Community Health Toolkit

Community Health Impact Coalition: Research Roundup Issue 12

Madeleine Ballard over at the Community Health Impact Coalition (CHIC) has been organizing a regular community health research round up, and I’ve found it extremely interesting and helpful so I’m pasting the latest below. More generally, CHIC is an important sister-community to the CHT. Several of the same organizations are key contributors in both of these communities, and we see CHIC’s focus on how to design the health system as complementary and necessary to the CHT vision for health systems. CHIC is building momentum for a new model of equipped and supported community health systems, and the CHT community is building tools for that model of care, because we see this integrated approach as the most promising opportunity to improve global health. This is why a focus on Universal Health Coverage and a committment to developing open access resources (such as health system design and implementer guides—not just code!) are key principles for the CHT. If you have any ideas/questions about how CHIC and CHT can work together, feel free to post, and othewise I hope you enjoy the papers!

Issue 012

June 4 - June 17, 2019

  1. What do community health workers want? Findings of a discrete choice experiment among Accredited Social Health Activists (ASHAs) in India
  • Comments: Turns out CHWs want to get paid, receive healthcare benefits, and have the opportunity to get promoted. Who knew?
  • Methods: Discrete choice experiment
  • Takeaway: ASHAs were found to exhibit a strong preference for jobs that incorporated training leading to promotion, a fixed salary and free family healthcare. ASHAs were willing to sacrifice 2530 Indian rupee (INR) from their monthly salary, for a job offering training leading to promotion opportunity and 879 INR for a free family health-check. However, there was significant heterogeneity in preferences across the respondents.
  1. The impact of the Ethiopian health extension program and health development army on maternal mortality: A synthetic control approach
  • Comments: Pair w/recent evidence re: psychosocial distress among unpaid community health workers and this recent C-RCT showing Ethiopia’s iCCM program did not generate levels of demand and utilization sufficient to achieve significant increases in intervention coverage and a resulting acceleration in reductions in child mortality.
  • Methods: A pool of 42 Sub-Saharan African countries, covering the period 1990 to 2016, is used to construct a synthetic comparator
  • Takeaway: On average, since 2004, maternal mortality in the control countries exhibits a moderate downward trend. In Ethiopia, the downward trend is considerably steeper as compared to its synthetic control. By 2016, maternal mortality in Ethiopia was lower by 171 (p-value 0.048) maternal deaths per 100,000 live births as compared to its synthetic control. Between 2003 and 2016, Ethiopia’s maternal mortality ratio declined from 728to 357. These estimates suggest that a substantial proportion of this decline may be attributed to Health Extension Program/Health Development Army
  1. Use of Mobile Health (mHealth) Technologies and Interventions Among Community Health Workers Globally: A Scoping Review
  • Comments: Much needed study identifying and describing over ten years of studies on the use, effectiveness, and potential of mHealth involving CHWs.
  • Methods: Scoping review
  • Takeaway: Large-scale, longitudinal, and clinical studies are lacking. The existing evidence indicates that interventions, which include both CHWs and mHealth tools, are effective. Challenges include the scarcity of culturally relevant mHealth interventions, lack of a consistent methodology to assess mHealth outcomes, the need for effective training for CHWs to adopt mHealth tools, and improved communication within health care teams working with CHWs.
  1. The role of community health workers in cervical cancer screening in low-income and middle-income countries: a systematic scoping review of the literature
  • Comments: Great new piece from our friends at Oxford
  • Methods: Systematic scoping review
  • Takeaway: The roles of CHWs in cervical cancer screening in LMICs have largely to date focused on education, outreach, and awareness programmes. Community-based approaches to cervical cancer screening are feasible, although the sociocultural context plays an important role in the acceptability of these interventions. Further in-depth contextually grounded studies exploring the acceptability of such interventions are required, as well as studies exploring the cost-effectiveness of involving CHWs in cervical cancer screening activities.
  1. Using technology to scale-up training and supervision of community health workers in the psychosocial management of perinatal depression: a non-inferiority, randomized controlled trial
  • Comments: Of relevance to the CHAcademy crew
  • Methods: Single-blind, non-inferiority, randomized controlled trial
  • Takeaway: Results indicated no significant differences between health workers trained using 'Technology-Assisted Cascaded Training and Supervision system’ and supervised from distance v. those trained and supervised by a specialist face-to-face and at 3 months follow-up assessment
  1. When I die, let me be the last.’ Community health worker perspectives on past Ebola and Marburg outbreaks in Uganda '
  • Comments: Timely article with the first cases from the latest ebola outbreak surfacing in Uganda this past week
  • Methods: Qualitative interviews
  • Takeaway: Health workers responding to outbreaks have frequently encountered isolation and stigma from their communities; this avoidance was sometimes accompanied by mistrust and, in rare instances, violence. Health workers also suffered emotional trauma, depressive symptoms, and fear from witnessing colleagues suffer violent deaths.
  1. BONUS: Unleashing Private Capital for Global Health Innovation: Innovator and Investor Support Opportunities
  • Comments: In hono(u)r of today’s event, hosted by UBS Optimus and USAID’s Centre for Innovation and Impact, on unlocking private capital for global health innovation
  • Takeaway: This needs assessment focused on understanding both innovator
    challenges in successfully scaling up and investor challenges to
    deploying more private capital. The ultimate goal is to stand-up
    a new (or add to an existing) blended finance and/or technical
    assistance (TA) facility that catalyzes the right type of private
    capital, to the right innovators, at the right time to help them scale.
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I found the article on psychosocial distress among unpaid community health workers especially troubling; thank you for sharing, @isaacholeman!

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I know, me too :grimacing:

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