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PubMed1989

National community health worker programs: how can they be strengthened?

This article is based on a collaborative research study of policy and practice in national community health worker (CHW) programs in developing countries. The study involved a review of the relevant literature, case studies in Botswana, Colombia and Sri Lanka, and an international workshop where the future of such programs was discussed. The findings of this research are discussed under four headings: unrealistic expectations, poor initial planning, problems of sustainability, and the difficulties of maintaining quality. It is clear that existing national community health worker programs have suffered from conceptual and implementation problems. However, given the interest and political will, governments can address these problems by adopting more flexible approaches within their CHW programs, by planning for them within the context of all health sector activities rather than as a separate activity, and by immediately addressing weaknesses in task allocation, training and supervision. CHWs represent an important health resource, whose potential in extending coverage and providing a reasonable level of care to otherwise underserved populations must be fully tapped.

Botswana↗
PubMed2006

Consumers stated and revealed preferences for community health workers and other strategies for the provision of timely and appropriate treatment of malaria in southeast Nigeria.

BACKGROUND: The African Heads of State meeting in Abuja, Nigeria on Roll Back Malaria adopted effective treatment of malaria nearer the home as one of the strategies for malaria control in Africa. A potentially effective strategy for bringing early, appropriate and low cost treatment of malaria closer to the home is through the use of community health workers (CHWs). There is paucity of information about people's actual preferences for CHWs and how stated preferences relates to revealed preferences for both the CHW strategy and other strategies for improving the timeliness of malaria treatment in not only Nigeria but in many malaria endemic countries. OBJECTIVES: To determine peoples' stated and actual preferences for different strategies for improving the timeliness and appropriateness of treatment of malaria before and after the implementation of a community health workers (CHW) strategy in their community. METHODS: A prospective study was undertaken in a rural malaria holo-endemic Nigerian community. A questionnaire was used to collect information on health-seeking from householders before (first survey) and after (second survey) implementation of a CHW malaria treatment strategy. RESULTS: The consumers mostly preferred the CHW strategy over self-treatment in the homes and other strategies of treatment. The use of community health workers (CHWs) increased from 0% to 26.1% (p < 0.05), while self-treatment in the homes decreased from 9.4% to 0% (p < 0.05) after the implementation of the CHW strategy. Use of patent medicine dealers also decreased from 44.8% to 17.9% (p < 0.05) after CHW strategy was implemented. CONCLUSION: Community health workers can be used to improve and ensure timely and appropriate treatment of malaria. The CHW strategy could also be sustained since it was preferred and used by consumers over self-treatment in the homes as well as other strategies for improving treatment. Hence, the CHW strategy is a feasible and promising method of improving home-management of uncomplicated malaria.

Adult↗
PubMed1993

How do health workers see community participation?

A survey of health workers in Rwanda suggested that they were somewhat reluctant to accept the involvement of lay people in the promotion and implementation of primary care programmes. Various obstacles to community participation were identified by the health workers, who, however, suggested general rather than specific remedies for the situation as they saw it.

Attitude of Health Personnel↗
PubMed1980

The role of lay workers in community health education: experiences of the North Karelia project.

The role of natural community leaders in serving as lay health workers in a comprehensive community health programme has been explored. In rural Finland, nearly 300 persons were trained to detect cardiovascular risk factors (smoking, high-cholesterol diet, high blood pressure) in their communities, and to advise community members of the desirability of lowering these risk factors. Initial data from studies of the lay health workers and their intervention work support the concept that carefully select community health workers who are to varying degrees representative of their local populations, can well act as intermediaries in preventive health care strategies.

Attitude to Health↗
PubMed1994

Use of community health workers with inner-city children who have asthma.

Use of community health workers (CHWs) to obtain health, social, and environmental information from African-American inner-city children with asthma was one component of a larger intervention study designed to reduce morbidity in African-American children with asthma. A subset of 140 school-aged children with asthma was recruited and enrolled in a program to receive home visits by CHWs for the purposes of obtaining medical information and teaching basic asthma education to the families. Data obtained by the CHWs revealed low inhaled steroid use, high beta 2 agonist use, frequent emergency-room visits, decreased primary-care visits, and increased allergen and irritant exposure. Appropriately recruited and trained CHWs are effective in obtaining useful medical information from inner-city families with children with asthma and providing basic asthma education in the home.

Asthma↗
PubMed2002

Using participant information to develop a tool for the evaluation of community health worker outreach services.

