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The barangay health workers (BHWs) or government-trained health volunteers have been operating in rural villages in the Philippines since 1981. Although malaria is a consistently recognized health problem, the BHWs do not contribute optimally to control activities even in endemic areas. This is so because of inadequate training, insufficient logistic support, poorly sustained motivational schemes and lack of community support. Prospects for involvement in malaria control are numerous, however there is need to enhance the existing BHW Program.
OBJECTIVE: To compare the cost-effectiveness of the tuberculosis (TB) programme run by the Bangladesh Rural Advancement Committee (BRAC), which uses community health workers (CHWs), with that of the government TB programme which does not use CHWs. METHODS: TB control statistics and cost data for July 1996 - June 1997 were collected from both government and BRAC thanas (subdistricts) in rural Bangladesh. To measure the cost per patient cured, total costs were divided by the total number of patients cured. FINDINGS: In the BRAC and government areas, respectively, a total of 186 and 185 TB patients were identified over one year, with cure rates among sputum-positive patients of 84% and 82%. However, the cost per patient cured was US$ 64 in the BRAC area compared to US$ 96 in the government area. CONCLUSION: The government programme was 50% more expensive for similar outcomes. Although both the BRAC and government TB control programmes appeared to achieve satisfactory cure rates using DOTS (a five-point strategy), the involvement of CHWs was found to be more cost-effective in rural Bangladesh. With the same budget, the BRAC programme could cure three TB patients for every two in the government programme.
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The South African Christian Leadership Assembly (SACLA) Health Project is a non-governmental organisation that runs a community health worker (CHW) programme in 4 peri-urban townships of Cape Town. A cross-sectional descriptive community survey was conducted in April 1990 to evaluate coverage and health education on oral rehydration solution (ORS) and to plan future preventive, promotive and development programmes. Research concepts and methods were made accessible to the CHWs through a training process designed to facilitate participation in every stage of the research. A multi-stage cluster sampling scheme was used, and the CHWs interviewed 822 residents. Coverage indicators showed that over 80% of all respondents had previously known about or consulted the CHW. The most common community problems related to water, filth and refuse, toilets, housing, unemployment and lack of community facilities. The most common health problems were generalised aches and pains, chest problems, skin problems, worms, and diarrhoea. An index developed to measure knowledge of ORS showed very few respondents had 'complete knowledge'. The community's expectations of the CHW included health education, attending to sanitation problems, providing a clean environment, organising community facilities, and helping with employment.
BACKGROUND: Neonatal jaundice (NNJ) is still a leading cause of preventable brain damage, physical and mental handicap, and early death among infants in many communities. Greater awareness is needed among all health workers. The objective of the study was to assess the knowledge of primary health care workers about the description, causes, effective treatment, and sequelae of NNJ. METHODS: The setting was a local government area i.e. an administrative district within the south-western part of Nigeria. Community health workers in this area were interviewed by means of a self-administered questionnaire which focused on awareness and knowledge of neonatal jaundice and its causes, treatment and complications. RESULTS: Sixty-six community health workers participated in the survey and male-to-female ratio was 1:5. Their work experience averaged 13.5 (SD 12.7) years. Only 51.5% of the respondents gave a correct definition of NNJ. 75.8 % knew how to examine for this condition while 84.9 % knew at least two of its major causes in our environment. Also, only 54.5 % had adequate knowledge of effective treatment namely, phototherapy and exchange blood transfusion. Rather than referring affected babies to hospitals for proper management, 13.4 %, 10.4 % and 3 % of the participants would treat with ineffective drugs, natural phototherapy and herbal remedies respectively. None of the participants knew any effective means of prevention. CONCLUSION: Primary health care workers may have inadequate knowledge and misconceptions on NNJ which must be addressed concertedly before the impact of the condition on child health and well-being can be significantly reduced. We recommend regular training workshops and seminars for this purpose.
In Gazankulu, a rural area in South Africa, there is an acute shortage of medical doctors and other health professionals. In an attempt to improve health care delivery at the village level, a program utilizing community health workers was introduced. Here, selection criteria, the training course content, and early experiences with the implementation of the program are examined.
Since the Alma-Ata Conference in 1978 reiterated the goal of "Health for All by the Year 2000", health service delivery programs promoting the primary health care approach using community health workers (CHWs) have been established in many developing countries. These programs are expected to improve the cost-effectiveness of health care systems by reaching large numbers of previously underserved people with high-impact basic services at low cost. However, there is a dearth of data on the cost-effectiveness of CHW programs to confirm these views. This may be because conventional approaches to economic evaluation, particularly cost-effectiveness, tend not to capture the institutional features of CHW programs. Therefore, this paper aims to examine the means by which economic methods can be extended to provide evidence regarding the cost-effectiveness of CHWs in developing countries.
