A Successful, Preventive-Oriented Village Health Worker Program in Hebron, The West Bank, 1985–1996

Tulchinsky, Theodore H.; Zeer, Abdul Majid Al; Mounshar, Jawad Abu; Subeih, Tagreed; Schoenbaum, Michael; Roth, Marcia; Gamulka, Beth; Abenueze, Michael; Acker, C.

doi:10.1097/00124784-199707000-00011

Cited by 11 publications

(21 citation statements)

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“…Five papers note that CLHW were recruited in new roles and provide brief demographic characteristics [22,60–62]. For example, Baqui et al discuss how recruits are women with at least a 10th grade education, a mean age at time of recruitment of 23 years, and more than 60% of whom are single, divorced or separated [61].…”

Section: Resultsmentioning

confidence: 99%

“…Relationships are described in slightly more detail in eight studies [22,37,43,45,52,53,61,62,64]. For example, Gazi et al dedicate a special section in their article to the interaction between depot holders and the community.…”

Section: Resultsmentioning

confidence: 99%

“…Both studies do note some community engagement during implementation, suggesting the importance of social interactions at family and community levels. Tulchinsky et al find 10% attrition during ten years of operation which, as already noted, is related to a high stipend [62]. However, the authors also note that those who left did so for reasons “unrelated to the operations of the program” but do not specify what this means.…”

Section: Synthesis Of Findingsmentioning

confidence: 97%

“…With regard to attrition, the discourse in some studies suggests a particularly high relevance of remuneration [31,62,64,67]. Rowe et al find that consultations performed by CLHWs who thought that they received four or more benefits had higher levels of overall patient adherence than consultations performed by CLHWs who thought that they received fewer than four benefits [38].…”

Section: Synthesis Of Findingsmentioning

confidence: 99%

“…Eight studies provide actual data on attrition [22,40,43,44,52,61,62,64], which ranges from 10% to 50% or “high”. High attrition—when discussed—is related to life events, a mismatch of expectations, or lack of supervision and monitoring.…”

Section: Synthesis Of Findingsmentioning

confidence: 99%

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The Influence of Community Health Resources on Effectiveness and Sustainability of Community and Lay Health Worker Programs in Lower-Income Countries: A Systematic Review

Vries

Pool

2017

PLoS ONE

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BackgroundDespite the availability of practical knowledge and effective interventions required to reduce priority health problems in low-income countries, poor and vulnerable populations are often not reached. One possible solution to this problem is the use of Community or Lay Health Workers (CLHWs). So far, however, the development of sustainability in CLHW programs has failed and high attrition rates continue to pose a challenge. We propose that the roles and interests which support community health work should emerge directly from the way in which health is organized at community level. This review explores the evidence available to assess if increased levels of integration of community health resources in CLHW programs indeed lead to higher program effectiveness and sustainability.Methods and FindingsThis review includes peer-reviewed articles which meet three eligibility criteria: 1) specific focus on CLHWs or equivalent; 2) randomized, quasi-randomized, before/after methodology or substantial descriptive assessment; and 3) description of a community or peer intervention health program located in a low- or middle-income country. Literature searches using various article databases led to 2930 hits, of which 359 articles were classified. Of these, 32 articles were chosen for extensive review, complemented by analysis of the results of 15 other review studies. Analysis was conducted using an excel based data extraction form. Because results showed that no quantitative data was published, a descriptive synthesis was conducted. The review protocol was not proactively registered. Findings show minimal inclusion of even basic community level indicators, such as the degree to which the program is a community initiative, community input in the program or training, the background and history of CLHW recruits, and the role of the community in motivation and retention. Results show that of the 32 studies, only one includes one statistical measure of community integration. As a result of this lack of data we are unable to derive an evidence-based conclusion to our propositions. Instead, our results indicate a larger problem, namely the complete absence of indicators measuring community relationships with the programs studied. Studies pay attention only to gender and peer roles, along with limited demographic information about the recruits. The historicity of the health worker and the community s/he belongs to is absent in most studies reviewed. None of the studies discuss or test for the possibility that motivation emanates from the community. Only a few studies situate attrition and retention as an issue enabled by the community. The results were limited by a focus on low-income countries and English, peer-reviewed published articles only.ConclusionPublished, peer-reviewed studies evaluating the effectiveness and sustainability of CLHW interventions in health programs have not yet adequately tested for the potential of utilizing existing community health roles or social networks for the development of effective and sus...

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Section: Resultsmentioning

confidence: 99%