the key outcomes (the percentage of FSWs who were diagnosed with HIV, on ART, and virally suppressed; the percentage of FSWs with zero condomless partners, and HIV incidence) were compared in 2030. The maximum cost for a sex worker programme to be cost-effective was calculated over a 50-year time period and in the context of 10 million adults. The cost-effectiveness analysis was conducted from a health-care perspective; costs and disability-adjusted life-years were both discounted to present US$ values at 3% per annum. Compared with continuing a low-intensity sex worker programme until 2030, discontinuation of the programme was calculated to result in a lower percentage of FSWs diagnosed (median 88·75% vs 91·37%; median difference compared to continuation of a low-intensity programme [90% range] 2·03 [-4·49 to 10·98]), a lower percentage of those diagnosed currently taking ART (86·35% vs 88·89%; 2·38 [-3·69 to 13·42]), and a lower percentage of FSWs on ART with viral suppression (87·49% vs 88·96%; 1·17 [-6·81 to 11·53]). Discontinuation of a low-intensity programme also resulted in an increase in HIV incidence among FSWs from 5·06 per 100 person-years (100 p-y; 90% range 0·52 to 22·21) to 4·05 per 100 p-y (0·21 to 21·15). Conversely, comparing a high-intensity sex worker programme until 2030 with discontinuation of the programme resulted in a higher percentage of FSWs diagnosed (median 95·81% vs 88·75; median difference compared to discontinuation [90% range] 6·36 [0·60 to 18·63]), on ART (93·93 vs 86.35%; median difference 7·13 [-0·65 to 26·48]), and with viral suppression (93·21% vs 87·49; median difference 7·13 [-0·65 to 26·48]). A high-intensity programme also resulted in HIV incidence in FSWs declining to 2·23 per 100 p-y (0·00 to 14·44), from 5·06 per 100 p-y (0·52 to 22·21) if the programme was discontinued. In the context of 10 million adults over a 50-year time period and a cost-effectiveness threshold of US$500 per disability-adjusted life-year averted, $34 million per year can be spent for a high-intensity programme to be cost-effective. A sex worker programme, even with low-level interventions, has a positive effect on key outputs for FSWs. A high-intensity programme has a considerably higher effect; HIV incidence among FSW and in the general population can be substantially reduced, and should be considered for implementation by policy makers. Wellcome Trust.

P19-23 A new approach of well-being assessment in the workplace: an integrated health promotion program for night-shift workers

P19-23 A new approach of well-being assessment in the workplace: an integrated health promotion program for night-shift workers

Building a High-Level Isolation Unit in Rwanda and Establishing a Training Program for the Medical Management of Patients With High-Consequence Infectious Diseases.

Rwanda is a country in East Africa, a region characterized by highly mobile populations and outbreaks of high-consequence infectious diseases occurring on a regular basis. To increase the level of outbreak preparedness in the region, the Rwandan government and the German Ministry of Health signed a joint agreement to construct a new high-level isolation unit in Rwanda, the first in East Africa, and implement a training program for Rwandan healthcare workers to equip them with the necessary skills and knowledge for medical management of patients under high-level isolation conditions, including intensive care treatment. To better understand the scope and format of the planned training program, a needs assessment was performed based on findings from a standardized survey of 4 intensive care units in Rwanda as well as observations from 2 members of a German high-level isolation unit who completed clinical internships at Rwandan hospitals. In this case study, we describe the necessary steps to promote the sustainability and capabilities of the new high-level isolation unit in Kigali and ensure the successful implementation of the training program.

The health effects and moral imperative of funding sex worker programmes

The health effects and moral imperative of funding sex worker programmes

Addressing Hypertension Disparities via Systems Dynamics: Insights From Community Health Connections.

