Optimising the performance of frontline implementers engaged in the NTD programme in Nigeria: lessons for strengthening community health systems for universal health coverage

Oluwole, Akinola Stephen; Dean, Laura; Lar, LA; Salami, Kabiru K.; Okoko, Okefu Oyale; Isiyaku, Sunday; Dixon, Ruth; Elhassan, Elizabeth; Schmidt, Elena; Thomson, Rachael; Theobald, Sally; Ozano, Kim

doi:10.1186/s12960-019-0419-8

Cited by 31 publications

(39 citation statements)

References 46 publications

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“…Globally, the lack of recognition of CHWs in MoH programmes has been cited as a challenge (20,40,41,45,46). Increased recognition is seen as potentially improving lay health worker performance (43).…”

Section: Recommendationsmentioning

confidence: 99%

“They have been neglected for a long time”: a qualitative study on the role and recognition of Rural Health Motivators in the Shiselweni region, Eswatini

Walker

Burtscher

Myeni³

et al. 2020

Preprint

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Background: Community health workers (CHWs) are increasingly engaged to address human resource shortages and fill primary healthcare gaps. In Eswatini, a cadre of CHWs called Rural Health Motivators (RHM) was introduced in 1976 to respond to key public health challenges. However, the emergence of health needs, particularly HIV/TB, has been met with inadequate programme amendments; and the role of RHMs has become marginalised following the addition of other CHWs supported by non-governmental organisations. This study was implemented to understand the role of RHMs in decentralised HIV/TB activities. In this paper, we explore the findings in relation to the recognition of RHMs and the programme. Methods : This exploratory qualitative study utilised individual in-depth interviews, group and focus group discussions, participatory methods (utilising a game format) and observations. Participants were purposively selected and comprised RHM programme implementers, community stakeholders, and local and non-governmental personnel. Data collection took place between August and September 2019. Interviews were conducted in English or siSwati and transcribed. SiSwati interviews were translated directly into English. All interviews were audio recorded, manually coded and thematically analysed. Data was validated through methodical triangulation. Results: Suboptimal organisational structure and support, primarily insufficient training and supervision for activities were factors identified through interviews and observation activities. Significant confusion of the RHM role was observed, with community expectations beyond formally endorsed tasks. Community participants expressed dissatisfaction with receiving health information only, preferring physical assistance in the form of goods. Additionally, gender emerged as a significant influencing factor on the acceptability of health messages and the engagement of RHMs with community members. Expectations and structurally limiting factors shape the extent to which RHMs are recognised as integral to the health system, at all social and organisational levels. Conclusions: Findings highlight the lack of recognition of RHMs and the programme at both community and national level. This, along with historical neglect, has hindered the capacity of RHMs to successfully contribute to positive health outcomes for rural communities. Renewed attention and support mechanisms for this cadre are needed. Clarification of the RHM role in line with current health challenges and clearer role parameters is essential.

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Section: Recommendationsmentioning

confidence: 99%

“They have been neglected for a long time”: a qualitative study on the role and recognition of Rural Health Motivators in the Shiselweni region, Eswatini

Walker

Burtscher

Myeni³

et al. 2020

Preprint

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“…The worms were generally ranked low in terms of their public health importance compared to others more acute infections like malaria. This study highlights the need for continued community sensitizations about public health importance of such neglected diseases in the context of folk beliefs [40,41]. The combination of epidemiological studies with rapid assessment techniques focusing on local understandings and practices will enrich the understanding of behavioural risk and lead to more pragmatic recommendations for interventions.…”