OBJECTIVE: Because there is no instrument that measures how clients judge community health worker (CHW) services, we sought to develop such a questionnaire. We report how we used client information to develop a brief questionnaire evaluating CHW services. DESIGN: We conducted and content-analyzed 18 in-depth semi-structured interviews of clients receiving CHW services to determine aspects of care salient to clients. Based on the results of these analyses, we developed and administered an in-person survey measuring the importance of 57 aspects of CHW services to 84 clients in 3 programs using CHWs to help control hypertension or diabetes. RESULTS: Clients perceived a broad array of aspects of CHW care including CHW attributes, services, benefits or outcomes of service and service arrangements. The 15 aspects ranking highest included: 1) CHW knows job; 2) CHW keeps client alive; 3) CHW gives information on high blood pressure; 4) CHW shows respect; 5) blood pressure is lowered; 6) CHW pays attention; 7) client gets better medical care; 8) CHW speaks understandably; and 9) client gets needed care. CONCLUSION: We used client information to generate and determine the relative importance of a pool of aspects that we and others can use to construct brief questionnaires to measure clients' judgments of CHW services. Such questionnaires are needed for ongoing evaluation as more providers and managed care organizations increase their use of CHWs for outreach programs.

Adult↗
PubMed1998

[Detecting sleeping sickness: comparative efficacy of mobile teams and community health workers].

The solution to the problem of human African trypanosomiasis (HAT) first of all requires improved case detection. Effective tests have been available for a number of years but the results of medical surveys are still mediocre, mainly because the populations are poorly mobilized. Those few mobile teams still visiting villages obtain very low presentation rates. In spite of major information campaigns among villagers, in Côte d'Ivoire the Institut Pierre Richet (IPR) and Trypanosomiasis Clinical Research Project (PRCT) teams examined only 42% (9311) of the 22,300 inhabitants of a disease focus during a conventional ten-day survey. In the same focus, community health workers specially trained in sleeping sickness and in the collection of blood samples on filter-paper examined 73% of the population (15,000 individuals) in less than two months. Implementation of a sleeping sickness control strategy is restricted to two types of intervention: either conventional mobile teams which are on hand, competent and rapidly operational but which fail to carry out exhaustive case detection, or integration of case detection into primary health care by entrusting surveillance to the community health workers. This approach requires a minimum of training but ensures that sentinels are permanently present in the village communities. By using the community health workers rather than mobile teams it should be possible to achieve comprehensive monitoring. In operational terms, the cost of surveillance per person is US$ 0.55 for the mobile teams as against US$ 0.10 for the community health workers. Integration of HAT case detection into primary health care is therefore an effective and economical solution, provided the community health workers are properly supervised and above all motivated.

Community Health Workers↗
PubMed1998

Community health workers reduce skin diseases in East African children.

BACKGROUND: Epidemiologic data concerning skin diseases in many rural areas in sub-Saharan Africa are not available. Little is known about the effect of regular treatment schedules by paramedical staff (especially community health workers) in the primary healthcare system on the severity and prevalence of dermatoses. METHODS: 5780 school and pre-school children from 13 primary schools in four sublocations in rural western Kenya (Kisumu District) were examined for dermatoses by the author, together with community health workers in 1993. On-the-spot training and weekend seminars about important and common dermatoses were also given. In 1994 a dermatology program was started within the primary healthcare system. Twelve trained community health workers carried out regular school visits once a week and diagnosed and treated pupils with dermatoses. Treatment was performed with gentian violet 1% solution for bacterial skin infections, Whitfield's ointment for dermatophytoses, benzylbenzoate emulsion 25% for scabies, and hydrocortisone acetate 1% cream for eczemas. All schools were visited again in 1995 to evaluate the long-term effects of the program. RESULTS: In 1993, the prevalence rate for dermatoses was 32.4%. Most of the skin diseases found were of infective origin (27.1% were caused by bacteria, 21.6% by fungi, and 17.6% by arthropods, mainly scabies mites). Dermatitis accounted for 3.5%. In 1995, the prevalence of dermatoses declined to 29.6% (p<0.05), and this reduction was most strongly observed for tropical ulcers and tinea capitis. Additionally, there was an improvement in the extent and severity of skin diseases. CONCLUSIONS: This study defines, for the first time, the number and extent of skin diseases in children in rural Kisumu District; most dermatoses were of infective origin. The study demonstrates that community health workers in the primary healthcare system are capable of dealing successfully with the most common dermatoses in children following a short training period.