Background and objective Hypertension remains a major public health challenge in the United States, disproportionately affecting various demographic groups. Significant disparities persist in hypertension prevalence and control due to interactions between socioeconomic factors, healthcare access, and systemic inequities. In this study, we aimed todetermine the impact of socioeconomic and healthcare factors on hypertension control among patients at Community Health Connections (CHC), a Federally Qualified Health Center serving 36 communities in North Central Massachusetts, and identify effective interventions using systems dynamics modeling to promote health equity. Materials and methods This was a retrospective observational study using data from 2023 CHC patients, and the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Systems dynamics modeling was employed to visualize interactions among factors influencing hypertension outcomes. The study included 4,870 CHC patients. Participants were selected based on clinical records and comprised 3,690 White participants (76%), 464 Black/African American participants (10%), 108 Asian participants (2%), and 608 classified as Other/Non-reported (12%). The cohort included 2,490 males (51%) and 2,380 females (49%). Socioeconomic factors (e.g., race, age, insurance status) and healthcare access were the study variables. The primary outcome was hypertension control, defined as a blood pressure reading of <140/90 mmHg. The study measured control rates across different demographic groups and assessed the impact of socioeconomic and healthcare factors on these rates. Results Among the 4,870 CHC patients, 3,007 (62%) achieved hypertension control. The overall hypertension control rate varied significantly by race: White: 68.6%, Black/African American: 61.6%, Asian: 63.2%, and Other/Non-reported: 65.6%. Insured patients had a control rate of 67.7%, compared to 37.5% for uninsured patients (p<0.001). Systems dynamics models illustrated how socioeconomic disparities and healthcare access issues amplify health inequities. Key interventions identified include, but are not limited to, multidisciplinary care teams, community health worker programs, and telehealth services. Conclusions Addressing hypertension disparities among CHC patients requires a systemic approach integrating socioeconomic, healthcare, and policy-related interventions. Systems dynamics modeling provides a framework for designing and implementing targeted interventions, enhancing health equity, and improving hypertension control outcomes in underserved populations. Further research is needed to test the effectiveness of these interventions before their broad implementation.

The Influence of Financial Literacy on The Investment Behavior of Indonesian Migrant Workers in Japan

This study aims to analyze the influence of financial literacy on the investment behavior of Indonesian migrant workers in Japan, taking into account factors such as age, education level, and income. The research focuses on 50 Indonesian migrant workers in the Miyazaki area of Japan. Financial literacy is considered a key factor that can affect investment behavior, helping these workers make better investment decisions. A quantitative approach was employed, using descriptive statistical methods and correlation analysis based on questionnaire data that measured respondents' understanding of financial literacy and its impact on their investment behavior. The results show that financial literacy has a positive and significant effect on investment behavior. Higher levels of financial literacy are associated with improved investment decisions. Additionally, age, education, and income also have a significant impact. These findings highlight the importance of developing more effective financial literacy education and training programs for Indonesian migrant workers in Japan, as improved financial literacy can lead to better investment decisions, increased access to investment opportunities, and enhanced financial well-being.

The long-term effects of job training on labor market and skills outcomes in Chile

Job training programs can be an effective policy for improving productivity and labor market outcomes in low- and middle-income countries. We report medium- and long-term impacts of a job training program for vulnerable workers in Chile on labor market and skill outcomes using experimental and administrative data. We estimate intention-to-treat effects, accounting for potential non-compliance by training providers in the assignment process, as well as local average treatment effects due to noncompliance with the assigned treatment status. Overall, the program shows limited effectiveness. While we find some positive impacts on labor income, the program fails to improve most labor outcomes. A detailed investigation of heterogenous effects by course-type, training provider and course quality, and gender reveals that the positive income effects are more likely to be realized for males and participants in courses that were offered by high-quality providers. Evidence on mechanisms indicates that the program's limited impact on labor outcomes could, at least partly, be due to its limited effect on workers’ skills.

