Tools for training health workers & Community Health Impact Coalition-Research Round-Up Issue 16

Hi Everyone,

I’m pasting below issue 16 of the CHIC research round-up, courtesy of @mballard. You can see an archive here.

I always find something helpful in these round ups, and in this issue I wanted to call attention to the review of mHealth interventions for training that Niall Winters and his team recently published. @beatrice and I have been working on a book chapter that Niall and a few others are editing–our chapter explores case studies in Nepal and Mali, and examines how ongoing education and training can be integrated into routine supervision, when supervision is also supported by digital tools. I know Mike Bailey from the Community Health Academy is also working on a chapter for the book. I haven’t had a chance to read Niall’s latest paper yet, but we should probably do so and consider how it might inform our chapter. What do you say @beatrice?

Community Health Research Round-Up, Issue 016

August 13 - August 26, 2019

1&2. The impact of India’s accredited social health activist (ASHA) program on the utilization of maternity services: a nationally representative longitudinal modelling study & Are community health workers effective in retaining women in the maternity care continuum? Evidence from India

  • Comments: Two related papers from our friends at Hopkins + UNC
  • Methods: Difference-in-difference analysis with cluster-level fixed effects (utilization & multinomial logistic regression model (dropout along continuum). Data from Indian Human Development Surveys done in 2004–2005 and in 2011–2012
  • Takeaway:
    • Substantial variations in the receipt of ASHA services were reported
      (66% of women in northeastern states, 30% in high-focus states, & 16% in other states).
    • In areas where active ASHA activity was reported, the poorest and most marginalized women had the highest odds of receiving ASHA services.
    • Exposure to ASHA services was associated with a 17% (95% CI 11.8–22.1) increase in ANC-1, 5% increase in four or more ANC visits (95% CI − 1.6–11.1), 26% increase in SBA (95% CI 20–31.1), and 28% increase (95% CI 22.4–32.8) in facility births.
    • While ASHA is effective in supporting women to initiate and continue care along the continuum, it does not significantly affect the completion of all services along the continuum.
  • –> The ASHA program is successfully connecting marginalized communities to maternity health services. Given the potential of the ASHA in impacting service utilization, there is a need to strengthen strategies to recruit, train, incentivize, and retain ASHAs.
  1. Motivational Factors Influencing Retention of Village Health Workers in Rural Communities of Bhutan
  1. Using mobile technologies to support the training of community health workers in low-income and middle-income countries: mapping the evidence
  • Comments: Of interest to CHAcademy team. Pair w/related recent scoping review here (RR 012)

  • Methods: Evidence mapping methodology, based on systematic review guidelines

  • Takeaway: While the evidence map shows a positive shift away from information dissemination towards approaches that use more interactive learner-centred pedagogies, including supervision and peer learning, this was not seen across all areas of global health. The evidence map shows significant gaps in the use of mobile technologies for training: no studies of trauma, disability, nutrition or mental health that use information dissemination, peer learning or supervision for training CHWs in LMICs were found.

  1. A poverty in understanding’: Assessing the structural challenges experienced by community health workers and their clients
  • Comments: Gentle PSA for use of “patients” rather than “clients”; otherwise a helpful ethnography on structural barriers to care and CH-led solutions in Indiana, USA
  • Methods: Ethnography
  • Takeaway: Key barriers encountered by CHWs included difficulty in accessing resources for clients, lack of effective public transportation, barriers within the professional workforce, and the overarching negative impact of structural violence on client motivation. In spite of these issues, CHWs can address these barriers via adoption of a structural competency approach
  1. Supporting hearing health in vulnerable populations through community care workers using mHealth technologies
  • Comments: More evidence of CHWs for NCDs
  • Methods: Cross-sectional
  • Takeaway: Trained CHWs can decentralise hearing services to vulnerable communities using smartphone screening incorporating automated testing and measures of quality control
  1. Do home pregnancy tests bring women to community health workers for antenatal care counselling? A randomized controlled trial in Madagascar
  • Comments: Of interest to PIVOT crew (+ all, really)
  • Methods: RCT
  • Takeaway: Providing pregnancy tests to CHWs to distribute to their clients for free significantly increased the number of women at risk of pregnancy who sought services from CHWs–enabling more women to confirm they are pregnant and receive antenatal counselling.

Another fascinating round up. I was especially intrigued by:

The evidence map shows significant gaps in the use of mobile technologies for training: no studies of trauma, disability, nutrition or mental health that use information dissemination, peer learning or supervision for training CHWs in LMICs were found.

Perhaps members of our community will tackle those gaps like resources like OppiaMobile!