The latest round-up (Issue 032) is below. We’re light on digital / mHealth topics this week, although #7 contains a subtle push for equipping CHWs with phones (in the USA).
- Comments: From our friends at Lwala Community Health Alliance! The team surveyed two groups of community health volunteers: one group had received training on obstetric & neonatal danger signs, and the other group had not. As we expected, the volunteers who received training outperformed on all indicators.
- Methods: X-sectional survey
- Takeaway: We cannot neglect the need for frequent training of CHWs.
- Comments: In Bihar, CHWs do not receive steady wages and endure regular scolding at management meetings. Nonetheless, they are expected to operate on the frontlines in our COVID response. This timely paper from the World Bank Development Research Group takes a look at why the global community has underinvested in CHWs, focusing on the Indian context.
- Method: Descriptive survey, applying economic theory of principal-agent relationships
- Takeaway: Bihar’s quasi-volunteer CHWs earn high-powered incentives rather than wages. Politicians are reluctant to professionalize CHWs in an institutional context dominated by rent-seeking behavior and systemic distrust. The current pandemic presents a rare opportunity to overturn the status quo. Economic theory points to the need for fair, steady wages for CHWs and a workforce approach that prioritizes their intrinsic motivation.
- Comments: This technical brief from the US Agency for Healthcare Research and Quality (AHRQ) takes a closer look at how CHW certification impacts patient health outcomes and CHW workforce outcomes (recruitment, retention, financial sustainability, and workforce development). N.B.: WHO suggests competency-based formal certification for CHWs.
- Method: Technical brief (based on rapid review of published & grey literature plus key informant interviews)
- Takeaway: The perceived positive impact of CHW certification is undermined by lack of rigorous evidence. The authors recognize a growing interest in the topic of certification and call for further research on the associations between CHW certification and patient health outcomes, perspectives on the usefulness of CHW certification, best practices for establishing CHW certification programs, and CHWs’ own beliefs about certification. Until we have more evidence, CHW certification programs will remain in infancy.
- Comments: The authors examine the impact of the GGR on various sexual and reproductive health services in Uganda, including CHW engagement in family planning activities.
- Method: Panel analysis
- Takeaway: The GGR has significantly reduced CHW involvement in family planning activities in select sites in Uganda (i.e., those “most exposed” to the consequences of the GGR).
- Comments: The Healthy Fit health promotion program serves over 2,500 low-income Hispanic immigrants in El Paso, Texas. One of Healthy Fit’s “innovative strategies” involves using CHWs to recruit participants, deliver health promotion messages, and conduct motivational interviews to promote behavior change by participants.
- Method: Article commentary
- Takeaway: Healthy Fit is a novel program linking CHWs, vouchers, and motivational interviewing techniques to address the health needs of Hispanic immigrants.
- Comments: CHW social networks provide a targeted platform for CHWs to deliver health interventions as well as build social capital.
- Methods: Lit review + perspective
- Takeaways: CHWs play a key role in brokering relationships among community members and institutions. Integrating CHWs into the formal health system can improve the effectiveness of CHWs. As we consider the role played by CHWs in shielding the vulnerable from the brunt of COVID-19, this article reminds us that CHWs will be most effective if they are integrated into and supported by the national health system as well as their communities.
- Comments: The intervention deployed CHWs in an urban, academic pediatric primary care system. Over 1000 patients were connected to CHWs over a ~2-year period. Early learnings point to the importance of modified outreach processes (CHW phone > clinic phone, home visits), trust (it’s key!), and community partner alignment.
- Methods: Evaluation of program embedded within Cincinnati Children’s general pediatrics, complex care, adolescent medicine, and school-based health clinics
- Takeaways: CHWs are effective when tightly integrated into and supported by the health systems in which they operate and communities in which they serve: “The CHWs bring a face to care that families relate to, connect with, and trust.”
- Comments: The latest in a series of studies on integrating CHWs into high-volume urban hospital settings in the USA (see Research Round-Up 030 for more), this time focusing on a program in Philadelphia, PA.
- Methods: Quasi-experimental
- Takeaways: Participants in the Safe Start CHW program demonstrated improved engagement in care, reduced antenatal inpatient admissions, and shorter neonatal intensive care unit stays.
- Comments: WHO target of 85% coverage of 3 doses of IPTp has not been met in Malawi, even though most women are attending 3+ ANC visits. This study explores women’s knowledge of malaria risks during pregnancy and considers CHW interventions as a way to bridge knowledge gaps.
- Methods: Pre-implementation baseline survey administered to recently pregnant women (n=370) in two districts in Malawi (Nkhata Bay and Ntcheu)
- Takeaway: Very few respondents were aware of IPTp as a means of preventing malaria during pregnancy. Most women had a positive view towards CHWs, although only a third reported talking to a CHW during their most recent pregnancy, and among those very few addressed IPTp. To improve awareness and uptake of IPTp, CHWs may need additional education on this topic. (N.B. respondents also cited barriers that are largely unaffected by CHWs education, such as stock-outs of malaria tests and distance to treatment)
10. Hot off the press! COVID-19: It Ain’t Over Until There’s PPE All Over
- Comments: In our latest article, CHIC calls attention to the critical bottleneck standing in the way of decisive action in our COVID-19 response: community health workers—despite being a critical part of the response—are not receiving personal protective equipment (PPE).
- Takeaway : None of us are safe until all health workers are protected. Achieving PPE for all is not only necessary, but possible. Read the full article on Think Global Health to find out how.