Community health workers for noncommunicable diseases prevention and control in Bangladesh:a qualitative study

Background:The increasing burden of Non-Communicable Diseases(NCDs)in Bangladesh underscores the importance of strengthening primary health care systems.In this study,we examined the barriers and facilitators to engaging Community Health Workers(CHWs)for NCDs prevention and control in Bangladesh.Methods:We used multipronged approaches,including a.Situation analyses using a literature review,key personnel and stakeholders’consultative meetings,and exploratory studies.A grounded theory approach was used for qualitative data collection from health facilities across three districts in Bangladesh.We conducted in-depth interviews with CHWs(Health Inspector;Community Health Care Provider;Health Assistant and Health Supervisor)(n=4);key informant interviews with central level health policymakers/managers(n=15)and focus group discussions with CHWs(4 FGDs;total n=29).Participants in a stakeholder consultative meeting included members from the government(n=4),non-government organisations(n=2),private sector(n=1)and universities(n=2).Coding of the qualitative data and identification of themes from the transcripts were carried out and thematic approach was used for data analyses.Results:The CHWs in Bangladesh deliver a wide range of public health programs.They also provide several NCDs specific services,including screening,provisional diagnosis,and health education and counselling for common NCDs,dispensing basic medications,and referral to relevant health facilities.These services are being delivered from the sub-district health facility,community clinics and urban health clinics.The participants identified key challenges and barriers,which include lack of NCD specific guidelines,inadequate training,excessive workload,inadequate systems-level support,and lack of logistics supplies and drugs.Yet,the facilitating factors to engaging CHWs included government commitment and program priority,development of NCD related policies and strategies,establishment of NCD corners,community support systems,social recognition of health care staff and their motivation.Conclusion:Engaging CHWs has been a key driver to NCDs services delivery in Bangladesh.However,there is a need for building capacity of CHWs,maximizing CHWs engagement to NCD services delivery,facilitating systemslevel support and strengthening partnerships with non-state sectors would be effective in prevention and control efforts of NCDs in Bangladesh.

Delivery of public health services by community health workers(CHWs)in primary health care settings in China:a systematic review(1996–2016)

Background:Community Health Workers(CHWs)have been widely used in response to the shortage of skilled health workers especially in resource limited areas.China has a long history of involving CHWs in public health intervention project.CHWs in China called village doctors who have both treatment and public health responsibilities.This systematic review aimed to identify the types of public health services provided by CHWs and summarized potential barriers and facilitating factors in the delivery of these services.Methods:We searched studies published in Chinese or English,on Medline,PubMed,Cochrane,Google Scholar,and CNKI for public health services delivered by CHWs in China,during 1996-2016.The role of CHWs,training for CHWs,challenges,and facilitating factors were extracted from reviewed studies.Results:Guided by National Basic Public Health Service Standards,services provided by CHW covered five major areas of noncommunicable diseases(NCDs)including diabetes and/or hypertension,cancer,mental health,cardiovascular diseases,and common NCD risk factors,as well as general services including reproductive health,tuberculosis,child health,vaccination,and other services.Not many studies investigated the barriers and facilitating factors of their programs,and none reported cost-effectiveness of the intervention.Barriers challenging the sustainability of the CHWs led projects were transportation,nature of official support,quantity and quality of CHWs,training of CHWs,incentives for CHWs,and maintaining a good rapport between CHWs and target population.Facilitating factors included positive official support,integration with the existing health system,financial support,considering CHW’s perspectives,and technology support.Conclusion:CHWs appear to frequently engage in implementing diverse public health intervention programs in China.Facilitators and barriers identified are comparable to those identified in high income countries.Future CHWs-led programs should consider incorporating the common barriers and facilitators identified in the current study to maximize the benefits of these programs.

Burnout and mental distress among community health workers in low- and middle-income countries: a scoping review of studies during the COVID-19 pandemic

