Health workers’ perspectives, knowledge and skills regarding community case management of childhood diarrhoea and pneumonia: a qualitative inquiry for an implementation research project “Nigraan” in District Badin, Sindh, Pakistan

Rabbani, Fauziah; Perveen, Shazia; Aftab, Wafa; Zahidie, Aysha; Sangrasi, Kashif; Qazi, Shamim

doi:10.1186/s12913-016-1699-5

Cited by 18 publications

(26 citation statements)

References 26 publications

(25 reference statements)

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“…When asked about services provided during the visit, caregivers most frequently reported polio vaccine administration (79% intervention arm [n = 3494] vs 78% comparison arm [n = 3531]) and vaccination (34% intervention arm [n = 3494] vs 32% comparison arm [n = 3531]). This finding corroborates LHWs’ statements in qualitative interviews that ‘we are best seen as polio workers’ . Less than 1% of caregivers in both arms (intervention n = 3494, comparison n = 3531) said that LHWs provide ORS, while less than 2% said that the LHWs provide any medicines.…”

Section: Resultssupporting

confidence: 79%

Improving community health worker performance through supportive supervision: a randomised controlled implementation trial in Pakistan

et al. 2018

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Aim: To assess the effect of enhanced supportive supervision of lady health workers (LHWs) by lady health supervisors on integrated community case management of childhood pneumonia and diarrhoea.Methods: A total of thirty-four supervisors were randomly assigned to intervention and comparison arms. The intervention included enhanced training of supervisors on supervisory skills and written feedback to LHWs by supervisors. The performance of both cadres was assessed three times. Household surveys judged caregiver practices.Results: Intervention arm LHWs performed better than those in the comparison arm in assessing dehydration (92% [n = 25] vs 64% [n = 25]) and in classifying diarrhoea correctly (68% [n = 25] vs 40% [n = 25]). The two arms differed little in correct disease classification for pneumonia (44% [n = 25] vs 40% [n = 25]). Supervisory performance of intervention arm supervisors was better than that in the comparison arm in correcting the workers' clinical examination skills (64% [n = 25] vs 40% [n = 25]) and more frequent feedback. In the household survey, only 18% (n = 2182) intervention and 23% (n = 2197) comparison arm caregivers considered LHWs capable of providing diarrhoea and pneumonia care. Commodities for integrated community case management were not regularly available to workers.Conclusion: Supportive supervision can improve community case management performance. Support through refresher training, logistics and commodities is essential.We explored whether enhancing supervision skills of supervisors improves the ability of community health workers to diagnose and manage childhood diarrhoea and pneumonia. We compared the effect of enhanced supervision of supervisors with routine supervisory practices on health worker performance. Supervisors in the intervention arm provided better quality supervision more frequently, and health workers in the intervention arm performed better in assessing dehydration and in correct classification of disease, particularly diarrhoea.

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Section: Resultssupporting

confidence: 79%

Improving community health worker performance through supportive supervision: a randomised controlled implementation trial in Pakistan

et al. 2018

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“…A small number of studies used self-reported satisfaction, 64 motivation 58 or increased agency 57 as outcomes to measure the impact of ongoing training. These are what Kok et al 88 refer to as ‘software’ of a training programme and can affect motivation and performance.…”

Section: Discussionmentioning

confidence: 99%

Ongoing training of community health workers in low-income and middle-income countries: a systematic scoping review of the literature