Section: Resultsmentioning

confidence: 91%

Community Perspectives on Worm Infections in a Peri-Urban Area of Lusaka, Zambia

Halwiindi

Hatwiinda²,

Lisulo

2020

JAMMR

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Soil transmitted helminths (STH) known as worm infections are more than a technical or biomedical problem. They can be linked directly to specific human behaviour in relation to sanitation and hygiene practices. Although these infections are prevalent in Zambia, There is paucity of data on community perceptions and beliefs with respect to STH infections. Therefore, this study sought to understand this aspect from a peri-urban point of view. Qualitative interviews were conducted on fifty-seven participants from Ngombe compound; a peri-urban area within Lusaka, Zambia. The study was carried out between August and December 2015 using semi-structured interviews and analysed by means of question analysis. Wide spread knowledge about the various types of worms was found in the community, although most of it was generally folk knowledge. However, this did not mean that the study population recognized STH as serious health problem as some participants considered having worms as normal. While consumption of food was commonly cited as cause of STH, most participants failed to give empirical evidence linking soil or faecal contaminated food items as direct cause of STH. Although the findings cannot be generalized, the study provides informative reference in understanding beliefs and perceptions regarding STH in Zambian peri-urban communities. There is need for concentrated efforts that are bio-medically relevant as well as beneficial to the targeted population.

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“…Similar studies have recommended that the program implementers consider allocating households to CDDs based on vastness the area and the sparse distribution of the population and to also consider their numerical strengths [36,37]. Results of a study conducted in Nigeria where CDDs complained of high workloads and requested for recruitment of more CDDs to support them on the job have been reported [38].…”

Section: Discussionmentioning

confidence: 87%

Implementation challenges and opportunities for improved mass treatment uptake for lymphatic filariasis elimination: Perceptions and experiences of community drug distributors of coastal Kenya

et al. 2020

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Community drug distributors (CDDs) who are volunteers have the responsibility of awareness creation, household census, drug distribution and record-keeping and are thus key stakeholders in the campaign for Lymphatic Filariasis (LF) elimination. Taking into account their experiences and perceptions is important for a successful elimination campaign. We conducted a qualitative study in 2018 to identify implementation challenges and opportunities for improved mass drug administration (MDA) uptake based on the CDDs perceptions and experiences. Within a larger study that used mixed methods quasi-experimental design, we collected qualitative data from two wards in Kaloleni Sub-County of Kilifi County which was purposively selected owing to its low, 56% and 50.5% treatment coverage in 2015 and 2016 respectively. Focus group discussions (FGDs) (n = 8) and in-depth interviews (IDIs) (n = 8) with CDDs, IDIs (n = 22) with opinion leaders and IDIs (n = 8) with health workers were conducted and the data analyzed by QSR NVIVO version 10 according to thematic areas. The results showed that based on the perceptions and experiences of the CDDs, several challenges: communities’ refusal to take the drugs; absenteeism during MDA; non-adherence to CDDs selection criteria; inadequacy in number of CDDs engaged during the campaign and training provided; insufficiency of drugs issued to CDDs; lack of CDDs supervision and low motivation negatively impact on MDA uptake. Opportunities to address the challenges included: awareness creation on MDA, health education on LF and observation of hygiene during drug administration, increased duration of awareness creation and drug administration, adherence to CDDs selection criteria and putting into consideration the vastness of an area and population density while deploying CDDs. Other opportunities include: improved CDDs training and scheduling; issuing of enough drugs to CDDs to meet the communities’ demand and improved supervision and motivation of CDDs. Addressing the challenges highlighted is an important step of maximizing MDA uptake. The opportunities presented need to be considered by the NTD program personnel, the county health personnel and the community while planning the implementation of MDA campaigns.

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Optimising the performance of frontline implementers engaged in the NTD programme in Nigeria: lessons for strengthening community health systems for universal health coverage

Cited by 31 publications

References 46 publications

“They have been neglected for a long time”: a qualitative study on the role and recognition of Rural Health Motivators in the Shiselweni region, Eswatini

“They have been neglected for a long time”: a qualitative study on the role and recognition of Rural Health Motivators in the Shiselweni region, Eswatini

Community Perspectives on Worm Infections in a Peri-Urban Area of Lusaka, Zambia

Implementation challenges and opportunities for improved mass treatment uptake for lymphatic filariasis elimination: Perceptions and experiences of community drug distributors of coastal Kenya

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