Background: Community Health Workers (CHWs) have a positive impact on the provision of community-based
primary health care through screening, treatment, referral, psychosocial support, and accompaniment. With a
broad scope of work, CHW programs must balance the breadth and depth of tasks to mainta...in CHW motivation for
high-quality care delivery. Few studies have described the CHW perspective on intrinsic and extrinsic motivation to
enhance their programmatic activities.
Methods: We utilized an exploratory qualitative study design with CHWs employed in the household model in Neno
District, Malawi, to explore their perspectives on intrinsic and extrinsic motivators and dissatisfiers in their work. Data
was collected in 8 focus group discussions with 90 CHWs in October 2018 and March–April 2019 in seven purposively
selected catchment areas. All interviews were audiotaped, transcribed verbatim, coded, and analyzed using Dedoose.
Results: Themes of complex intrinsic and extrinsic factors were generated from the perspectives of the CHWs in
the focus group discussions. Study results indicate that enabling factors are primarily intrinsic factors such as positive
patient outcomes, community respect, and recognition by the formal health care system but can lead to the chal-
lenge of increased scope and workload. Extrinsic factors can provide challenges, including an increased scope and
workload from original expectations, lack of resources to utilize in their work, and rugged geography. However, a posi-
tive work environment through supportive relationships between CHWs and supervisors enables the CHWs.
Conclusion: This study demonstrated enabling factors and challenges for CHW performance from their perspec-
tive within the dual-factor theory. We can mitigate challenges through focused efforts to limit geographical distance,
manage workload, and strengthen CHW support to reinforce their recognition and trust. Such programmatic empha-
sis can focus on enhancing motivational factors found in this study to improve the CHWs’ experience in their role. The
engagement of CHWs, the communities, and the formal health care system is critical to improving the care provided
to the patients and communities, along with building supportive systems to recognize the work done by CHWs for
the primary health care systems.
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Towards the Peoples Health Assembly Book -2
Background: Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expan...ding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC).
Methods: We conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20–40 households for monthly (or more frequent) visits.
Findings: The intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (−0.8 percentage points (pp) (95% credible interval: −2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: −0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (−0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (−0.6 per 1000 (95% CI −2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges.
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The guideline uses state-of-the-art evidence to identify effective policy options to strengthen community health worker (CHW) programme performance through their proper integration in health systems and communities.
Successful delivery of services through CHWs requires evidence-based models for edu...cation, deployment and management of these health workers. The guideline is intended as a tool for national policy makers and planners and their international partners to use in the design, implementation, performance and evaluation of effective community health worker programmes. It contains pragmatic recommendations on selection, training and certification; management and supervision: and integration into health systems and community engagement.
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Civil Society Organisations’ contribution towards community engagement to access and demand health services and encourage communities to practice appropriate health-seeking behaviour in Mon and Chin States. The study recognizes that civil society can promote people-centered health by creating an e...nabling environment for broad and active citizen participation. The VHCs/Volunteer Working Groups play a key role in facilitating engagement between the village community and the Basic Health Staff (BHS).
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Thesis presented in partial fulfilment of the requirements for the degree of Master of Nursing Science in the Faculty of Health Sciences at Stellenbosch University.
The mobile clinic health care services fulfil an essential role in delivering primary health care to the dwellers in the rural commun...ities of the Western Cape. However, occupational health and safety, as well as quality assurance are issues that need to be addressed urgently. It is thus recommended that policy makers take cognizance of the specific needs of every individual mobile clinic team.
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Civil Society Organisations’ contribution towards community engagement to access and demand health services and encourage communities to practice appropriate health-seeking behaviour in Mon and Chin States
The following report is a study of 14 villages under the Collective Voices project (Nov...ember 2015-December 2017) in the states of Mon and Chin. The objectives of the study were:
(1) to explore Village Health Committee (VHC) members, Basic Health Staff (BHS), and community members’ perceptions on community engagement in seeking and demanding health care and
(2) to describe health-seeking behaviours relating to Maternal, Newborn, and Child Health and hygiene practices among target beneficiaries.
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What We Know, What We Don’t Know, and What We Need to Do
Risk Communication and Community Engagement (RCCE) is an essential part of any disease outbreak response. Risk communication in the context of an Ebola outbreak refers to real time exchange of information, opinion and advice between frontline responders and people who are faced with the threat of Eb...ola to their survival, health, economic or social wellbeing. Community engagement refers to mutual partnership between Ebola response teams and individuals or communities in affected areas, whereby community stakeholders have ownership in controlling the spread of the outbreak.
It is intended to be used to guide RCCE work which is central to stopping the outbreak and preventing its further amplification. Unlike other areas of response, RCCE draws heavily on volunteers, frontline personnel and on people without prior training in this area. As such, the document provides basic background information, scopes the socio-economic and cultural aspects (that are known at the time of publication), and provides the latest evidence-based advice and approaches
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A booklet on how CHWs were addressing eye health across Africa based on desk research and a survey in 23 countries
A series of information sheets to help empower communities and strengthen health systems
This series of information sheets introduces health literacy, its
relevance to public policy, and the ways it can be used to inform
the promotion of good health, the prevention and management
of communicab...le and noncommunicable diseases, and the
reduction of health inequities. It provides information and links
to further resources to assist organizations and governments
to incorporate health literacy responses into practice, service
delivery systems, and policy.
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In the context of the Support to National Malaria Control Programme (SuNMaP), demand creation is the strategic combination of advocacy, communication and mobilisation approaches that seek to achieve increased community awareness of, and demand for, effective malaria prevention and treatment services.... For malaria treatment, demand creation focuses on promoting improved testing, prompt and proper use of artemisinin combination therapy (ACT) treatment for individual cases of malaria, and effective home management of fever, together with referrals of severe cases to a higher-level health facility.
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