Ethics of task shifting in the health workforce: exploring the role of community health workers in HIV service delivery in low- and middle-income countries

Mundeva, Hayley; Snyder, Jeremy; Ngilangwa, David Paul; Kaida, Angela

doi:10.1186/s12910-018-0312-3

Cited by 51 publications

(37 citation statements)

References 50 publications

(234 reference statements)

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“…Previous research has illustrated how task shifting, the systematic redistribution of healthcare tasks from specialized health professionals to individuals with less training such as lay workers, may help to reduce health inequities by improving access to care for underserved populations (Buchman et al, 2018;Mijovic et al, 2016;Mundeva et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Peer worker involvement in low-threshold supervised consumption facilities in the context of an overdose epidemic in Vancouver, Canada

Kennedy

Boyd

Mayer

et al. 2019

Social Science & Medicine

108

135

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Overdose prevention sites (OPS) are a form of supervised consumption facility that have been implemented in Vancouver, Canada as an innovative response to an ongoing overdose epidemic. OPS are primarily staffed by peers-people who use(d) drugs (PWUD)-trained in overdose response. We sought to characterize peer worker involvement in OPS programming, including how this shapes service dynamics and health outcomes among PWUD. Data were drawn from a rapid ethnographic study examining the implementation, operations and impacts of OPS in Vancouver from December 2016 to April 2017. We conducted approximately 185 hours of observational fieldwork at OPS and 72 in-depth qualitative interviews with PWUD. Data were analyzed thematically, with a focus on peer worker involvement at OPS and related outcomes. OPS implementation and operations depended on peer worker involvement and thus allowed for recognition of capacities developed through roles that peers were already undertaking through local programming for PWUD. Peer involvement at OPS enhanced feelings of comfort and facilitated engagement with OPS among PWUD. These dynamics and appreciation of peer worker expertise enabled communication with staff in ways that fostered harm reduction practices and

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Section: Discussionmentioning

confidence: 99%

Peer worker involvement in low-threshold supervised consumption facilities in the context of an overdose epidemic in Vancouver, Canada

Kennedy

Boyd

Mayer

et al. 2019

Social Science & Medicine

108

135

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“…Findings show that supportive supervision could optimize the interface position of CHWs between communities and the health sector, thereby enhancing health system performance, as also highlighted by earlier studies ( Glenton et al , 2013 ; Kok et al , 2017 ). The interface position of CHWs can result in emotional burden and workload when interacting and dealing with (expectations from) both the community and the health sector ( Glenton et al , 2013 ; Maes and Kalofonos, 2013 ; Cataldo et al , 2015 ; Mundeva et al , 2018 ). We found that CHWs in all four settings perceived supportive supervision from health professionals and peers, e.g.…”

Section: Discussionmentioning

confidence: 99%

Does supportive supervision enhance community health worker motivation? A mixed-methods study in four African countries

Kok

Vallières

Tulloch

et al. 2018

Health Policy and Planning

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Supportive supervision is an important element of community health worker (CHW) programmes and is believed to improve CHW motivation and performance. A group supervision intervention, which included training and mentorship of supervisors, was implemented in Ethiopia, Kenya, Malawi and Mozambique. In three of the countries, this was combined with individual and/or peer supervision. A mixed-methods implementation study was conducted to assess the effect of the supervision intervention on CHWs’ perceptions of supervision and CHW motivation-related outcomes. In total, 153 in-depth interviews were conducted with CHWs, their supervisors and managers. In addition, questionnaires assessing perceived supervision and motivation-related outcomes (organizational and community commitment, job satisfaction and conscientiousness) were administered to a total of 278 CHWs pre- and post-intervention, and again after 1 year. Interview transcripts were thematically analysed using a coding framework. Changes in perceived supervision and motivation-related outcomes were assessed using Friedman’s ANOVA and post hoc Wilcoxon signed-rank tests. Interview participants reported that the supervision intervention improved CHW motivation. In contrast, the quantitative survey found no significant changes for measures of perceived supervision and inconsistent changes in motivation-related outcomes. With regard to the process of supervision, the problem-solving focus, the sense of joint responsibilities and team work, cross-learning and skill sharing, as well as the facilitating and coaching role of the supervisor, were valued. The empowerment and participation of supervisees in decision making also emerged in the analysis, albeit to a lesser extent. Although qualitative and quantitative findings differed, which could be related to the slightly different focus of methods used and a ‘ceiling effect’ limiting the detection of observable differences from the survey, the study suggests that there is potential for integrating supportive group supervision models in CHW programmes. A combination of group with individual or peer supervision, preferably accompanied with methods that assess CHW performance and corresponding feedback systems, could yield improved motivation and performance.

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“…As a necessity, effective health services can only be delivered on functioning systems, which are often deficient in LMICs. The goals of health systems are health achievement, fairness of financial contribution, and responsiveness to the expectations of the population (Witter et al, 2017;Mundeva et al, 2018).…”

Section: Cholera Among the Idps Resulting From The Bh Conflict In Normentioning

confidence: 99%

The Effect of Religious Conflicts in Northern Nigeria on Public Health Outcomes: A Case Study of Cholera Outbreak

Nuhu

Yusuf

2018

ESJ

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Violent conflicts, in most cases, pose an unquantifiable challenge to human health and health systems especially in developing countries. Complex humanitarian emergencies as a result of conflicts could severely have negative consequences on public health. Nigeria has faced series of threatening security challenges, but the one caused by the activities of the socalled Islamist sect, the Boko Haram (BH), remains protracted, especially in Borno, a State in the north-eastern part of the country. The resultant outcome is the internally displaced persons (IDPs) who have suffered from many diseases especially cholera, which has continued to ravage these displaced populations. Conflict can contribute to water shortage through the destruction of water sources, such as wells, reservoirs and laid pipes, and its contamination. This is happening on an already weak health system. Though cholera is easily treatable, concerted efforts by government and medical humanitarian agencies are urgently required to ameliorate the situation of the IDPs. An appropriate strategy of control of the transmission of cholera and emergency medical intervention can help alleviate the devastating effects. The management of cholera transmission include the supply of sufficient water sources, adequate sanitation, and a public health campaign to maximize the effects of these measures. One key health system challenge that could limit the effectiveness of the interventions would be the people. This paper focuses on studying the resultant large numbers of IDPs from the BH conflict, discussing cholera outbreak as a specific health issue, and presenting a focused humanitarian intervention to address this health need.

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Ethics of task shifting in the health workforce: exploring the role of community health workers in HIV service delivery in low- and middle-income countries

Cited by 51 publications

References 50 publications

Peer worker involvement in low-threshold supervised consumption facilities in the context of an overdose epidemic in Vancouver, Canada

Peer worker involvement in low-threshold supervised consumption facilities in the context of an overdose epidemic in Vancouver, Canada

Does supportive supervision enhance community health worker motivation? A mixed-methods study in four African countries

The Effect of Religious Conflicts in Northern Nigeria on Public Health Outcomes: A Case Study of Cholera Outbreak

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