African American women have significantly higher mortality rates from heart disease and stroke than White women despite advances in treatment and the management of risk factors. Community health workers (CHWs) serve important roles in culturally relevant programs to prevent disease and promote health. This article describes the Pine Apple Heart and Stroke Project's activities to (1) revise the Women's Wellness Sourcebook Module III: Heart and Stroke to be consistent with national guidelines on heart disease and stroke and to meet the needs of African American women living in rural southern communities; (2) train CHWs using the revised curriculum; and (3) evaluate the training program. Revisions of the curriculum were based on recommendations by an expert advisory panel, the staff of a rural health clinic, and feedback from CHWs during training. Questionnaires after training revealed positive changes in CHWs' knowledge, attitudes, self-efficacy, and self-reported risk reduction behaviors related to heart disease, stroke, cancer, and patient-provider communication. This study provides a CHW training curriculum that may be useful to others in establishing heart disease and stroke programs in rural underserved communities.
A central component of the primary health care approach in developing countries has been the development and utilization of community-based health workers (CHWs) within the national health system. While the use of these front line workers has the potential to positively influence health behavior and health status in rural communities, there continues to be challenges to effective implementation of CHW programs. Reports of high turnover rates, absenteeism, poor quality of work, and low morale among CHWs have often been associated with weak organizational and managerial capacity of government health systems. However, no systematic research has examined the contribution of work-related factors to CHW job performance. The research reported in this paper examines the relative influence of reward and feedback factors associated with the community compared to those associated with the health system on the performance of CHWs. The data are drawn from a broader study of health promoters (CHWs) conducted in two departments (provinces) in Colombia in 1986. The research was based on a theoretical model of worker performance that focuses on job related sources of rewards and feedback. A survey research design was employed to obtain information from a random sample of rural health promoters (N = 179) and their auxiliary nurse supervisors about CHW performance and contributing factors. The findings indicate that feedback and rewards from the community have a greater influence on work performance (defined as degree of perceived goal attainment on job tasks) than do those stemming from the health system.(ABSTRACT TRUNCATED AT 250 WORDS)
Scorpion envenomation is a public health problem in Tunisia (40.000 cases/year), particularly in the zone of central Tunisia (region of Sidi Bouzid). The size of the province, its low rate of urbanization and the relatively limited health ressources required an anti-scorpion approach based on the implication of community health workers. During the year 1997, the 338 health workers who assure 76% of the emergency points treated 42% of scorpion envenomation cases. In spite of the success of the experience, authors discuss "the specialization" of these agents whose the contribution to others aspects of primary care could be improven. These health workers don't constitute a basic component of the organization of health care, but an exceptional measure for special geographical considerations.
BACKGROUND: Acute respiratory infections (ARI) are the leading cause of death in childhood. Most of children's deaths happen at home without health level first cares. However in Senegal only health workers are allowed to prescribe antibiotics. A competency-based training was developed to improve and assess the management of acute respiratory infections in young children aged 2 to 59 months by low level educated community health workers (CHWs) in 4 districts of Senegal. The first findings showed the CHWs capable of acquiring the skills needed to effectively manage ARI cases in accordance with the World Health Organization's ARI case management strategy. The aim of this study was to assess the quality of their management after a 1 year follow-up. METHODS: We provided to CHWs 3 days course in ARI management. After the 3-day course, a 4-month follow-up was performed. We organized a 1-day refresher course every month and in every district. In order to assess the quality of management of CHWs we analyzed the management process and compared the CHWs classification to the classification of the first level health facilities. RESULTS: Twenty-three percent (3727/15,965) of IRA cases of district were managed by CHWs. Ninety percent (2738/3042) among them were well classified, well managed and well followed-up. But 28% of severe pneumonia cases were misclassified as pneumonia. About treatment, 22.5% of 'cough or cold' got wrong treatment with cotrimoxazole and 10.3% of severe pneumonia got cotrimoxazole without referral. Less than half of severe pneumonia benefited of the first follow-up and only 18% of the second. CONCLUSIONS: The results highlight that a CHWs low-level educated in French, trained and followed-up could apply the WHO algorithm of IRA management. They could help to give proximal care related to children ARI, to the community. But it seems useful of emphasizing the recognition of danger signs and the follow-up of severe cases.