The Changing Roles of Community Health Workers

Community Health Workers (CHWs) have been gaining attention from policymakers because of their unique role in addressing health disparities and socioeconomic drivers of disease, and because of their potential integration into the health care delivery system. To date, there has been limited research specifically describing the variation in CHWs’ roles and relationships, and how that variation relates to management, to financing, to health system integration, and to the competencies CHWs should have in different contexts. This report provides a snapshot of the varied landscape of CHW programs to better understand how CHWs are integrating with the health system both in terms of the structural elements of these programs, and the relational elements of CHW-health system interaction that make integrated models succeed. Authors suggest that there is no blueprint for success; rather, there are certain unifying structural elements of various integration types, and certain useful mechanisms that enable the preservation of the CHW concept

The effect of payment and incentives on motivation and focus of community health workers: five case studies from low- and middle-income countries

Community health workers (CHWs) have been proposed as a means for bridging gaps in healthcare delivery in rural communities. Recent CHW programmes have been shown to improve child and neonatal health outcomes, and it is increasingly being suggested that paid CHWs become an integral part of health systems. Remuneration of CHWs can potentially effect their motivation and focus. Broadly, programmes follow a social, monetary or mixed market approach to remuneration. Conscious understanding of the differences, and of what each has to offer, is important in selecting the most appropriate approach according to the context

Methadone Maintenance Treatment Decentralization in Vietnam

BackgroundTo respond to the dual HIV and injecting drug use epidemic, Vietnam has implemented methadone maintenance treatment (MMT) nationwide since 2010 and decentralized it to primary care (i.e. commune health centers) since 2015. The study aims to explore the challenges that Vietnamese community health workers (CHW) at commune health centers encounter in providing MMT and the factors associated to these challenges.MethodsThis study had a mixed method design. We used two types of data in this study. For the sub-study 1, we used the secondary data from a quantitative survey conducted in Vinh Phuc and Phu Tho provinces among 300 CHWs who did not provide MMT at the time of the study. For the sub-studies 2 and 3, we collected quantitative and qualitative primary data from Dien Bien province. We conducted a quantitative survey among 276 CHWs including both MMT providers and non-MMT providers. From this sample, we selected 26 MMT providers with various characteristics for in-depth interviews.ResultsIn the sub-study 1, the mean score of CHWs’ interaction with PWUD 36.4 (SD 8.8) on a scale of 60. The interaction between CHW not providing MMT and people who use drugs (PWUD) was negatively associated with their stigmatizing attitude towards PWUD (β = -0.84, 95% CL: -1.05; -0.63) after adjusting for their background (gender, education level, job position and years of working experience) and job-related characteristics (perceived risk and challenges when working with PWUD, job satisfaction and empathy towards PWUD). In the sub-study 2, 114 (41.3%) CHW had ever provided MMT services. Better MMT knowledge was associated with higher levels of confidence in providing MMT services among CHW who had no experience with MMT program (β=0.90, 95%CL: 0.29; 1.51), not among those who had experiences. On the other hand, technical support in working with PWUD was associated with a higher level of confidence in providing MMT services for both groups (β=0.71, 95%CL: 0.35; 1.08 and β=0.58, 95%CL: 0.19; 0.96 among CHWs who had ever and who had never worked in MMT, respectively). In sub-study 3, the perceived challenges for MMT provision included lack of confidence and motivation to provide MMT, inadequate human resource, lack of institutional support, insufficient technical support, lack of referral resources and additional support for patients, lack of policies to support the MMT program at CHCs and to protect service providers.ConclusionCHWs in Vietnam faced several challenges in working with PWUD and providing MMT services at primary care settings. Supportive policies and tailored interventions should be developed at different levels to ensure the quality and effectiveness of the MMT decentralization program

Designing for Practice Development in a Social Learning System: Communicating Norms and Vicarious Experience

Over the past quarter century, the United States has experienced an increase in demand for health services. Expanded use of community health workers (CHWs) has been identified as a strategic response for more effective distribution of healthcare resources by alleviating pressures on clinical personnel and infusing prevention education into the community-to-clinical care continuum. Expansion of the CHW workforce poses many challenges. For CHWs to effectively reduce costs and pressures on the healthcare system, ‘expansion’ implies not only increasing their numbers, but also assuring a workforce that has the capacity to perform in diverse settings. I propose a theoretical framework for practice development in a healthcare workforce and use the framework as a guide to test whether system design can motivate specific types of communications in an online social learning system. The results have important implications for 1) system design for development of a diverse healthcare workforce like CHWs, 2) designing for specific types of learning communications, and 3) the theoretical support for practice development. We successfully designed a social learning system to motivate what we believe to be norm affirming and self-efficacy developing communications. Further studies will determine whether this supports practice in healthcare as proposed by the theoretical framework

mHealth Innovation in Asia: Grassroots Challenges and Practical Interventions

This book offers a detailed account of a range of mHealth initiatives across South, Southeast and East Asia. It provides readers with deep insights into the challenges such initiatives face on the ground, and a view of the diverse cultural contexts shaping strategies for overcoming these challenges. The book brings together various discussions on the broader mHealth literature, and demonstrates how a research focus on diverse Asian contexts influences the success and/or failure of current mHealth initiatives. It also highlights the important roles social scientists can play in advancing theoretical approaches, as well as planning, implementing and evaluating mHealth initiatives. The book is a valuable resource for project planners, policy developers in NGOs and government institutions, as well as academics, researchers and students in the fields of public health, communications and development studies

