Community Health Research Round-Up, Issue 036

Hi All -

It’s time for another Community Health Research Round-Up! Issue 036 contains several articles on mHealth that will be of interest to this audience - check out #3 and #7!

Happy reading,

Community Health Research Round-Up, Issue 036

June 16 - June 29, 2020

1. COVID-19 Outbreak Situation in Nigeria and the Need for Effective Engagement of Community Health Workers for Epidemic Response .

  • Comments: The authors describe a bleak situation in Nigeria: ongoing and increasing community transmission of COVID19, inadequate testing, overwhelming of health resources, and infection of health workers. The solution they propose? CHWs, along with deployment of rapid epidemic intelligence and use of mobile apps for contact tracing.
  • Methods: Rapid review
  • Takeaway: CHWs can help Nigeria prevent, detect, and respond to outbreaks like COVID19; as well as ensure maintenance of essential health services. To do so, CHWs need PPE, training, and a litany of other supports from the national, subnational, and international community.

2 & 3. Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study & Community-based postpartum contraceptive counselling in rural Nepal: a mixed-methods evaluation.

  • Comments: Two studies on post-partum family planning (PPFP) counselling in Nepal (including one from Coalition Member, Possible, that includes an mHealth intervention). The first study looks at Nepal’s Female Community Health Volunteers (FCHVs), and the second includes paid, salaried CHWs employed by a local NGO, Nyaya Health Nepal.
  • Methods: Mixed methods
  • Takeaway: The first study documents an improvement FCHVs’ knowledge of PPFP which in turn improved their ability to provide wide coverage of counseling on PPFP to women. The second study w/ paid, mHealth-equipped CHWs trained in PPFP found that modern contraceptive use increased from 29% pre-intervention to 46% post-intervention (p<0.0001).

4. Establishing voluntary certification of community health workers in Arizona: a policy case study of building a unified workforce.

  • Comments : WHO recommends formal competency-based certification for CHWs, but this practice is not widespread. That makes this case study from Arizona (USA) especially interesting: the authors describe the process of getting two major CHW workforces ( promotoras de salud and community health representatives) to join forces and advocate for legislated voluntary certification.
  • Methods: Case study
  • Takeaway: Great example of the transformative change that can occur when multiple CHW cadres unite to demand pathways that support professionalization of the CHW workforce. May this be the first of many more case studies on CHW certification!

5. Prevention and treatment of suspected pneumonia in Ethiopian children less than five years from household to primary care.

  • Comments: Adding to the array of literature on CHWs and iCCM, this paper analyzes prevention, care seeking, and treatment of suspected pneumonia from household to health facility in Ethiopia.
  • Methods: x-sectional
  • Takeaway: What caught our eye is this finding in the conclusion: “Some of the health extension workers were not knowledgeable about suspected pneumonia.” The study also confirmed caregivers’ low preference for seeking care from HEWs. Even in an ‘exemplar’ country like Ethiopia, where HEWs have long been lauded for their tremendous contributions to reducing preventable maternal and child mortality, quality-producing practices (supportive supervision, training, supplies, etc.) are needed - urgently - to improve community-level care!

6. Coverage of community case management for malaria through CHWs: a quantitative assessment using primary household surveys of high-burden areas in Chhattisgarh state of India.

  • Comments: Another addition to the CHW + CCM literature, this one focuses on coverage. Nearly 40k CHWs were trained and equipped w/ RDTs, ACTs, and chloroquine as part of a large-scale CCM malaria program in Chhattisgarh.
  • Methods: 3 rounds of household surveys (2015, 2016, and 2018) w/ 15k household interviews per round
  • Takeaway: CHWs achieved high coverage and treatment-completion rates. In 2018, 62% of febrile cases in rural population contacted CHWs. N.B. CHWs had sufficient supplies (RDT, ACT and chloroquine) and cash incentives (CHWs were paid an incentive of Indian Rupees 23 per fever case tested & Indian Rupees 150 per case treated). The potential risks of performance-based incentives (discussed in WHO guidelines) are not addressed in the article.

7. Experiences and intentions of Ugandan household tuberculosis contacts receiving test results via text message: an exploratory study.

  • Comments: This exploratory study (part of a larger RCT) interviewed household contacts to understand how they experience TB test results delivered by SMS.
  • Methods: Semi-structured interviews with household contacts who received TB results via SMS
  • Takeaway: Technology can supplement CHW services, but it cannot replace them! Household contacts were less confident in TB test results delivered via text message versus results delivered via CHWs.

8. A comparative impact evaluation of two human resource models for community-based active tuberculosis case finding in Ho Chi Minh City, Viet Nam.

  • Comments: In a study examining scale up of active case finding (ACF) for TB in Viet Nam, researchers look at whether salaried CHWs or volunteer CHWs generate more TB case notifications.
  • Methods: 2-year controlled intervention
  • Takeaway: Both salaried and volunteer CHWs generated more case notifications using ACF versus the routine case finding approach. Salaried, employed CHWs achieved a greater impact on notifications and should be prioritized for scale-up.

9. “I cannot say no when a pregnant woman needs my support to get to the health centre”: involvement of community health workers in Rwanda’s maternal health.

  • Comments: The title is no shocker - many CHWs are intrinsically motivated and desire to help their communities. That doesn’t mean they shouldn’t be paid. This case study examines maternal-CHWs’ experiences and perceptions on access and provision of maternal health services in Rwanda.
  • Methods: Case study
  • Takeaway: The authors discuss critical issues that prevent CHWs from delivering adequate maternal health services: “The fact that M-CHWs are volunteers operating in limited resources settings with no formal training in maternal health and with considerable workloads translates into challenges regarding the quality and quantity of services they provide in their communities. Such challenges create an impact on M-CHWs service provision, satisfaction and retention.”

10. A qualitative study of social connectedness and its relationship to community health programs in rural Chiapas, Mexico.

  • Comments: From our friends at PIH, this study utilizes video interviews to explore how health programs impact social connectedness of communities. CHW programs are well set up for this by design, given the CHW’s role in conducting home visits and forming relationships with community members.
  • Methods: Qualitative
  • Takeaway: Patients appreciate the social component of CHW home visits! The combination of a staffed health clinic & a CHW program augmented social connectedness. Benefits included a stable community structure, provision of equal access to healthcare, and enhancement of interpersonal relationships among providers, CHWs, and community members.