Community health workers(CHWs)represent the backbone of primary health systems,especially in many low-and middle-income countries(LMICs).The coronavirus disease 2019(COVID-19)pandemic stretched health sys-tems and increased the workload for CHWs.The objective of this scoping review was to identify the mental health symptoms experienced among CHWs in LMICs during the COVID-19 pandemic.We searched PubMed for published literature,from January 1,2020 to December 31,2022 that focused on documenting the experiences of burnout,distress,and mental health symptoms among CHWs in LMICs.The quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Tool.Included studies were grouped into the follow-ing broad thematic categories:(1)symptoms experienced;(2)drivers of different mental health symptoms;and(3)strategies for coping with different symptoms.We identified 10 cross-sectional,qualitative,and observational studies from 11 LMICs in South and Southeast Asia,South America,and Eastern/Southern Africa that assessed the mental health burden CHWs faced during the pandemic.The studies identified disorders and symptoms such as depression,anxiety,fear,burnout,worsened stress,and fatigue.Contributing factors included increased work-load,financial constraints,and an understaffed and underequipped workplace.CHWs reported using different adaptive responses like humor,support from family and colleagues,denial,and substance use,and asked for recommended regular mental health checkups and counseling.More research and policies should be targeted to-wards promoting the mental wellbeing of CHWs to help ensure responsive and resilient health systems in LMICs in the face of future emerging public health threats.

Integration of community health workers into health systems in developing countries:Opportunities and challenges

Background:Developing countries have the potential to reach vulnerable and underserved populations marginalized by the country’s health care systems by way of community health work-ers(CHWs).It is imperative that health care systems focus on improving access to quality continu-ous primary care through the use of CHWs while paying attention to the factors that impact on CHWs and their effectiveness.Objective:To explore the possible opportunities and challenges of integrating CHWs into the health care systems of developing countries.Methods:Six databases were examined for quantitative,qualitative,and mixed-methods stud-ies that included the integration of CHWs,their motivation and supervision,and CHW policy making and implementation in developing countries.Thirty-three studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programs.Thematic coding was conducted and evidence on the main categories of contextual factors influencing integration of CHWs into the health system was synthesized.Results:CHWs are an effective and appropriate element of a health care team and can assist in addressing health disparities and social determinants of health.Important facilitators of integration of CHWs into health care teams are support from other health workers and inclusion of CHWs in case management meetings.Sustainable integration of CHWs into the health care system requires the formulation and implementation of polices that support their work,as well as financial and nonfinancial incentives,motivation,collaborative and supportive supervision,and a manageable workload.Conclusions:For sustainable integration of CHWs into health care systems,high-performing health systems with sound governance,adequate financing,well-organized service delivery,and adequate supplies and equipment are essential.Similarly,competent communities could contrib-ute to better CHW performance through sound governance of community resources,promotion of inclusiveness and cohesion,engagement in participatory decision making,and mobilization of local resources for community welfare.

What Does Research Say for Improving the Efficiency of Lady Healthcare Workers in Pakistan? Review Article

Background: In Pakistan, the crucial role of Lady Health Workers (LHWs) cannot be over looked and must be supported. Their alliance position between the community and health system allows them to provide services to the most marginalised groups. However, LHWs face numerous challenges and issues resulting in reduced efficiency and effectiveness of LHW program. Aims: The study aims to identify the challenges highlighted in various studies that undermine the performance of LHWs and attempts to combine the recommendations of the studies for addressing these challenges. Methods: Literature search included articles from 2000 to 2024. PubMed and Google Scholar were the main search engines utilized. Initial search resulted in 1380 articles, out of which only those showing a link to the study title were included in the study. From the total articles searched, 55 were selected for writing this article. Results: Literature highlighted the importance of community selection, monitoring, monetary as well as non-financial incentives;trainings;availability of supervision, workload balance, monitoring;recognition, clarity on roles, resources and uninterrupted supply of logistics, support and embedment of LHWs in community and health system. Lack or poor quality of these aspects may lead to low performance of LHWs. Conclusions: This paper explores the extent of issues and challenges faced by LHWs in Pakistan. A number of interventions appear to be effective in improving the efficiency of LHWs in Pakistan. The review may serve as an essential resource for program planners and decision-makers in improving the effectiveness and efficiency of LHW programs.

Community workers contribution for data quality improvement in routine health information system: Live births number estimation by capture recapture method

The lack of reliable vital statistics raises questions about the role of the health information system in acquiring such data, which are essential for planning health services and for the general management of the population’s needs. This study analyzed completeness of the vital data registration system and assessed the potential contribution of a community worker net-work to this system in rural Benin. The capture-recapture method was used in this interventional study to estimate the number of live births from three sources: the Routine Health Information System, the municipality, and community workers in two groups of villages. Log linear modelling was carried out with a Bayesian Information Criterion-weighted estimate of the number of live births. The exhaustiveness of the Routine Health Information System was improved by the contribution of the community workers from 29.3% to 42.5% in the first group, and from 61.7% to 77.5% in the second group. Estimating live births by the capture method in rural settings based on the contribution of community workers could be a more efficient alternative to censuses in acquiring reliable vital statistics.

