Community Health Toolkit

Community Health Research Round-Up, Issue 030

Hi All -

I’m stepping in for @mballard today. I recently joined the Community Health Impact Coalition and am pleased to share the latest version of our fortnightly Research Round-Up. This issue covers papers indexed (largely!) since March 24. Please feel free to reply to this thread with anything we may have missed.

Because I’m a new user, I can only post two links at a time. Apologies in advance for multiple posts on this thread! :slight_smile:

Community Health Research Round-Up, Issue 030

March 24, 2020 - April 6, 2020

  1. In-kind incentives and health worker performance: Experimental evidence from El Salvador
  • Comments: BMGF-funded study by IADB evaluates effect of in-kind, group-based incentives on community health worker performance. Incentives were awarded in the form of “points” that teams could choose to redeem for laptops, air conditioners, microwaves, and other assets. (N.B In their recent guideline - which came out at the end of 2018 - the WHO suggests not the WHO suggests not paying CHWs exclusively or predominantly according to performance-based incentives (PBI). The rationale for this recommendation was based on the evidence of potential harm: (1) PBI encouraged uneven focus on certain activities due to their association with higher incentives, especially when CHWs had no basic remuneration, leading to the neglect of other important activities or responsibilities + (2) CHWs expressed dissatisfaction with performance-based incentive models in relation to amounts paid and inconsistent and incomplete payment of incentives. Only the first pitfall is considered in this study)

  • Methods: Randomized trial (12 month intervention)

  • Takeaway: In-kind, group-based incentives generated significant improvements in a variety of indicators (community outreach, quality of care, timeliness of care, and utilization of maternal and child health services after 12 months); “in-kind group incentives may be a viable alternative to monetary incentives in certain contexts” ( Editorial note: that context being a barter economy…?)

[Post 2/5]

  1. Pluralism and practicality: village health workers’ responses to contested meanings of mental illness in Southern Malawi
  • Comments: Explores potential role for Malawian health surveillance assistants (HSAs) to help patients and communities navigate tensions between traditional and biomedical explanations for mental illness

  • Methods: Qualitative

  • Takeaway: Traditional beliefs and spirituality can impact perceptions of the nature and causes of psychological distress; with the right support, HSAs can help promote a biomedical understanding of mental illness in communities where traditional “bewitchment” ideas dominate. A call for pluralism + pragmatism

3. Optimizing Test and Treat in Malawi: health care worker perspectives on barriers and facilitators to ART initiation among HIV-infected clients who feel healthy

  • Comments: Health workers (including CHWs) participating in focus groups report that patients who feel healthy are less likely to initiate ART even after a positive diagnosis due to perception that risks (stigma, disruption of daily routine, side effects) outweigh benefits

  • Methods: Focus group discussions

  • Takeaway: To achieve universal test and treat, more innovative service delivery methods such as potentially extending HIV services like ART initiation beyond the facility setting are needed (although more research would be required )

[Post 3/5]

  1. The fight against lymphatic filariasis: perceptions of community drug distributors during mass drug administration in coastal Kenya
  • Comments: Examines factors that mediate relations between community members and community drug distributors (CDDs) during mass drug administration campaigns (trust, community knowledge, timing of campaigns, fragmented supervision, CDD bias)
  • Methods: Focus group + semi-structured interviews
  • Takeaway: Motivation, supervision, and ongoing training influence quality of care by CDDs in Kenya
  1. Strengthening health care worker engagement with early adolescence in low- and middle-income countries: an overdue area for action
  • Comments: Colleagues from WHO, Kenya MOH, Nepal NFCC, Pop Council, and Columbia call for building health worker capacity to engage with early adolescents since this is a formative time for shaping preventative and promotive health behaviors

  • Methods: Advocacy paper

  • Takeaway: We need to keep innovating on how community health teams can better reach adolescents - a key demographic!

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Not sure what happened to post 4/5 and 5/5, but will note that the archive can be found here.

