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PubMed1971

The social worker.

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Community Health Services↗
PubMed2002

Costs and cost-effectiveness of different DOT strategies for the treatment of tuberculosis in Pakistan. Directly Observed Treatment.

An economic study was conducted alongside a clinical trial at three sites in Pakistan to establish the costs and effectiveness of different strategies for implementing directly observed treatment (DOT) for tuberculosis. Patients were randomly allocated to one of three arms: DOTS with direct observation by health workers (at health centres or by community health workers); DOTS with direct observation by family members; and DOTS without direct observation. The clinical trial found no statistically significant difference in cure rate for the different arms. The economic study collected data on the full range of health service costs and patient costs of the different treatment arms. Data were also disaggregated by gender, rural and urban patients, by treatment site and by economic categories, to investigate the costs of the different strategies, their cost-effectiveness and the impact that they might have on patient compliance with treatment. The study found that direct observation by health centre-based health workers was the least cost-effective of the strategies tested (US dollars 310 per case cured). This is an interesting result, as this is the model recommended by the World Health Organization and International Union against Tuberculosis and Lung Disease. Attending health centres daily during the first 2 months generated high patient costs (direct and in terms of time lost), yet cure rates for this group fell below those of the non-observed group (58%, compared with 62%). One factor suggested by this study is that the high costs of attending may be deterring patients, and in particular, economically active patients who have most to lose from the time taken by direct observation. Without stronger evidence of benefits, it is hard to justify the costs to health services and patients that this type of direct observation imposes. The self-administered group came out as most cost-effective (164 dollars per case cured). The community health worker sub-group achieved the highest cure rates (67%), with a cost per case only slightly higher than the self-administered group (172 dollars per case cured). This approach should be investigated further, along with other approaches to improving patient compliance.

Adult↗
PubMed1991

Reduction in total under-five mortality in western Nepal through community-based antimicrobial treatment of pneumonia.

Pneumonia is a leading cause of death among children world wide but those at highest risk in developing countries have limited access to clinical services; effective and low-cost alternatives are a global public health priority. We have done a controlled intervention trial among 13,404 children under five in Jumla, Nepal, which relied exclusively on indigenous community health workers to detect and treat pneumonia according to the World Health Organisation decision strategy, with a five-day home-treatment course of oral co-trimoxazole. No other health services were provided, and referral of children to hospital was not practicable. During the three-year study, 2101 deaths were recorded. The programme led to a 28% reduction in the risk of death from all causes by the third year of services (relative risk 0.72, 95% confidence interval 0.63-0.82), with a significant trend (p less than 0.02) of lower mortality with greater duration of the programme. The greatest benefit was among infants. In addition to reduction in deaths due to pneumonia, there was a significant reduction in deaths due to diarrhoea and measles, indicating that reduction in pneumonia morbidity had considerable carry-over effect. Our findings show that indigenous community workers can effectively detect and treat pneumonia, and reduce overall child mortality, even without other primary care activities.

Administration, Oral↗
PubMed1997

Zambia moves towards reproductive health.

Several events in Zambia this year have marked the development of an integrated approach to reproductive health. A team met in March to draw up a national safe motherhood policy, plus strategies and guidelines. These were completed by April and are being distributed for comments. Clinical guidelines for safe motherhood in health centers have also been developed. These aim to reduce mortality and morbidity among mothers and infants by helping health workers to provide quality care to women at every stage of pregnancy and delivery. A reproductive health workshop was held in Ngwerere in May to create awareness of the concept of reproductive health, identify reproductive health problems in the area, propose solutions and outline activities. The 75 participants included community health workers, community leaders, teachers, youth leaders, and community members, as well as health workers and policymakers. The workshop was conducted in the local language so that those present were able to participate fully. June 1997 saw the official launch of Zambia's new policy framework, guidelines and strategy on family planning within reproductive health. The country's Minister of Health, Dr. Katele Kalumba, said the family planning guidelines were a sign of the government's commitment to providing a basic health care package for all Zambians. To promote widespread discussion of the whole concept of reproductive health, local newspapers printed feature articles with the headline "Let's talk reproductive health." The articles raised a variety of sensitive issues that ranged from safe sex and adolescent sexuality to safe motherhood and HIV prevention. Plans are going ahead in Zambia for drawing up a national training curriculum for safe motherhood and family planning. The curriculum for health workers will cover both pre-service and in-service training.

Africa↗
PubMed2005

Sustainability of a privatized community-based animal health worker system in Mwingi District, Kenya.

This paper describes a study on the sustainability of Community-based Animal Health Worker (CAHW) services in Mwingi District, Kenya. These services began in 1992 and were supported by the District Veterinary Authority (DVA) with assistance from the Integrated Food Security Programme-Eastern (IFSP-E). Over time and using a process of participatory reviews with multiple stakeholders, the system evolved into a network of CAHWs. The study focused on CAHWs' service sustainability and their relationships with other animal health service providers. A mutually beneficial and supportive arrangement existed between the CAHWs and Animal Health Assistants (AHAs), based on a private drug supply system, referral and backstopping support. The CAHWs derived sufficient income from their veterinary work to maintain their interest in the system. Seventy percent of CAHWs were continuing to offer adequate animal health services 3 years or more after their initial training and the withdrawal of donor support. Ninety-five percent of sampled CAHWs (n = 40) viewed their business as successful and expanding. Considering the agro-ecological and socio-economic conditions of the district, the CAHW system can be viewed as an initial stage in the process of extending quality private sector veterinary services.