What enables and hinders implementation? A mixed-methods case study of a mental health programme implemented in primary care clinics in rural Mexico

Background: The integration of mental health services into primary health care (PHC) is considered a key strategy to improve access to care for people with common mental disorders (CMDs) in low- and middle-income countries (LMICs), yet mental health services remain largely unavailable at the PHC level. In Mexico, mental health services are only available at 30% of PHC clinics. Difficulties in translating research findings into routine health service delivery represent a major obstacle to integration of mental health care in PHC. This project investigated the barriers and facilitators to the implementation of mental health programmes integrated in PHC platforms in low-resource settings. Methods: I conducted a systematic review of the barriers and facilitators to the implementation of programmes for CMDs in primary care in LMICs. Then I conducted a mixed-methods case study of a mental health programme integrated in PHC clinics located in rural Mexico to examine implementation process and outcomes, and elicit potential barriers and facilitators to the programme implementation. First, I used mixed-methods to describe the programme implementation and examine outcomes. Subsequently, I used mixed-methods to explore factors related to non-attendance to mental health follow-up consultations. Finally, I used qualitative methods to elicit barriers and facilitators to implementation from the perspectives of service providers and service users. Results: Factors influencing programme implementation were identified through the systematic review including the organisation’s readiness for implementation, the attributes, knowledge and beliefs of service providers, complex service user needs, adaptability and perceived advantage of interventions, and the processes of planning and evaluating the implementation. The case study showed that implementation outcomes included: programme integration, and high levels of acceptability and feasibility enabled through support from the implementing organisation. Fidelity was limited due to the low provision of talk-based interventions. Providers identified that delivering talk-based interventions was unfeasible due to time constraints and limited specialist support to develop the skills needed to provide them. Non-attendance to mental health consultations was an important challenge to implementation fidelity. Main barriers to attendance included, long distance to the clinics, type of treatment, and waiting times; facilitators were the presence of a comorbidity, and perceived need of treatment. Experiences with providers or treatments were identified as both facilitators and barriers. Key facilitators to the programme implementation were the cultural adaptation and perceived advantage of interventions to deliver mental health care, the commitment of health providers, the availability of key resources, an organisational culture that promoted health care as a human right, and the presence of a strong programme leadership. Key barriers included the complexity of mental health interventions, low self-efficacy from health providers, insufficient availability of mentorship from specialists, and the complex needs and expectations of service users. Conclusions: Strengthening the health system is a necessary first step to implement mental health programmes in PHC to ensure ongoing capacity building mechanisms, essential resources, and specialist support are available. Moreover, to adequately address the health and social needs of service users in low-resource settings, locally relevant social interventions and intersectoral collaboration are essential

AN ASSESSMENT OF M-HEALTH IN DEVELOPING COUNTRIES USING TASK TECHNOLOGY FIT MODEL

Health challenges present arguably the most significant barrier to sustainable global development. The introduction of ICT inhealthcare, especially the application of mobile communications, has created the potential to transform healthcare delivery bymaking it more accessible, affordable and effective across the developing world. However, current research into theassessment of mHealth from the perspective of developing countries particularly with community Health workers (CHWs) asprimary users continues to be limited. The aim of this study is to analyze the contribution of mHealth in enhancing theperformance of the health workers and its alignment with existing workflows to guide its utilization. The proposed researchtakes into account this consideration and aims to examine the task-technology alignment of mHealth for CHWs drawing uponthe task technology fit as the theoretical foundation

mHealth Innovation in Asia: Grassroots Challenges and Practical Interventions

mHealth Innovation in Asia; mHealth Initiatives and Policy; Grassroots mHealth Projects in Asia; Practical mHealth Interventions in Asia; Structures and Infrastructures of mHealth in Asia; Mobile Health; Health and Wellbeing; Media and Communications; Development Studies on Public Health; Community Health Workers; Mobile Phones in Healt

Digital Health-Enabled Community-Centered Care: Scalable Model to Empower Future Community Health Workers Using Human-in-the-Loop Artificial Intelligence

Digital health–enabled community-centered care (D-CCC) represents a pioneering vision for the future of community-centered care. D-CCC aims to support and amplify the digital footprint of community health workers through a novel artificial intelligence–enabled closed-loop digital health platform designed for, and with, community health workers. By focusing digitalization at the level of the community health worker, D-CCC enables more timely, supported, and individualized community health worker–delivered interventions. D-CCC has the potential to move community-centered care into an expanded, digitally interconnected, and collaborative community-centered health and social care ecosystem of the future, grounded within a robust and digitally empowered community health workforce.</p