Community Perceptions of Community Health Workers (CHWs) and Their Roles in Management for HIV, Tuberculosis and Hypertension in Western Kenya

Abstract

Given shortages of health care providers and a rise in the number of people living with both communicable and non-communicable diseases, Community Health Workers (CHWs) are increasingly incorporated into health care programs. We sought to explore community perceptions of CHWs including perceptions of their roles in chronic disease management as part of the Academic Model Providing Access to Healthcare Program (AMPATH) in western Kenya. In depth interviews and focus group discussions were conducted between July 2012 and August 2013. Study participants were purposively sampled from three AMPATH sites: Chulaimbo, Teso and Turbo, and included patients within the AMPATH program receiving HIV, tuberculosis (TB), and hypertension (HTN) care, as well as caregivers of children with HIV, community leaders, and health care workers. Participants were asked to describe their perceptions of AMPATH CHWs, including identifying the various roles they play in engagement in care for chronic diseases including HIV, TB and HTN. Data was coded and various themes were identified. We organized the concepts and themes generated using the Andersen-Newman Framework of Health Services Utilization and considering CHWs as a potential enabling resource. A total of 207 participants including 110 individuals living with HIV (n = 50), TB (n = 39), or HTN (n = 21); 24 caregivers; 10 community leaders; and 34 healthcare providers participated. Participants identified several roles for CHWs including promoting primary care, encouraging testing, providing education and facilitating engagement in care. While various facilitating aspects of CHWs were uncovered, several barriers of CHW care were raised, including issues with training and confidentiality. Suggested resources to help CHWs improve their services were also described. Our findings suggest that CHWs can act as catalysts and role models by empowering members of their communities with increased knowledge and support.

Technology and rehabilitation training for community health workers: Strengthening health systems in Malawi

“…In this study, CHWs noted how training programmes, phones and manuals are helpful. Several studies also identified similar barriers in various rural settings for CHWs (Huang et al, ; Knettel et al, ; Oliver, Geniets, Winters, Rega, & Mbae, ; Rachlis et al, ). In this study, CHWs in Malawi faced the barriers of limited transportation, resources and materials for patient care, and rapport between CHWs and target population.…”

“…Results of this study revealed three main considerations for using technology to support community‐driven healthcare delivery systems. These main considerations included embedding systems of feedback and processes for organised communication within training programmes (Vital Wave Consulting, ), considering material needs such as transportation (Huang et al, ; Knettel et al, ; Oliver et al, ; Rachlis et al, ) and building capacity through training programmes and supervisory structures (Abdel‐All et al, ; Knettel et al, ; Vijay & Mincy, ). Moreover, this study provided an example of how a training programme that included use of technology to facilitate communication with hospital resources is consistent with the new WHO health policy guidelines for supporting integration of community health workers into health systems (Asweto, Alzain, Andrea, Alexander, & Wang, ; Cometto et al, ).…”

“…Results of this study revealed three main considerations for using technology to support community-driven healthcare delivery systems. These main considerations included embedding systems of feedback and processes for organised communication within training programmes (Vital Wave Consulting, 2011), considering material needs such as transportation (Huang et al, 2018;Knettel et al, 2017;Oliver et al, 2015;Rachlis et al, 2016) Wright, 2015). Community health workers are not only effective but also possess great potential for reducing the burden of disease in resource-limited settings (Perry & Zulliger, 2012).…”

The impact of para-professional social workers and community health care workers in Côte d'Ivoire: Contributions to the protection and social support of vulnerable children in a resource poor country

“…Community health workers (CHWs) also face particulate barriers related to community perceptions. For participants in one study taking place in Kenya, CHWs were perceived as having the inability to provide confidential services, which ultimately prevents community members' linkage to and management of health care (Rachlis et al, 2016). The authors go on further to report that given the case that CHWs are seen as a part of the community, community members are fearful of recognition especially in the context of their health status (Rachlis et al, 2016, p. 8).…”

Integrating the prevention of mother-to-child transmission of HIV after AIDS denialism in South Africa: Perspectives of experts and health care workers - A qualitative study

“…Participants in this study explained how and why the CHWs are increasingly accepted into PHC. CHWs have emerged as key players in response to HIV/AIDS, tuberculosis and the Ebola virus, among other health problems -particularly in overwhelmed health systems such as South Africa's(69)(70)(71)(72). In case of PMTCT services, the CHWs' role has evolved to improve health for both mothers and their infants, as well as for other family members in the households in different areas of health priority such as disease prevention, hygiene, nutrition, family planning, social support and domestic abuse(73)(74)(75)(76)(77).Even though critical, investment in CHWs in South Africa has to date been through NGOs partnerships and have not yet been formally institutionalised nor thoroughly documented despite being considered as a key element of PHC re-engineering strategy, launched almost a decade ago(72,78,79).…”