Child↗
PubMed2003

Explanatory models of psychosis among community health workers in South India.

OBJECTIVE: To examine commonly held indigenous beliefs about mental illness, which often differ markedly from the biomedical models, among community health workers in rural South India. METHOD: Indigenous beliefs about chronic psychosis were elicited from community health workers. The Short Explanatory Model Interview formed the basis of the interview. RESULTS: A variety of indigenous beliefs, which contradicted the biomedical model, were elicited. A significant proportion of health workers did not recognize chronic psychosis as a disease condition, believing that it was caused by black magic, evil spirits and poverty, and felt that doctors could not help. CONCLUSION: The results of the study suggest that training programmes should elicit and discuss local beliefs prior to the teaching of the biomedical model of mental disorders.

Community Health Services↗
PubMed1999

Linking community-based blood pressure measurement to clinical care: a randomized controlled trial of outreach and tracking by community health workers.

OBJECTIVES: This study assessed the effectiveness of enhanced tracking and follow-up services provided by community health workers in promoting medical follow-up of persons whose elevated blood pressures were detected during blood pressure measurement at urban community sites. METHODS: In a randomized controlled trial, 421 participants received either enhanced or usual referrals to care. Participants were 18 years or older, were either Black or White, and had blood pressure greater than or equal to 140/90 mm Hg and income equal to or less than 200% of poverty. The primary outcome measure was completion of a medical follow-up visit within 90 days of referral. RESULTS: The enhanced intervention increased follow-up by 39.4% (95% confidence interval [CI] = 14%, 71%; P = .001) relative to usual care. Follow-up visits were completed by 65.1% of participants in the intervention group, compared with 46.7% of those in the usual-care group. The number needed to treat was 5 clients (95% CI = 3, 13) per additional follow-up visit realized. CONCLUSIONS: Enhanced tracking and outreach increased the proportion of persons with elevated blood pressure detected during community measurement who followed up with medical care.

Adolescent↗
PubMed1989

Community care workers in rural southern Illinois: job satisfaction and implications for employee retention.

This study examined factors related to community care worker job satisfaction, as a method of assessing problems related to employee turnover, based on data collected from 393 community care workers who worked with elderly clients from the 13 southernmost rural counties in Illinois in 1987. Results suggested that the majority of workers were satisfied with their job; however, there was a difference in the mean scores of those employed for more than one year and those employed for less than one year (those employed for longer than one year had significantly lower satisfaction scores than those employed for less than one year). Although only 19 individuals indicated they were intending to quit within the year, 88 respondents answered "no opinion." Reasons given why new employees quit were: low wages, no benefits, no raises or promotions, cannot cope with the elderly, do not like the elderly, or not well-suited for this type of work. Also, many of the workers responded that people quit because the job was not what they expected, they did not give it a chance, they did not receive the proper training, and that the job was too stressful or frustrating. Recommendations made on the basis of these study data include the development of a new job hierarchy (which will increase the probability of being promoted) and more detailed pre-service training program which covers in detail what new employees can expect from the job. Health education training programs are recommended as a major tool for reducing the problem of employee turnover by helping the worker manage the high levels of stress experienced on the job.

Adult↗
PubMed2004

A model for home care clinician and home health aide collaboration: diabetes care by nurse case managers and community health workers.

Researchers at Johns Hopkins University conducted a randomized clinical trial to test the effect of nurse case management and community health worker interventions on diabetes control among inner city African Americans. The results demonstrated that the greatest improvement occurred when nurse case managers and community health workers worked together. This study has implications for how nurse/home health aide collaboration can enhance diabetes management in home care.

Adult↗
PubMedDate not supplied

Community health workers and professional nurses: defining the roles and understanding the relationships.

The use of community health workers (CHWs) has been advocated in both developed and developing countries for many years. This article reports the findings of a descriptive research study that explored the relationship between CHWs and nurses working in resource-poor settings in South Africa. The findings of the study highlight dimensions of complex interactions occurring between these two main providers of care at the district level. Understanding the primary interaction of CHWs with nurses offers further understanding of the broader role of CHWs within the district health system. It is evident that CHWs are ideally suited to play a pivotal role in supporting the public health services. However, their role and functions are not formalized and the effectiveness of programs is often not rigorously evaluated. This article discusses some of the issues related to this cadre of health worker and their role in public health care structures.

Adult↗