Community health systems: allowing community health workers to emerge from the shadows

Zambruni, Jérôme Pfaffmann; Rasanathan, Kumanan; Hipgrave, David; Miller, Nathan P; Momanyi, Maureen; Pearson, Luwei; Rio, Dolores Del; Romedenne, Magali; Singh, Sagri; Young, Mark; Peterson, Stefan

doi:10.1016/s2214-109x(17)30268-1

Cited by 42 publications

(21 citation statements)

References 3 publications

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“…In the worldwide effort to achieve universal health coverage (UHC), community health workers (CHW) play a key role in the provision of health services due to their close proximity to end users, socially adapted service delivery and engagement with families and communities 1 2. CHWs’ contributions to reaching global and national health goals have been recognised since the 1978 Alma-Ata Declaration, which was strongly influenced by China’s ‘barefoot doctors’ and similar programmes and policies 3.…”

Section: Introductionmentioning

confidence: 99%

Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?

Dalglish

Straubinger²,

Kavle³

et al. 2019

BMJ Glob Health

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Recent years have seen increasing momentum towards task shifting of basic health services, including using community health workers (CHW) to diagnose and treat common childhood illnesses. Yet few studies have examined the role of traditional healers in meeting families’ and communities’ health needs and liaising with the formal health system. We examine these issues in Tshopo Province in the Democratic Republic of the Congo, a country with high rates of child mortality (104 deaths per 1000 live births). We conducted 127 in-depth interviews and eight focus group discussions with a range of community members (mothers, fathers and grandmothers of children under 5 years of age) and health providers (CHWs, traditional healers, doctors and nurses) on topics related to care seeking and case management for childhood illness and malnutrition, and analysed them iteratively using thematic content analysis. We find significant divergence between biomedical descriptions of child illness and concepts held by community members, who distinguished between local illnesses and so-called ‘white man’s diseases.’ Traditional healers were far less costly and more geographically accessible to families than were biomedical health providers, and usually served as families’ first recourse after home care. Services provided by traditional healers were also more comprehensive than services provided by CHWs, as the traditional medicine sphere recognised and encompassed care for ‘modern’ diseases (but not vice versa). Meanwhile, CHWs did not receive adequate training, supervision or supplies to provide child health services. Considering their accessibility, acceptability, affordability and ability to recognise all domains of illness (biomedical and spiritual), traditional healers can be seen as the de facto CHWs in Tshopo Province. National and international health policymakers should account for and involve this cadre of health workers when planning child health services and seeking to implement policies and programmes that genuinely engage with community health systems.

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Section: Introductionmentioning

confidence: 99%

Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?

Dalglish

Straubinger²,

Kavle³

et al. 2019

BMJ Glob Health

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“…Female health workers—particularly those at the front line—themselves face gender biases and discrimination where they occupy lower status health occupations 38 56. Similarly, female community health workers are under-recognised, underpaid and overworked, and often lack support from the wider health system 57…”

Section: How Gender Interacts With Implementationmentioning

confidence: 99%

The influence of gender on immunisation: using an ecological framework to examine intersecting inequities and pathways to change

Feletto

Sharkey

2019

BMJ Glob Health

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There is still a substantial knowledge gap on how gender mediates child health in general, and child immunisation outcomes in particular. Similarly, implementation of interventions to mitigate gender inequities that hinder children from being vaccinated requires additional perspectives and research. We adopt an intersectional approach to gender and delve into the social ecology of implementation, to show how gender inequities and their connection with immunisation are grounded in the interplay between individual, household, community and system factors. We show how an ecological model can be used as an overarching framework to support more precise identification of the mechanisms causing gender inequity and their structural complexity, to identify suitable change agents and interventions that target the underlying causes of marginalisation, and to ensure outcomes are relevant within specific population groups.

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“…Studies over the last 5 years in poor communities in south Asia and Africa have conclusively shown that community health worker (CHW) home visiting during the antenatal and postnatal periods can improve both the demand for and use of ANC, delivery and PNC services, and reduce maternal and newborn mortality by at least 15–20% [ 8 – 11 ]. CHWs are increasingly being ‘institutionalised’ in the workforce in south Asia and Africa through enhanced training and incentive packages [ 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…Home visiting from female CHWs during the antenatal and postnatal periods is likely to be an important way to improve the demand for and use of MCH services in fragile and conflict-affected countries such as Afghanistan [ 7 , 12 , 15 , 16 ]. Many CHW studies have been conducted in Africa and South Asia [ 8 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Can community health worker home visiting improve care-seeking and maternal and newborn care practices in fragile states such as Afghanistan? A population-based intervention study

Edmond

Yousufi

Anwari

et al. 2018

BMC Med

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BackgroundThe effects of community health worker (CHW) home visiting during the antenatal and postnatal periods in fragile- and conflicted-affected countries such as Afghanistan are not known.MethodsWe conducted a non-randomised population-based intervention study from March 2015 to February 2016. Two intervention and two control districts were selected.All female CHWs in the intervention districts were trained to provide eight home visits and behaviour change communication messages from pregnancy to 28 days postpartum. The primary outcome was the proportion of women who reported delivering in a health facility. Secondary outcomes were the proportion of women who reported attending a health facility for at least one antenatal and one postnatal visit. Outcomes were analysed at 12 months using multivariable difference-in-difference linear regression models adjusted for clustering.ResultsOverall, 289 female CHWs in the intervention districts performed home visits and 1407 eligible women (less than 12 months postpartum) at baseline and 1320 endline women provided outcome data (94% response rate). Facility delivery increased in intervention villages by 8.2% and decreased in the control villages by 6.3% (adjusted mean difference (AMD) 11.0%, 95% confidence interval (CI) 4.0–18.0%, p = 0.002). Attendance for at least one antenatal care visit (AMD 10.5%, 95% CI 4.2–16.9%, p = 0.001) and postnatal care visit (AMD 7.2%, 95% CI 0.2–14.2%, p = 0.040) increased in the intervention compared to the control districts.ConclusionsCHW home visiting during the antenatal and postnatal periods can improve health service use in fragile- and conflict-affected countries. Commitment to scale-up from Ministries and donors is now needed.Trial registrationThis trial was retrospectively registered at the Australian and New Zealand Clinical Trial Registry (ACTRN12618000609257).

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Community health systems: allowing community health workers to emerge from the shadows

Cited by 42 publications

References 3 publications

Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?

Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?

The influence of gender on immunisation: using an ecological framework to examine intersecting inequities and pathways to change

Can community health worker home visiting improve care-seeking and maternal and newborn care practices in fragile states such as Afghanistan? A population-based intervention study

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