Community Health Research Round-Up 019

Hi all,

Welcome to the latest edition of the Community Health Research Round-up! The Round-up gives you the key takeaways from important new CHW academic papers every two weeks.

This issue covers papers (largely!) indexed since October 7. Please feel free to reply w/ anything we may have missed.

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All the best,


Community Health Research Round-Up, Issue 019

October 7 - October 21, 2019

  1. Towards universal health coverage: what are the system requirements for effective large-scale community health worker programmes?
  • Comments: New commentary out, flagged by Eric Sarriot. Touches on a number of fairly well-trodden recommendations for the effective development of large-scale CHW programmes, drawing these insights from recent (and not so recent…) reviews. A really stark example of how delays in publishing reduce research relevance–this was accepted in Sept 2018, but only came out this month! What has changed in a year? Oh, just the release of a comprehensive WHO Guideline, based on 15 newly commissioned systematic reviews, on precisely this subject! (In which Uta, the lead other was intimately involved) Sigh.
  • Methods: Narrative synthesis
  • Takeaway: The key elements of successful CHW programmes identified are (1) embeddedness, connectivity and integration into the larger system of healthcare service delivery; (2) cadre differentiation and role clarity in order to maintain clear scopes of work and accountability; (3) sound programme design based on local contextual factors and effective people management; and (4) ongoing monitoring, learning and adapting based on accurate and timely local data in order to ensure optimal fit to local context since one size does not fit all. (But seriously, refer to the Guideline!)
  1. The state of community health information systems in West and Central Africa
  • Comments: Flagged on the Community Health Toolkit Forum by @Scott_Russpatrick. Interesting mapping of the status of centralized, government owned community health information system (CHIS) in 17 West and Central African Countries. Charts the results and process of doing the assessment itself
  • Methods: x-sectional survey + qualitative assessment
  • Takeaway: The need and desire among countries to have a CHIS that harmonizes the fragmented landscape of CHW reporting tools and populates data into the national health management information system (HMIS) is high. Barriers include: (i) budget limitations to develop, deploy, and sustain a CHIS (infrastructure, access to cell phones, reliable electrical power supply, and mobile network), (ii) CHIS governance, (iii) adherence to SOPs and (iv) system design. Interoperability layers between mHealth apps and the CHIS will be complex and expensive.
  1. Mobile training and support (MOTS) service—using technology to increase Ebola preparedness of remotely-located community health workers (CHWs) in Sierra Leone
  • Comments: The Ministry of Health in Sierra Leone has developed and operationalized the national Digital Health Strategy to guide integrated roll out of e-health/mobile health solutions. This paper looks at two mobile-based training modules—one covering vaccination and one covering outbreak response and disease surveillance–delivered on cellphones as audio messages in the preferred local language (interactive voice response - IVR - technology)
  • Methods: Pre- and post-quiz on knowledge change
  • Takeaway: “Transparent partnership and alignment with the Ministry of Health & Sanitation in Sierra Leone from the outset of this project is considered an important element to ensure successful implementation.” The extent of knowledge acquired was higher with the Vaccine training module when compared to the (Ebola) Disease Surveillance & Outbreak Response module. The order in which training modules are delivered as well as general fatigue of the IVR methodology for participating in the quiz assessments may be of importance and requires further investigation.
  1. Community Health Workers Improve Linkage to Hypertension Care in Western Kenya
  • Comments: Interesting NCD paper that touches on the larger question of do CHWs improve linkages to care or not? Other literature on systolic blood pressure reduction: this SR(RR 006) + this(RR 009), this(RR 015), & this (RR 018) trial in India.
  • Methods: 3 arm C-RCT
  • Takeaway: A strategy combining tailored behavioral communication and mHealth for community health workers led to improved linkage to care, but not statistically significant improvement in SBP reduction.
  1. Community health worker-delivered counselling for common mental disorders among chronic disease patients in South Africa: a feasibility study
  • Comments: Examines the feasibility and acceptability of integrating a ‘designated’ approach to CHW-delivered mental health counselling (where existing CHWs deliver counselling in addition to usual duties) and a ‘dedicated’ approach (where additional CHWs have the sole responsibility of delivering mental health counselling) into chronic disease care. (N.B. in this study, CHWs were delivering care at clinics)
  • Methods: Feasibility test
  • Takeaway: Retention in counselling (85%) and the study (90%) was good and did not differ by approach. Dedicated and designated approaches to CHW-delivered mental health counselling were matched in terms of their feasibility and acceptability. A comparative efficacy trial of these approaches is justified, with some adjustments to the training and implementation protocols to provide further support to CHWs.
  1. Preparing for Community Health Worker Integration Into Clinical Care Teams Through an Understanding of Patient and Community Health Worker Readiness and Intent
  • Comments: With respect to article #5, an interesting piece on integration of CHWs into clinics
  • Methods: x-sectional
  • Takeaway: CHW and patient readiness to become or utilize a cCHW (clinic-based community health worker) significantly predicted CHW and patient intent to become or utilize a cCHW. CHWs, however, experienced greater readiness to serve as cCHWs than did patients to utilize cCHWs. Investment in the cCHW promotion program across patient and CHW groups may strengthen the transition of cCHWs into existing care teams.
  1. BONUS: The foreign gaze: authorship in academic global health
  • Comments: “Like ships in the night, local and global conversations often pass each other by” - new editorial talks about entrenched power asymmetries in global health —between researchers in HIC (often the source of funds and agenda) and those in LMIC
  • Takeaway: Many. “In many ways, the growing concerns about imbalances in authorship are a tangible proxy for concerns about power asymmetries in the production (and benefits) of knowledge in global health.” - how to make our work in these less than ‘ideal’ situations more consequential, and our choices less corrupting.