O’Donovan

Kuhn

et al. 2018

BMJ Open

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ObjectivesUnderstanding the current landscape of ongoing training for community health workers (CHWs) in low-income and middle-income countries (LMICs) is important both for organisations responsible for their training, as well as researchers and policy makers. This scoping review explores this under-researched area by mapping the current delivery implementation and evaluation of ongoing training provision for CHWs in LMICs.DesignSystematic scoping review.Data sourcesMEDLINE, Embase, AMED, Global Health, Web of Science, Scopus, ASSIA, LILACS, BEI and ERIC.Study selectionOriginal studies focusing on the provision of ongoing training for CHWs working in a country defined as low income and middle income according to World Bank Group 2012 classification of economies.ResultsThe scoping review found 35 original studies that met the inclusion criteria. Ongoing training activities for CHWs were described as supervision (n=19), inservice or refresher training (n=13) or a mixture of both (n=3). Although the majority of studies emphasised the importance of providing ongoing training, several studies reported no impact of ongoing training on performance indicators. The majority of ongoing training was delivered inperson; however, four studies reported the use of mobile technologies to support training delivery. The outcomes from ongoing training activities were measured and reported in different ways, including changes in behaviour, attitudes and practice measured in a quantitative manner (n=16), knowledge and skills (n=6), qualitative assessments (n=5) or a mixed methods approach combining one of the aforementioned modalities (n=8).ConclusionsThis scoping review highlights the diverse range of ongoing training for CHWs in LMICs. Given the expansion of CHW programmes globally, more attention should be given to the design, delivery, monitoring and sustainability of ongoing training from a health systems strengthening perspective.

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“…A study from Uganda shows that trust in CHWs and level of community awareness leads to higher utilization of CHW services [ 20 ]. In Badin, LHWs’ prestige in the community suffers due to lack of commodities and medicines [ 21 , 22 ]. CHWs’ respect and prestige is related to both CHWs’ own motivation and with community’s utilization of her services [ 14 , 15 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Exploring health care seeking knowledge, perceptions and practices for childhood diarrhea and pneumonia and their context in a rural Pakistani community

Aftab

Shipton

Rabbani

et al. 2018

BMC Health Serv Res

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BackgroundWhere access to facilities for childhood diarrhea and pneumonia is inadequate, community case management (CCM) is an effective way of improving access to care. In Pakistan, utilization of CCM for these diseases through the Lady Health Worker Program remains low. Challenges of access to facilities persist leading to delayed care and poor outcomes. Estimating caregiver knowledge, understanding their perceptions and practices, and recognizing how these are related to care seeking decisions about childhood diarrhea and pneumonia is crucial to bring about coherence between supply and demand-side practices.MethodsData was collected from family caregivers to explore their knowledge, perceptions and practices regarding childhood diarrhea and pneumonia. Data from a household survey with 7025 caregivers, seven focus group discussion (FGDs), seven in-depth interviews (IDIs), and 20 detailed narrative interviews are used to explore caregiver knowledge, perceptions and practices.ResultsHousehold survey shows that most family caregivers recognize main signs and symptoms of diarrhea such as loose stools (76%). Fewer recognize signs and symptoms of pneumonia such as breathing problems (21%). Few caregivers (18%) have confidence in lady health workers’ (LHWs) ability to treat childhood diarrhea and pneumonia. Care seeking from LHWs remains negligible (< 1%). Caregivers overwhelmingly prefer to seek care from doctors (97%). Seventy-five percent caregivers sought care from private providers and 45% from public providers.FGDs, IDIs, and narrative interviews show that care mostly begins with home remedies and sometimes self-prescribed medicines. Treatment delays occur because of caregiver inability to recognize disease, use of home remedies, financial constraints, and low utilization of community based LHW services. Caregivers do not seek care from LHWs because of lack of trust and LHWs’ inability to provide medicines. If finances allow, private doctors, who caregivers perceive as more responsive, are preferred over public sector doctors. Financial resources, availability of time, support for household chores by family and community determine whether, when, and from whom caregivers seek care.ConclusionsMany children do not receive recommended diarrhea and pneumonia treatment on time. Taking into consideration caregiver concerns, adequate supply of medicines to LHWs, improved facility level care could improve care seeking practices and child health outcomes.Trial registrationThe trial is registered with ‘Australian New Zealand Clinical Trials Registry’. Registration Number: ACTRN12613001261707. Registered 18 November 2013.

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Health workers’ perspectives, knowledge and skills regarding community case management of childhood diarrhoea and pneumonia: a qualitative inquiry for an implementation research project “Nigraan” in District Badin, Sindh, Pakistan

Cited by 18 publications

References 26 publications

Improving community health worker performance through supportive supervision: a randomised controlled implementation trial in Pakistan

Improving community health worker performance through supportive supervision: a randomised controlled implementation trial in Pakistan

Ongoing training of community health workers in low-income and middle-income countries: a systematic scoping review of the literature

Exploring health care seeking knowledge, perceptions and practices for childhood diarrhea and pneumonia and their context in a rural Pakistani community

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