Effectiveness of Adherence to Standardized Hypertension Management by Primary Health Care Workers in China:a Cross-sectional Survey 3 Years after the Healthcare Reform

The standardized hypertension management provided by primary health care workers is an important part of China＇s recent health care reform efforts. Investigating 5,116 hypertensive patients from a cross-sectional survey conducted by the Chinese Center for Disease Control and Prevention in 2012, this study found that adherence to standardized hypertension management is associated with positive effects on hypertension- related knowledge, healthy lifestyle behavior, antihypertensive medical treatments, and blood pressure control. It will be necessary to provide primary health care workers with sufficient training and reasonable incentives to ensure the implementation and effectiveness of hypertension management.

Community health worker model for health care delivery and environment programs focused on initiatives in USA and India

Community health workers are equipped with the tools and resources necessary to bring about a change in the form of a rapid chain reaction.The community health workers model focuses on the practices,strategies,plans,and implementation techniques needed to organize a community health event based on diverse agendas:health,environment,and minorities.This model encompasses past experiences as a guide with tested strategies to assist future health interns with a ground framework and resources to showcase the importance of adopting healthy and environmentally friendly practices.The basic outline of the model is based on data collected from various community health events in Illinois(United States of America)and New Delhi(India).These events included back to school fairs,cleanliness drives,health camps,and educational events.As community health workers can help in implementing better practices in the masses through one-on-one interactions,this model of community health worker programs would outline event organization tips,predicted outcomes,targeted audience,and required material templates.The next phase of this model highlights utilizing the data and experience from these events to report to the health ministries of different countries for the incorporation of the proposed practices in their health agendas and policies.This model,if implemented unanimously,could bring about a revolution in the arena of health workers.They will be assisted at each step,will establish connections with health workers globally,and share their health and environment-based agendas to collaborate and organize important events.This model envisions a strong established network of community health workers,display of their agenda,and creation of a ripple effect throughout the society by the means of these programs.

Exploring effort-reward imbalance and professional quality of life among health workers in Cape Town,South Africa:a mixed-methods study

Background:In the context of a growing appreciation for the wellbeing of the health workforce as the foundation of high-quality,sustainable health systems,this paper presents findings from two complementary studies to explore occupational stress and professional quality of life among health workers that were conducted in preparation for a task-shifting intervention to improve antenatal mental health services in Cape Town.Methods:This mixed-methods,cross-sectional study was conducted in public sector Midwife Obstetric Units and associated Non-Profit Organisations in Cape Town.Semi-structured interviews and a quantitative survey were conducted among facility-and community-based professional and lay health workers.The survey included demographic as well as effort-reward imbalance(ERI)and professional quality of life(PROQOL)questionnaires to examine overall levels of work-related psychosocial stress and professional quality of life,as well as differences between lay and professional health workers.Qualitative data was analysed using a thematic content analysis approach.Quantitative data was analysed using STATA 12.Results:Findings from 37 qualitative interviews highlighted the difficult working conditions and often limited reward and support structures experienced by health workers.Corroborating these findings,our quantitative survey of 165 professional and lay health workers revealed that most health workers experienced a mismatch between efforts spent and rewards gained at work(61.1%of professional and 70.2%of lay health workers;p=0.302).There were few statistically significant differences in ERI and PROQOL scores between professional and lay health workers.Although Compassion Satisfaction was high for all health worker groups,lay health workers also showed elevated levels of burnout and compassion fatigue,with community-based health workers particularly affected.Conclusions:Findings of this study add to the existing evidence base on adverse working conditions faced by South African public-sector health workers that should be taken into consideration as national and local governments seek to‘re-engineer’South Africa’s Primary Health Care system.Furthermore,they also highlight the importance of taking into consideration the wellbeing of health workers themselves to develop interventions that can sustainably foster resilient and high-quality health systems.

Effects of scaling up various communitylevel interventions on child mortality in Burundi,Kenya,Rwanda,Uganda and Tanzania:a modeling study

