“<i>Eternally restarting</i>” or “<i>a branch line of continuity</i>”? Exploring consequences of external shocks on community health systems in Haiti

Sripad, Pooja; Casseus, Alain; Kennedy, Sarah M.; Isaac, Benito; Vissieres, Kenia; Warren, Charlotte E.; Ternier, Ralph

doi:10.7189/jogh.11.07004

Cited by 16 publications

(21 citation statements)

References 25 publications

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“… 4 , 6 Studies repeatedly emphasize that CHWs continue to provide routine services to a degree of normalcy when the rest of the health system becomes inaccessible for many, demonstrating resilience. 34 , 35 Furthermore, communities place immense value on CHWs given that they are primed to provide emotional and psychosocial support during crises. 36 Given the inherent trust that their communities place on them, government-employed CHWs in Bangladesh are in a critical position to educate and support COVID-19 immunization efforts, 22 and future implementation research should involve and explore how CHWs link their communities to the government’s COVID-19 vaccination efforts.…”

Section: Discussionmentioning

confidence: 99%

Examining Roles, Support, and Experiences of Community Health Workers During the COVID-19 Pandemic in Bangladesh: A Mixed Methods Study

Roy¹,

Kennedy²,

Hossain³

et al. 2022

Glob Health Sci Pract

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During the first wave of the coronavirus disease (COVID-19) pandemic in Bangladesh, across all health areas, community health workers (CHWs) described a slight decrease in the routine services they were able to provide due to restrictions in movement posed by lockdowns and other challenges.nThe government and various nongovernmental organizations provided supportive mechanisms to CHWs through training, supplies, and supportive supervision; however, these supports were not always uniformly distributed across cadres, leading to some discontent among CHWs. n CHWs were crucial actors in the government's COVID-19 response, as they took on new pandemic-related responsibilities in their communities to prevent the spread of the disease while continuing their routine work.

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Section: Discussionmentioning

confidence: 99%

Examining Roles, Support, and Experiences of Community Health Workers During the COVID-19 Pandemic in Bangladesh: A Mixed Methods Study

Roy¹,

Kennedy²,

Hossain³

et al. 2022

Glob Health Sci Pract

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“…Exploring referral processes in the context of expanding community health programming to support CHWs as they reduce service coverage gaps and improve outcomes is critical. In countries like Haiti that struggle with frequent political transition, decreasing economic resources, and environmental and disease outbreaks, all of which have left it with the worst health indicators in the Western Hemisphere, CHWs are often the only source of care for many [6][7][8][9]. Haiti's ratio of physicians and nurses to individuals is 2.5 and 1.1 to 10,000, respectively, has led CHWs, to serve as the primary health workforce in delivering care and counseling to communities [10].…”

Section: Introductionmentioning

confidence: 99%

Lessons Learned from Implementing a Community Health Worker-Initiated Referral Strengthening Intervention in Haiti: A Mixed-Methods Program Case Study

Casseus¹,

Vissieres²,

McClair³

et al. 2023

Rural Health - Investment, Research and Implications

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Referral processes linking communities to facilities are under-appreciated and lack evaluation, particularly in humanitarian settings. Community health workers or agents de santé communautaire polyvalent (ASCPs) in Haiti refer communities to health facilities for a range of services. This program case study assessed implementation of a public-private referral strengthening intervention within on-going community health programming, including a triplicate referral form, supportive training, and follow-up structures. We applied mixed methods to describe referral trends using routine programmatic data, factors affecting implementation and referral completion through a pre-intervention referred patient survey (n = 525), meeting observations, and interviews with ASCPs, supervisors, and key stakeholders (n = 88). We found that the intervention demonstrates little influence on referral trends, but qualitatively enhances the referral process for ASCPs and supervisory stakeholders in Haiti. It improves supervision relationships and shows promise for enhanced community-integrated patient monitoring systems – when supported by financial support and non-governmental and governmental partners, but is vulnerable to sociopolitical, geographic, and insecurity challenges preventing referral completion. Integrating intervention activities within existing programming and scaling the triplicate referral form in Haiti can strengthen the national ASCP curricula. Globally, we suggest adapting the triplicate referral form as a promising job-aid and data-reporting tool within community health worker programs.

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“…Maternal health inequities that exist across and within countries reflect wider social disparities and determinants of health [25]. Political and social drivers influence the burden of disease in different contexts [26][27][28]. A lack of trust in authorities and disconnects between communities and health services has led to a lack of access or uptake of care, particularly in more vulnerable populations [29].…”

Section: Introductionmentioning

confidence: 99%

Developing shared understanding of pre-eclampsia in Haiti and Zimbabwe using Theory of Change

Robbins

Musiyiwa²,

Gidiri³

et al. 2022

PLOS Glob Public Health

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Pre-eclampsia, a complex and multi-system disorder specific to pregnancy, is a leading cause of preventable maternal and perinatal deaths in low-resource settings. Early detection and appropriate intervention with management of hypertension, prevention of eclampsia and timely delivery are effective at reducing mortality and morbidity. Outcomes can be greatly improved with the provision and uptake of good quality care. Cultural contexts of maternal care, social practices and expectations around pregnancy and childbirth profoundly shape understanding and prioritisation when it comes to seeking out care. Few studies have addressed health education specifically targeting pre-eclampsia in low resource settings. The existing literature has limited descriptions of contextual barriers to care or of the intervention development processes employed. More engaging, holistic approaches to pre-eclampsia education for women and families that recognise the challenges they face and that support a shared understanding of the disorder, are needed. We describe our experience of developing a Theory of Change (ToC) as part of the co-production of educational resources for pre-eclampsia in Haiti and Zimbabwe.

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“Eternally restarting” or “a branch line of continuity”? Exploring consequences of external shocks on community health systems in Haiti

Cited by 16 publications

References 25 publications

Examining Roles, Support, and Experiences of Community Health Workers During the COVID-19 Pandemic in Bangladesh: A Mixed Methods Study

Examining Roles, Support, and Experiences of Community Health Workers During the COVID-19 Pandemic in Bangladesh: A Mixed Methods Study

Lessons Learned from Implementing a Community Health Worker-Initiated Referral Strengthening Intervention in Haiti: A Mixed-Methods Program Case Study

Developing shared understanding of pre-eclampsia in Haiti and Zimbabwe using Theory of Change

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