  1. M‐SAKHI—Mobile health solutions to help community providers promote maternal and infant nutrition and health using a community‐based cluster randomized controlled trial in rural India: A study protocol
  • Objective: Cluster randomized controlled trial to evaluate the effectiveness of an mHealth intervention “Mobile Solutions Aiding Knowledge for Health Improvement” (M‐SAKHI) to be delivered by rural community health workers or Accredited Social Health Activists (ASHAs) for rural women, below or up to 20 weeks of pregnancy through delivery until their infant is 12 months of age
  1. Protocol for a quasiexperimental study testing the effectiveness of strengthening growth monitoring and promotion in community clinics for improving the nutritional status of under-two children in rural Bangladesh
  • Objective : Quasiexperimental, two-arm, mixed methods study to examine the effectiveness of growth monitoring and promotion activities strengthened in community clinics to improve the nutritional status of children under 2 years of age

Thanks for sharing @mballard!

@beatrice you might want to take a look at the M-SAKHI study mentioned above in relation to your dietary diversity concept note. The M-SAKHI has just published a protocol, their intervention focuses on mobile-supported behavior change communication and counseling. While the primary outcome is stunting, they’re also looking at impacts on dietary diversity, so both the way they’re measuring dietary diversity and the ways they’re trying to improve it may be relevant to your work. Here’s what the protocol says about the app they’re developing:

The ASHAs will interview the mothers once every month at aprearranged time with the aid of an audio file in the app that presentsthe question in the local language. This will ensure the questions areasked in the same standard way by all ASHAs, who will then enterthe responses to the question options in the app. Each question inthe app will be also denoted with a regionally appropriate picture(for example, a question that inquires about the age of the participantwill have a picture of a young Asian woman in a saree)…

In addition, the app will be embedded with health‐promoting audio and video counselling messages (developed using recommendations from WHO, UNICEF, and the Indian government) for maternal and infant nutrition, appropriate health and hygiene practices. These messages will be tailored to the participants’ responses to routine healthcare questions. If a response suggests that the participant is not performing an expected health practice (e.g., not attending antenatal care or introducing bottle feeds), the app will trigger alert text messages to both the client and her designated study Auxiliary Nurse Midwife(ANM) who has been trained as a phone counsellor. The project staff will monitor in real time, the data collected by the ASHAs on the CommCare server.

The proposal also includes a supervisor workflow. For the most part this seems like a pretty common set of features for a digital tool like this, though I had never before seen the approach of having an audio file ask the questions of patients, rather than having the health worker ask the questions. Kind of wish there were more context on that, but I imagine it’s related to a concern about quality, either of the messages being delivered, or of the data being collected (or both).

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