Background:Improving child health remains one of the most significant health challenges in sub-Saharan Africa,a region that accounts for half of the global burden of under-five mortality despite having approximately 13%of the world population and 25%of births globally.Improving access to evidence-based community-level interventions has increasingly been advocated to contribute to reducing child mortality and,thus,help low-and middle-income countries(LMICs)achieve the child health related Sustainable Development Goal(SDG)target.Nevertheless,the coverage of community-level interventions remains suboptimal.In this study,we estimated the potential impact of scaling up various community-level interventions on child mortality in five East African Community(EAC)countries(i.e.,Burundi,Kenya,Rwanda,Uganda and the United Republic of Tanzania).Methods:We identified ten preventive and curative community-level interventions that have been reported to reduce child mortality:Breastfeeding promotion,complementary feeding,vitamin A supplementation,Zinc for treatment of diarrhea,hand washing with soap,hygienic disposal of children’s stools,oral rehydration solution(ORS),oral antibiotics for treatment of pneumonia,treatment for moderate acute malnutrition(MAM),and prevention of malaria using insecticide-treated nets and indoor residual spraying(ITN/IRS).Using the Lives Saved Tool,we modeled the impact on child mortality of scaling up these 10 interventions from baseline coverage(2016)to ideal coverage(99%)by 2030(ideal scale-up scenario)relative to business as usual(BAU)scenario(forecasted coverage based on prior coverage trends).Our outcome measures include number of child deaths prevented.Results:Compared to BAU scenario,ideal scale-up of the 10 interventions could prevent approximately 74,200(sensitivity bounds 59,068-88,611)child deaths by 2030 including 10,100(8210-11,870)deaths in Burundi,10,300(7831-12,619)deaths in Kenya,4350(3678-4958)deaths in Rwanda,20,600(16049-25,162)deaths in Uganda,and 28,900(23300-34,002)deaths in the United Republic of Tanzania.The top four interventions(oral antibiotics for pneumonia,ORS,hand washing with soap,and treatment for MAM)account for over 75.0%of all deaths prevented in each EAC country:78.4%in Burundi,76.0%in Kenya,81.8%in Rwanda,91.0%in Uganda and 88.5%in the United Republic of Tanzania.Conclusions:Scaling up interventions that can be delivered at community level by community health workers could contribute to substantial reduction of child mortality in EAC and could help the EAC region achieve child health-related SDG target.Our findings suggest that the top four community-level interventions could account for more than threequarters of all deaths prevented across EAC countries.Going forward,costs of scaling up each intervention will be estimated to guide policy decisions including health resource allocations in EAC countries.

Community-based intervention of chronic disease management program in rural areas of Indonesia

Objective:This study evaluates the community-based intervention of chronic disease management(CDM)through the Integrated Non-Communicable Diseases Health Post(Posbindu-NCD)conducted by a community of health workers(CHWs)in Indonesia’s rural areas.Methods:A cohor t retrospective study evaluated 577 par ticipants from Posbindu-NCD in 7 public health centers(PHCs)in 2019.Activities of intervention of CDM for Posbindu-NCD was included,identified risk factors to NCDs,and provided counselling education and other follow-ups based on interviews and measurement results from the five Desk systems that recorded in a medical record as a form of the monthly activity report each the first month,the 6 months,and the 12th month.Results:There were statistically significant differences for alcohol consumed and diabetes mellites(χ^(2)=10.455;P=0.001).There were significant differences on gender(χ^(2)=3.963;P=0.047),on ethnicity(χ^(2)=19.873;P<0.001),and hypertension.In addition,there were also significant differences on ethnicity(χ^(2)=15.307;P<0.001),vegetable consumption(χ^(2)=4.435;P=0.035),physical exercise(χ^(2)=6.328;P=0.012),and the current diseases of hypercholesterolemia of par ticipants.Fur thermore,the survival rate among patients who have overweight,abdominal overweight,hyper tension,diabetes mellitus,and hypercholesterolemia increased among par ticipants who regularly visited Posbindu-NCD compared with the non-regularly one.Conclusions:The CDM program’s community-based intervention through Posbindu-NCD conducted by CHWs improved survival rates in Indonesia’s rural areas.Therefore,this program can be fur ther developed in conducting CDM in the community with the active involvement of CHWs so that the community becomes active regularly in par ticipating in Posbindu-NCD activities in rural areas of Indonesia.

Applying the workload indicators of staffing needs method in determining frontline health workforce staffing for primary level facilities in Rivers state Nigeria

