Acceptable and appropriate: Program priorities vs. felt needs in a CHW program

Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: qualitative evidence synthesis

“…In approximately 13 studies, from Australia (Downie 2004), Canada (Heaman 2006;, UK (Murphy 2008;Perkins 2001;Smith 2007), USA (Sheppard 2004;Warrick 1992), Brazil (Wayland 2002), Mexico (Ramirez-Valles 2003), India (Alcock 2009), Papua New Guinea (Ashwell 2009) and Viet Nam (Hendrickson 2002), LHWs carried out a package of tasks that were primarily promotional, and mainly involved information and advice about topics such as family planning, pregnancy and childbirth, breastfeeding, vaccinations and other aspects of newborn and child health care.…”

“…Although recipients in most of the studies indicated a high level of acceptability with the LHW programmes, some studies also described less positive attitudes. In some studies the target groups had poor knowledge of the LHW programme itself or were not fully aware of the services that the programme could o er (Bisika 2008;Kaufmann 1997;Mathews 1994;Murphy 2008;Wayland 2002). In one study recipients were aware of the existence of trained traditional birth attendants but were mostly unable to utilize them because they could not a ord their services (Ngoma 2009).…”

“…Some studies pointed to a low use of LHW services when these services failed to meet the perceived needs of community members (Mathews 1994;Murphy 2008;Wayland 2002). LHWs were sometimes confronted with non-healthcare related problems such as housing, food insecurity, and social and domestic violence (Lancman 2009;Meier 2007); and, in some cases, the poverty-related and social problems recipients faced in their everyday lives were experienced as more pressing than the issues that the LHW programmes aimed to address (Meier 2007;Wayland 2002). In one study from Brazil, this led to an almost complete failure of the programme.…”

“…Here, LHW tasks included assessing children's nutritional status, enrolling malnourished children into a milk programme, and spreading information about nutrition, immunisation, hygiene, respiratory infections, breastfeeding and prenatal care. According to study authors, programme administrators "[assumed that] once people learn how to correctly manage their environment and care for their children, health will improve" (Wayland 2002). Community members disagreed with this assumption, arguing that they knew how to care for their children but that their income and living conditions prevented them from doing so.…”

Cost-effectiveness analysis of an alternative tuberculosis management strategy for permanent farm dwellers in South Africa amidst health service contraction

“…A Namibian study found when the project aims and expectations of the residents were incongruent, LHWs became frustrated and as a result performed poorly (Wayland, 2002). Developing clear objectives for LHW programmes as well as detailed planning of the implementation strategy are vital (Low and Ithindi, 2003).…”