Community Health Workers in Low- and Middle-Income Countries: What Do We Know About Scaling Up and Sustainability?

Pallas, Sarah Wood; Minhas, Dilpreet; Pérez‐Escamilla, Rafael; Taylor, Lauren A.; Curry, Leslie; Bradley, Elizabeth H.

doi:10.2105/ajph.2012.301102

Cited by 240 publications

(279 citation statements)

References 32 publications

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“…These findings suggest that, as with other communitybased programmes, focus should be given to maintaining motivation of community-based staff (37,38) . The Ethiopian programme is implemented within national health systems with limited resources.…”

Section: Discussionmentioning

confidence: 76%

Barriers to access for severe acute malnutrition treatment services in Pakistan and Ethiopia: a comparative qualitative analysis

Puett¹,

Guerrero

2014

Public Health Nutr.

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Objective: To understand and compare the primary barriers households face when accessing treatment for cases of childhood severe acute malnutrition (SAM) in different cultural settings with different types of implementing agencies. Design: The study presents a comparative qualitative analysis of two SAM treatment services, selected to include: (i) one programme implemented by a nongovernmental organization and one by a Ministry of Health; and (ii) programmes considered to be successful, defined as either coverage level achieved or extent of integration within government infrastructure. Results from individual interviews and group discussions were recorded and analysed for themes in barriers to access. Setting: Sindh Province, Pakistan; Tigray Region, Ethiopia. Subjects: Beneficiary communities and staff of SAM treatment services in two countries. Results: Common barriers were related to distance, high opportunity costs, knowledge of services, knowledge of malnutrition and child's refusal of ready-touse foods. While community sensitization mechanisms were generally strong in these well-performing programmes, in remote areas with less programme exposure, beneficiaries experienced barriers to remaining in the programme until their children recovered. Conclusions: Households experienced a number of barriers when accessing SAM treatment services. Integration of SAM treatment with other community-based interventions, as the UN recommends, can improve access to life-saving services. Efforts to integrate SAM treatment into national health systems should not neglect the community component of health systems and dedicated funding for the community component is needed to ensure access. Further research and policy efforts should investigate feasible mechanisms to effectively reduce barriers to access and ensure equitable service delivery.

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Section: Discussionmentioning

confidence: 76%

Barriers to access for severe acute malnutrition treatment services in Pakistan and Ethiopia: a comparative qualitative analysis

Puett¹,

Guerrero

2014

Public Health Nutr.

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“…17 A recent meta-analysis showed that one of the most important aspects of scalable interventions with CHWs is community acceptance. 18 Although some studies have demonstrated that iCCM interventions are acceptable to the community, 19,20 others have shown that programs are resisted if CHWs do not provide services of value. 21 This is important because iCCM programs, which have low utilization and likely low acceptance of services are the least costeffective, do not lead to decreases in mortality, and may decrease demand for biomedical health care, leading the most marginalized to seek care from ineffective providers.…”

Section: Introductionmentioning

confidence: 99%

Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

Shaw

Asadhi

Owuor

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Integrated community case management (iCCM) programs that train lay community health workers (CHWs) in the diagnosis and treatment of diarrhea, malaria, and pneumonia have been increasingly adopted throughout subSaharan Africa to provide services in areas where accessibility to formal public sector health services is low. One important aspect of successful iCCM programs is the acceptability and utilization of services provided by CHWs. To understand community perceptions of the quality of care in an iCCM intervention in western Kenya, we used the Primary Care Assessment Survey to compare caregiver attitudes about the diagnosis and treatment of childhood pneumonia as provided by CHWs and facility-based health workers (FBHWs). Overall, caregivers rated CHWs more highly than FBHWs across a set of 10 domains that capture multiple dimensions of the care process. Caregivers perceived CHWs to provide higher quality care in terms of accessibility and patient relationship and equal quality care on clinical aspects. These results argue for the continued implementation and scale-up of iCCM programs as an acceptable intervention for increasing access to treatment of childhood pneumonia.

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“…This professional, drawn from the community itself, is responsible for regular home visits, establishing the link between residents and the FHS team, and helping to improve the latter's actions regarding health determinants 5 . Numerous benefits of these professionals have been reported, particularly in low-to-middle income countries 6 . With regard to the population served, each FHS team is responsible for 4,000 persons at most versus 12,000 persons/team under the traditional model, in which there must be sufficient CHW to serve 100% of the registered population.…”

Section: Introductionmentioning

confidence: 99%

Primary health care as assessed by health professionals: comparison of the traditional model versus the Family Health Strategy

Flôr

Oliveira

Cardoso

et al. 2017

Rev. bras. epidemiol.

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Introduction:The Family Health Strategy (FHS) should be first-contact care in the Brazilian Health System. However, Primary Health Care (PHC) still encompasses two models: the FHS and the traditional health care facilities. The expansion of the FHS has been slow and heterogeneous in many cities, rendering a comparative evaluation of key quality-related elements of PHC models crucial. Objective: To compare the performance of PHC models as perceived by health professionals. Methods: A cross-sectional study involving managers and health professionals from PHC of a medium-size city in South-eastern Brazil. Data were collected by applying the Primary Care Assessment Tool. The performance was estimated through primary health care indexes (general and partial PHCI by attributes). Univariate polytomous logistic regression was performed to compare care model performances according to their attributes. Strength of association was estimated by odds ratio with 95% confidence interval. Results: Three managers and 81 health professionals participated in the study. The FHS had a better index rating than the traditional care model for general PHCI and for the attributes longitudinality, comprehensiveness, family focus and professional level. Conclusion: Although the FHS attained higher scores compared to the traditional model, it has not yet achieved the performance expected. This scenario points to the need for increased FHS cover and quality improvements at the existing units.

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Community Health Workers in Low- and Middle-Income Countries: What Do We Know About Scaling Up and Sustainability?

Cited by 240 publications

References 32 publications

Barriers to access for severe acute malnutrition treatment services in Pakistan and Ethiopia: a comparative qualitative analysis

Barriers to access for severe acute malnutrition treatment services in Pakistan and Ethiopia: a comparative qualitative analysis

Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

Primary health care as assessed by health professionals: comparison of the traditional model versus the Family Health Strategy

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