Background:Nigeria faces health workforce challenges and poor population health indices resulting from disparities in health worker densities by geographical locations and levels of health care delivery.Nigeria is constantly reforming its health system with the primary aim of having the right number of health workers in the right place at the right time to meet the population’s health needs.The majority of primary health facilities in the country are staffed using perceived needs.The Workload Indicators of Staffing Need(WISN)tool developed by the World Health Organization is used to determine staffing requirements for facilities.Methods:The WISN tool was used in assessing the staffing requirements for nurses/midwives and community health practitioners in 26 primary health facilities in Port Harcourt City Local Government Area(PHALGA)and Obio Akpor Local Government Area(OBALGA).Documents were reviewed to obtain information on working conditions and staffing,and interviews conducted with key informants in 12 randomly selected facilities.We supported an expert working group that comprised of nurses/midwives and community health practitioners to identify workload components and activity standards and validate both.We also retrieved workload data from January 1-December 31,2015 from the national district health information system.Results:Findings showed varying degrees of shortages and inequitable distribution of health workers.Health facilities in PHALGA had a WISN ratio of 0.63 and a shortage of 31 nurses/midwives.There was also a shortage of 12 community health practitioners with a WISN ratio of 0.85.OBALGA had a shortage of 50 nurses/midwives and 24 community health practitioners;and WISN ratios of 0.60 and 0.79 for nurses/midwives and community health practitioners respectively.Conclusion:Our findings provide evidence for policies that will help Nigeria improve the population’s access to quality health services and reduce inequities in distribution of the health workforce.Evidence-based health workforce planning and redistribution using WISN should be institutionalized.Review of scopes of practice of health workforce should be conducted periodically to ensure that the scope of practice matches the training received by the specific cadres and those skills are used to deliver quality services.

Vestibular Function Evaluation in Endemic Diseases Combat Agents

Introduction: Simultaneous exposure to certain chemical agents and noise may cause synergistic, additive or potentiating effects on the auditory and vestibular system. However, there is still a lack of studies investigating simultaneous exposure to pesticides and noise in the vestibular system. Purpose: To analyze the findings of the vestibular evaluation of endemic diseases combat agents when simultaneously exposed to pesticides and noise. Method: Thirty-three male pesticide-exposed and noise-fighting endemic diseases combat agents participated in the study. The age range was 48 to 67 years (mean = 56 years). All participants underwent vestibular examinations, such as positional nystagmus research, spontaneous nystagmus with open and closed eyes, semi-spontaneous nystagmus, optokinetic nystagmus, pendular screening, per rotatory, caloric tests and tonal audiometry. Data were analyzed by descriptive statistics. Results: Altered exams were presented in 36.4% of the cases. There was no statistically significant relationship between pesticide handling time and test results (p = 0.2825). The results of pure tone audiometry correlated significantly (p = 0.0494) with the vestibular exams, as participants who presented with worse hearing thresholds at the frequency of 4000 Hz in the right ear also presented altered results in the vestibular exam. Conclusion: The present study concluded that more than 1/3 of the studied population presented with vestibular dysfunction, which was related to anterior and posterior labyrinth alteration (Cochlear-Vestibular Syndrome). No central vestibular alteration was noted in this population.

Women’s Perceptions and Attitudes Related to Family Planning Use among Poor Population in Rural Rwanda

INTRODUCTION: In 2012, Rwandan Government has declared family planning (FP) a national priority for poverty reduction and socioeconomic development. However, rural areas still contribute to higher fertility rates. OBJECTIVE: To explore factors to influence FP uptake in rural families. METHODS: This study used mixed (quantitative and qualitative) methods consisted of two separate surveys. The first survey (quantitative-based cross-sectional design) determined FP use in households while the second survey (qualitative-based design) identified socio-cultural factors which hindered FP uptake in households. In total, 119 households with women in reproductive age (15 - 45) were targeted in rural areas in Western province, Karongi District. The data collected during door-to-door visits using paper-based-questionnaires and administered through interviews. A database mask was designed under OnaCollect, then processed in SPSS software. The results were presented in tables of frequencies, the difference between proportions assessed using Chi-Square-test, the difference between means assessed using t-tests, significance at p = or <0.05, confidence level at 0.95, and a margin error of 0.09. RESULTS: Socio-cultural norms influenced no use of contraception (32.8%) or only promoted natural methods (12.6%). Social norms were religious in origin (38.5%) where Christianity (91.8%) discouraged modern methods (viewed as killing children) but encouraged using natural methods, preferably abstinence (73.3%). Cultural norms (17.9%) influenced families to have many children as resources of wealth, evidence of productivity, and a way to decrease parents’ workloads including assisting mothers in home-based activities such as cooking, and assisting fathers in farming activities such as keeping cows, goats and pigs. Other attitudes included gender-based issues (2.5%) mainly due to spousal disapproval (men dominated in taking FP decisions in families), whereas other non-users of modern methods (28.2%) feared side-effects. This study was registered with IRB: CMHS/IRB/097/2019. CONCLUSION: Religious, social, and cultural norms affect FP in rural areas. In order to accelerate FP uptake, men and religious leaders should be targeted as key partners who influence women’s choices.