Animal Technicians↗
PubMed2005

Assessment of the technical competence and ethical behaviour of Community-based Animal Health Workers in Mwingi District, Kenya.

This paper describes an assessment of the technical competence and ethical behaviour of Community-based Animal Health Workers (CAHWs) in Mwingi District, Kenya. From 99 trained CAHWs, 40 participated in the study. Using a pre-tested semi-structured questionnaire, direct observation of the relevant veterinary drug kits and participatory discussions, the study team found that the CAHWs knowledge of clinical signs of local livestock diseases and notifiable and zoonotic diseases and their ability to use veterinary drugs correctly and safely were adequate. Marks were awarded to the candidates according to an agreed marking scheme between the CAHWs' trainers and study team members. The results showed that, overall, 36 out of 40 (90%) of the sampled CAHWs passed the tests. The existence of a referral system for CAHWs and refresher trainings helped to ensure that CAHW competence and ethical behaviour were maintained. However, it was also found that some areas of the current curriculum required more detailed input based on field experience. The CAHW system could serve as an alternative animal health care system in areas lacking veterinary services.

Animal Technicians↗
PubMed1996

Community participation in malaria control in Tigray region Ethiopia.

During the Ethiopian civil war from 1974 to 1991, the Tigrean People's Liberation Front established a primary health care system in Tigray in which community residents helped to plan and implement health services through health committees and community health workers (CHWs). To strengthen and update this system, a Community-Based Malaria Control Programme was initiated in 1992. The primary objectives of the Programme are to reduce malaria morbidity and mortality and to prevent malaria in pregnant women through early diagnosis and treatment of cases, chemoprophylaxis during pregnancy, and vector control by environmental management. A secondary objective is to introduce a cost-sharing scheme for eventual development of a village revolving fund. A total of 681 volunteers chosen by their communities have received malaria training and serve a rural population of 1,682319 (CHW/population ratio 1:2,500). The principal success of the programme at this stage is that a significant proportion of the rural population at risk for malaria is now being treated at the village level. During the last major transmission season from September through November 1993, each CHWs treated a mean of 45178 clinical malaria cases per month. Under-utilization of treatment services by women and children under 5 years and low chemoprophylaxis coverage of pregnant women have been documented. After focus group discussions with community members and CHWs to identify the reasons for these problems, changes in programme policies were made to improve coverage of these groups. Since 1992, considerable progress toward meeting programme objectives has been made, and continued evaluation will allow for interventions that should further strengthen the malaria control efforts in the region.

Child, Preschool↗
PubMed2006

Psychosocial support in disaster-affected communities.

The paper outlines psychosocial interventions in providing care and support to disaster-affected communities. Any impact of disaster can be looked at in two ways: firstly by ascertaining the characteristics of the event itself, and secondly, how that event is appraised by those affected. Depending on different phases of the impact of the disaster, individuals will respond in different styles. Psychosocial interventions must be tailored to address the needs of the target population, with special attention paid to vulnerable groups such as children, women and the elderly. These should also be modulated according to the phase of recovery following the event occurrence because each phase will highlight different needs. The four phases of intervention, although determined separately, may show an overlap. In the initial phases, the emphasis is on social intervention that can be delivered by community-level workers. In the later phases, the psychological issues that emerge necessitate the services of trained professionals. Initial social care will need to give way to psychological care, and on occasion both will need to be combined for a considerable period. Since psychosocial care is a long-term, continuous process, disaster management and preparedness programmes must invest in training for capacity building by training community workers and primary care health professionals.

Community Mental Health Services↗
PubMed2004

Performance of community-based animal health workers in the delivery of livestock health services.

Since the liberalization of animal health services in Kenya in the early 1990s, community-based animal health workers (CBAHWs) have become an important alternative animal health delivery channel in the country's marginal areas. However, professional veterinary practitioners have questioned the effectiveness of CBAHW programmes in animal health service delivery in Kenya. This is partly due to lack of information about their performance and partly because CBAHW programmes were implemented before the necessary changes in the existing legal, policy and institutional frameworks had been made. This study was designed to provide such information. In this regard, the productivity of livestock herds among farmers who utilized the services of CBAHWs was compared to that of livestock belonging to farmers who utilized the services of professional veterinarians. The annual live births per mature female (birth ratio) and the proportion of young stock to mature females (breeding index) was computed over a period of 3 years in cattle and goat herds under care of CBAHWs and professional veterinarians. The birth ratios in cattle and goats under CBAHWs were not significantly different from those under the care of professional veterinarians (p > 0.05). Furthermore, the breeding index of cattle and goats under the two categories was not statistically different. Besides the CBAHWs providing clinical services, they also created positive externalities through participatory learning enjoyed by neighbouring livestock keepers, who later dispensed with their services. Policy attention is therefore needed to enhance the participation of CBAHWs in animal health service delivery and to appropriately integrate their activities into the existing formal animal health delivery system in Kenya. Interventions that improve the professional development of these workers, with emphasis on areas pertaining to care of young stock, would not only promote the sustainability of CBAHW programmes but would also improve livestock productivity in the country's marginal areas.

Animal Husbandry↗