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

Abstract

Community health workers (CHWs) have been effectively utilised in resource‐limited settings to combat a growing demand for health access that cannot be met by the current workforce. The purpose of this study was to evaluate a CHW training programme in Malawi that integrated technology into rehabilitation care delivery. This was a retrospective cross‐sectional study of a training programme conducted in December 2018. The participants were a convenience sample of all active home‐based palliative care CHWs at St. Gabriel's Hospital (n = 60). The data collected included the following: a written pre‐ and post‐knowledge test, skills competency checklist and a post‐training programme survey. Descriptive frequencies described skill competency and quantitative responses from the post‐training programme survey. Paired t test (α = 0.05) analysis determined the significance of knowledge acquisition. Themes in the narrative responses in the post‐training survey were identified. Both training programme groups showed significantly greater knowledge on the post‐test (M = 9.50, SD = 0.861; M = 9.43, SD = 0.971) compared to the pre‐test (M = 7.97, SD = 1.351; M = 7.90, SD = 1.900); t(29) = 6.565, p < .001; t(29) = 4.104, p < .001 for Group 1 and Group 2, respectively. All participants demonstrated skill competency in 100% of the skills. All participants responded that the training programme helped them review skills and understand how to use technology ‘A lot’ on a Likert scale (no, a little, some, a lot). Facilitators of their work included training programmes, phones, communication with the hospital and collaboration amongst CHWs. Barriers included transportation needs, lack of patient care supplies and lack of caregiver compliance. Overall, utilisation of their knowledge and skills from the training programmes helped their patients make improvements in mobility and function that are meaningful to their quality of life in the village. This study highlights the importance of assessing programmes in low‐resource settings with a focus on feasibility and developing local capacity.

Community health workers’ provision of physical rehabilitation services in sub-Saharan Africa: a scoping review

“…A total number of six articles reported CHWs operating in the area of assistive devices [31,35,38,41,54,55]. Wilson, et al (2020) shows that home-based care palliative workers were providing assistive device tting and adaptations to the village environment to clients in the programme in Malawi [31]. And in their study, Naidoo et al (2019) reports that among the roles of CHWs was identifying the assistive devices for disabled children in Kwazulu-Natal, South Africa [35].…”

“…Community-based was reported by twelve articles to be the mode of delivery of CHWs in physical rehabilitation services [27,31,32,38,39,43,45,54,55,56,58,59]. One prevalence study by Couper (2002), showed CHWs conducting a disability assessment of children in communities [27], and two articles (Dawad & Jobson, 2011;Chappell & Johannsmeier 2009) showed CHWs working in communitybased rehabilitation providing physical rehabilitation in communities [31,43]. And according to Ennion & Rhoda (2016), the community caregivers worked at the community level as members of a multidisciplinary team involved in trans-tibial amputation and prosthetic rehabilitation in a rural community in South Africa [38].…”

“…Six articles reported transport and distance as a barrier in their physical rehabilitation service delivery [31,35,36,41,45,46]. Wilson et al (2020), in a study aimed at evaluating the CHW training programme in Malawi that integrated technology into rehabilitation care delivery reported that distances between clients' homes were a barrier experienced by home-based palliative care CHWs in palliative home-based rehabilitation care programs in Malawi [31].…”

“…Eight articles highlight barriers emanating from the community and society itself faced by the CHWs in this review [31,35,36,39,40,47,54,57]. In their evaluation of the palliative home-based care training programme in Malawi Wilson et al (2020) reported that home-based care CHWs in palliative home-based care programs were affected by a lack of caregiver compliance in their physical rehabilitation service delivery in Malawi [31].…”

“…A total of 29 articles published between September 1990 and November 2021 were included in the review. One article is from Eritrea [53], two articles are from Ethiopia [32,39], one article is from Kenya [58], ve articles are from Malawi [25,26,28,31,46], one article is from Mauritius [54], one from Namibia [56], sixteen articles from South Africa [17, 27, 29, 35-38, 40, 42, 43, 45, 47, 48, 57, 59], and three articles from Uganda [30, 40, 55.] South Africa, Namibia, and Mauritius are upper middle-income countries with Kenya being a lower middle-income country while Malawi, Uganda, Ethiopia, and Eritrea are low-income countries. Figure 2 presents the distribution of evidence in SSA.…”