The latest round-up is below. Note particularly # 2 & # 5

Madeleine

  1. National UK programme of community health workers for COVID-19 response
  • Comments: ICYMI, there was a great recent comment in the Lancet calling for a national UK CHW cadre for COVID-19 response. This follows similar calls in other media and other high-income countries for similar. Thanks to founding Coalition member, PIH, Massachusetts, USA has begun!
  • Methods: Commentary
  • Takeaway: Based on experience in Brazil, Pakistan, Ethiopia, and other nations, the authors propose a large-scale emergency programme to train CHWs to support people in their homes, initially the most vulnerable but with potential to provide a long-term model of care in the UK
  1. Using mobile phones to improve community health workers performance in low-and-middle-income countries
  • Comments: Probably a question better answered by a systematic review, but this “debate”-style paper does a good job hitting a wide swathe of relevant issues
  • Methods: Non-systematic review
  • Takeaway: mHealth interventions can improve CHWs’ performance and work environment in LMICs. There are some challenges concerning the implementation and sustainability of mobile phone interventions (incl. lack of CHWs training, weak technical support, issues of internet connectivity, administrative and management related issues, poor sustainability of pilot projects, and high investment, operational, and maintenance costs of equipment.) Future research efforts and policy dialogue should be directed to explore health system readiness for adopting sustainable mHealth solutions.
  1. Prioritizing Competencies for “Research” Promotores and Community Health Workers
  • Comments: Interesting paper that attempts to identifying necessary competencies for CHWs participating in research. Table 1 could serve as a helpful checklist for those involving CHWs in research planning, implementation or reporting.
  • Methods: Mixed-methods - survey and focus-groups
  • Takeaway: There is a clear need for research ethics education designed specifically for people who have limited or no formal academic research training—especially when these individuals play a key role on the research team and related research outcomes. This list of competencies is a start.
  1. Performance of volunteer community health workers in implementing home-fortification interventions in Bangladesh: A qualitative investigation
  • Comments: This qualitative study was conducted as part of a large evaluation of the MIYCN Home- fortification Programme (see RR 029). We’re just shocked by the conclusion!
  • Methods: in-depth interviews, focus group discussions, and key informant interviews w/ thematic analysis
  • Takeaway: Getting an adequate number of volunteers at the community level was a challenge for BRAC local offices. The high dropout of the CHWs mostly related to no or insufficient earning options. The authors conclude: “BRAC’s [CHWs] require a living wage to earn essential income for their family. Considering the current socio-cultural and economic context of Bangladesh, BRAC may need to revise the existing volunteer [CHW] model to ensure that [CHWs] receive an adequate income so that they can devote themselves to implementing its home-fortification intervention”
  1. Surgical symptomatic knowledge among medical staff and community health workers in rural Cambodia: a descriptive study for workforce improvement
  • Comments: The latest in a long line of studies to assess CHWs on subjects for which they have never received trained. The overarching point, however, is a good one and speaks to the need for further integration of CHWs into national health systems.
  • Methods: Self-report questionnaire
  • Takeaway: Knowledge of surgical symptoms among medical staff and CHWs was inadequate. To at least double the surgical workforce by 2030 successfully, accurate evaluation and improvement of surgical symptomatic knowledge among medical staff in rural areas is crucial.
  1. Assessing community health worker service delivery in humanitarian settings
  • Comments: Helpful and timely review from colleagues at UNICEF
  • Methods: Rapid review, summarized as a viewpoint
  • Takeaway: Several, including: (i) more work is needed to develop standard definitions for the spectrum of essential health services. (ii) a database of health facilities, human resources (including CHWs), and services available should be developed pre-crisis, (ii) Cell phone-based data collection could enable evaluation in otherwise inaccessible settings, including in emergencies, (iv) most key implementation strength indicators at community level are not included in the WHO’s HeRAMSHealth Resources Availability Mapping System (HeRAMS) tool
  1. The everyday political economy of health: community health workers and the response to the 2015 Zika outbreak in Brazil
  • Comments: Another cogent and timely political economy piece by our colleague, João Nunes
  • Takeaway: The working conditions of CHWs, overwhelmingly characterized by precarity and low pay, reveal the presence of global neoliberal dynamics pertaining to the reconfiguration of the Brazilian state as healthcare provider in a context of encroaching austerity, privatization and narrowly-defined cost-efficiency. These dynamics impacted detrimentally upon the effectiveness of the Zika response.
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