Immigrant labour, rural economies, and the question of housing

AbstractThere is a renewed interest in policy initiatives that aim to ruralize and regionalize immigration in Canada. These efforts are visible through temporary foreign worker programs linked to Provincial Nominee Programs, as well as the increase in the number of refugee resettlement programs in smaller communities. Against this backdrop, cities in Canada are experiencing a housing crisis. There is a tacit assumption that immigrants in smaller and more rural settings will fare better with respect to housing. This paper examines the assumptions underpinning efforts to ruralize and regionalize immigration—namely that immigrants to smaller centres will find more affordable and available housing. By presenting two case studies of small towns that have successfully leveraged immigration to meet their labour market needs, this paper demonstrates that housing remains a critical issue for newcomers, even outside of large urban centres. Further, the paper argues that discussions about housing need to be linked to broader policy conversations about immigration and labour, especially in contexts where transnational corporations leverage immigration and temporary labour programs to secure their workforce, without parallel investments in infrastructure and housing.

Sustaining village malaria worker programmes with expanded roles: Perspectives of communities, healthcare workers, policymakers, and implementers in Vietnam.

In Vietnam, multiple types of community-based malaria workers are recruited to promote access to malaria testing and treatment for at-risk mobile and migrant populations. However, as the country approaches elimination, these roles are at risk from declining investment. This article characterises the different types of workers and relevant health policy in Vietnam, and explores stakeholder perspectives on sustaining and expanding the roles of these workers in the malaria elimination context. We conducted a rapid policy document review to describe the policy background of community-based health care in Vietnam and identify key informants. In-depth interviews were conducted with policymakers and implementers (n = 11) in different government sectors, international, and civil society organizations. We also conducted interviews (n = 8) and two focus group discussions with community members (n = 12), and interviews with health workers (n = 9) in 18 communities in Phu Yen and Binh Thuan provinces in the central region. Our study identified three main types of malaria workers: village health workers (VHWs), malaria post workers (MPWs) and other groups of workers supported by civil society organisations (CSO). Workers reported being willing to maintain their current roles and potentially provide additional services that respond to community needs, although they were concerned about excess workload and inadequate income. Besides working in a variety of jobs to secure their incomes, mainly in agriculture, VHWs in particular were primarily tasked with supporting the delivery of a wide range of health services from commune health stations. Faced with reduced patients, MPWs and CSO-supported workers could be tasked with the following potential roles: case notification for infectious diseases, real-time data collection and reporting, and screening for non-malaria illnesses using other rapid test kits. There was agreement that the community-based health network is crucial to health care delivery in remote communities and to ensure comprehensive access to care among vulnerable populations. However, policymakers and implementers stressed concerns about their limited skillsets, the inadequate budget to support these workers, and the regulation constraining them from performing diagnosis and treatment activities, highlighting the priority to maintain the capacity of workers and funding allocation through provincial advocacy and multi-programme collaboration. This study highlights the crucial role of community-based health workers in eliminating malaria in Vietnam. Sustained efforts are needed to maintain accessible case detection and treatment while addressing local health concerns beyond malaria. Implementing these strategies requires prioritizing the mapping of groups most in need and developing enablers to raise community awareness and maintain the capacity of these workers. Ensuring political advocacy, financial resources, and coordination between multiple groups are key to maximizing impact and integrating malaria activities into the broader health system.

Implementing a Population-Based Social Determinants of Health Intervention: Early Lessons Learned from Collaboration between Clinical and Community Organizations

Abstract: The purpose of this study was to understand the barriers and facilitators among diverse health care and community organization stakeholders implementing a populationbased social determinants of health (SDOH) intervention. The SDOH intervention included three core programs: SDOH screening, a community health worker program, and a digital referral platform. After one year of implementation, we conducted semi-structured qualitative interviews with clinical and community-based organization stakeholders about (1) the three SDOH programs, (2) organizational implementation strategies, (3) interactions with partner organizations, and (4) perceived target population needs. Findings from the first year of implementation highlighted several factors to consider when designing and implementing SDOH programming, including (1) the successful features of the three SDOH programs, (2) the local implementation strategies and challenges across organizations, (3) the impact of broader community needs and resource availability on implementation, and (4) the importance of intentionally fostering relationships and collaboration among partner organizations.