Community Health Research Round-up 041

mballard · September 8, 2020, 9:29pm

August 25 - Sept 7, 2020

Comments: This study sought to examine determinants of ASHA RMNCH&N knowledge and develop a reliable phone survey tool, which could be used for the rapid, routine, and low cost measurement of knowledge. The importance of knowledge impacting service delivery has been highlighted through studies on the know-do gap around tuberculosis care and childhood diarrhea and pneumonia care in India
Methods: x-sectional survey & inter-rater and inter-modal (person vs. phone) assessment of tool
Takeaway: Overall results suggest that ASHAs may benefit from additional training across a number of areas, including maternal health and family planning. Leading determinants of knowledge included geographic location (closer to capital), age <30 years of age, education, experience as an ASHA, completion of seven or more client visits weekly, phone ownership and use as a communication tool for work, as well as the ability to navigate interactive voice response prompts (a measure of digital literacy).

Comments: Great commentary by David Musoke & colleagues reflecting on the pros and cons of volunteer and paid/institutionalized CHWs working together based on experience in Uganda
Methods: Commentary
Takeaway: Any new cadre would require adequate support systems including performance management, regular refresher trainings, availability of necessities and supplies such as drugs, sufficient logistics such as motorcycles for transportation, regular supervision, mentorship from health practitioners, as well as community trust and acceptance. Introduction of a paid cadre without addressing these health system challenges would most likely result in a health cadre that is not adequately supported to yield the desired results in improving population health. This should not be looked at in isolation but rather in context of the broader health system - strengthening health facilities to which cases from the community are referred is also critical

Comments: At the onset of the COVID-19 pandemic, the US’s National Association of CHWs (NACHW) began convening regular meetings with state ambassadors to provide ongoing support & to adapt to the evolving needs and concerns of CHWs. This paper describes how COVID-19 affected CHWs both professionally and personally.
Methods: Focus group w/CHW leaders from 7 US states
Takeaway: (i) CHWs are generally resilient and often self-reliant and may hesitate to ask for help - these traits may not serve them well in a time of burgeoning workload, intense stress, and a new content area (COVID-19). (ii) It is critical for leaders to allow CHWs the flexibility to tend to personal needs such as caring for children or ill family members. They must also ensure a living wage and paid time off. (iii) Organizational leaders must encourage CHW team members to ask for help and encourage CHWs to rely on and support each other. (iv) Given their substantial grassroots knowledge, engaging CHWs in the planning, implementation, and evaluation of COVID-19 strategies for communities is essential.

Comments: CHWs make up the largest single group involved in health delivery in Rwanda; this is a sobering look at what they gain—and lose—by participating in an unsalaried workforce
Methods: Mixed methods
Takeaway: CHWs contributed approximately four hours of volunteer work per day which translated to 127 684 RWF per year in lost personal income—62% of an average CHW income. CHW out-of-pocket expenditures (e.g. patient transportation) were estimated at 36 228 RWF per year.

Comments: Taking two NGOs—BRAC and Jamkhed—as examples, the authors examine the role of NGOs in health development, particularly community health in low-income countries.
Methods: Case studies
Takeaway: The Jamkhed experience in India shows how a small NGO effort in 30 villages can spread to influence government policies and programs across India. That said NGOs continue to face many challenges, including governments in a number of countries restricting their ability to operate, funding shortages, and lack of documentation of the effectiveness of their work

6 & 7. Implementing the census-based, impact-oriented approach to comprehensive primary health care over three decades in Montero, Bolivia: 1. Program description & 2. Program achievements, including long-term trends in mortality of children and mothers

Comments: Helpful overview of a long-running program in Bolivia
Methods: Mixed - review of available documents, prior evaluations, & health information, and interviews with 19 key informants.
Takeaway: The program CHWs achieved near-universal coverage of key child survival interventions and achieved levels of child and maternal mortality comparable to those in the USA. Community collaboration, routine systematic home visitation, & targeted visits to high-risk households are notable components of the program.

Comments: Knowledge translated to action!
Methods: Quasi-experimental (N=425 CHWs)
Takeaway: Cervical cancer training significantly improved the CHVs’ knowledge on cervical cancer and uptake of screening services in the intervention area

Comments: Another analysis of the effects of a standardized CHW intervention on hospitalization. This is the largest analysis of randomized trials to demonstrate reductions in hospitalization with a health system‐based social intervention.
Methods: Pooled data from three randomized clinical trials (n = 1340)
Takeaway: Data from three randomized clinical trials across multiple settings show that a standardized CHW intervention reduced total hospital days and hospitalizations outside the primary health system.