Community Health Toolkit

Community Health Research Round-Up, Issue 035

Hi all,

Am chiming in w/issue 035. This is a really strong issue that I’d encourage you to scroll through–items #1,2,3, 4, 6, 8, & 9 are all salient to mobile app design & data collection more generally.


Community Health Research Round-Up, Issue 035
June 2 - June 15, 2020

1. Community health workers for pandemic response: a rapid evidence synthesis

  • Comments: A more thorough complement to the COVID-19 Special Edition Research Roundup from March
  • Methods: Rapid evidence synthesis including 36 articles
  • Takeaway: CHWs play a critical role in pandemics. Evidence came mostly from LMICS; evidence from high-income countries was scant. Most common additional activities during pandemics were community awareness and contact tracing. It is important to ensure role clarity, training, supportive supervision, as well as CHW work satisfaction, health and well-being. Providing PPE, housing allowance, training opportunities, transportation allowance, improving salaries (paid on time) & awards in high-profile public events contributed to better recruitment and retention.

2. The distinctive roles of urban community health workers in low- and middle-income countries: a scoping review of the literature

  • Comments: Urbanization will be a defining feature of low- and middle-income countries (LMICs) in the next decades; this study is the first to systematically examine urban CHW roles in LMICs.
  • Methods: Scoping review including 160 studies
  • Takeaway: There are significant similarities in the way CHW roles are delivered in both urban and rural contexts. This may reflect common barriers to accessing health services (e.g. limited transport) and underlying determinants of poor health (e.g. precarious livelihoods) across urban & rural populations–however, it may also be the result of failure to pay sufficient attention to the different realities of urban settings/the simplistic transplantation of rural models to urban contexts. Only two urban adaptations were identified: targeting low-income neighbourhoods (vs. population-wide services) and stigmatized communities (e.g. MSM) who might self-exclude from health services.

3. How do decision-makers use evidence in community health policy and financing decisions? A qualitative study and conceptual framework in four African countries

  • Comments: This study was conducted to understand the use of evidence in policy and financing decisions for large-scale community health programmes in low- and middle-income countries
  • Methods: Qualitative (key informant interviews with 43 respondents in countries with community health embedded in national UHC strategies - Ethiopia, Kenya, Malawi, Mozambique)
  • Takeaway: Evidence use in national community health policy and financing decisions is limited by capacity of decision-makers to use it + perceived poor quality. This perception stems from (i) desire for local evidence that reflects the context, and (ii)much existing economic evidence does not deal with what decision-makers value when it comes to community health systems—i.e. coverage and (to a lesser extent) quality. Elected officials also face structural obstacles to evidence use, including the outsized influence of donor priorities

4. When financial incentives backfire: Evidence from a community health worker experiment in Uganda

  • Comments: Entrepreneurial CHW models are growing in popularity. This study examines how an entrepreneurial community health worker (CHW) model affects CHW effort compared to a free distribution model.
  • Methods: Randomized trial
  • Takeaway: The growth in entrepreneurial CHW models is at odds with a large body of economics literature that documents that households are very sensitive to the price of health products. This study found that, despite stronger financial incentives (CHWs kept the sales revenue), the entrepreneurial model led to less effort (fewer household visits) than the free delivery model and dampened demand. Qualitative evidence suggests that selling had a social penalty whereas free distribution was socially rewarding. Implementors of CHW programs should think carefully before incorporating entrepreneurial features and strive to understand how these features compare to alternatives.

5. Community Health Worker Initiatives: An Approach to Design and Measurement

  • Comments: Another logic model! Though this one is specifically tailed to the distinct bodies of work occurring at a statewide policy level (e.g. vs. Naimoli 2014) so may be particularly relevant for US colleagues
  • Methods: Three phases: (1) gathering and organizing M&E metrics currently used by various CDC organizational units; (2) developing a logic model; and (3) mapping M&E metrics to the logic model.
  • Takeaway: The logic model presents the policy activities needed at
    a statewide infrastructural level, related inputs, and the
    outcomes resulting from these. Public health practitioners can use existing metrics or develop new ones to measure the outcomes reflected in the
    logic model.

6&7. Impact of mobile health-enhanced supportive supervision and supply chain management on appropriate integrated community case management of malaria, diarrhoea, and pneumonia in children 2-59 months: A cluster randomised trial in Eastern Province, Zambia& Cost analysis of integrated community case management of childhood malaria, diarrhea and pneumonia enhanced by mobile health technology in rural Zambia

  • Comments: A randomized trial with cost data! This study looked at if mHealth technology could be used to strengthen supervision and supply chain management of iCCM commodities for community-level workers
  • Methods: C-RCT & cost analysis
  • Takeaway: The paper found the mHealth intervention was not associated w/statistically significant difference in supportive supervision; appropriate treatment of malaria, diarrhoea, or pneumonia; or the overall impact on stockouts of iCCM commodities. Adding mobile health technology to iCCM activities was associated with an incremental cost of USD 11.50 per child contact. Over two thirds of this cost was attributable to program costs; economies of scale would be expected.

8. A monitoring and evaluation gap for WHO’s community health worker guidelines, Botswana

  • Comments: Worth a read. Some damning stats on global reporting of CHWs, which explain why there are no good global estimates. “Since 1978, WHO has asked Member States to report data on CHWs annually to the Global Health Observatory data repository…the definition of CHW is not standardized; WHO lets each country use its own definition…only 57 Member States have ever reported CHW numbers to the repository. Only six Member States have reported CHW numbers more than 10 times”
  • Methods: Perspective
  • Takeaway: The Botswana analysis confirms that the WHO guidelines for CHWs are a useful tool for action at the national level. More robust and systematic monitoring of the WHO guideline will identify trends in evening-out imbalances in CHW integration in the health system, provide evidence for CHW contributions to health system performance and track WHO Member States’ commitment to universal health coverage.

9. Prioritising the role of community health workers in the COVID-19 response

  • Comments: In March, the Community Health Impact Coalition released a widely circulated white paper articulating priorities for the global COVID-19 response. This week, the white paper was published in BMJ Global Health.
  • Methods: NGT
  • Takeaway: The article outlines the targeted actions needed at different stages of the pandemic to achieve the following goals: (1) PROTECT healthcare workers, (2) INTERRUPT the virus, (3) MAINTAIN existing healthcare services while surging their capacity, and (4) SHIELD the most vulnerable from socioeconomic shocks. The four priorities articulated in the paper remain a critical yardstick against which to measure the response - read an update to the paper on CHW Central