Health by the people, again? The lost lessons of Alma-Ata in a community health worker programme in Zambia

Wintrup, James

doi:10.1016/j.socscimed.2022.115257

Cited by 8 publications

(4 citation statements)

References 47 publications

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“…The conceptual model of CHW-facilitated access to primary care developed in this article explores the way in which CHWs support people living in socio-economically vulnerable circumstances in their access to primary care in Belgium. strengthen primary healthcare [14][15][16]. CHWs are trusted members of local communities, who have shared life experience with the people they support.…”

Section: Discussionmentioning

confidence: 99%

Facilitating access to primary care for people living in socio-economically vulnerable circumstances in Belgium through community health workers: towards a conceptual framework

Masquillier,

Cosaert

2023

Preprint

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Introduction Inspired by examples in low- and middle-income countries, 50 community health workers (CHWs) were introduced in Belgium to improve access to primary care for people living in socio-economically vulnerable circumstances. This article aims to explore the ways in which community health workers (CHWs) support people living in socio-economically vulnerable circumstances in their access to primary care. Methods The qualitative research focuses on the first year of implementation of this pioneer nationwide CHW programme in Belgium. To respond to the research aim, thirteen semi-structured in-depth interviews were held with people living in socio-economically vulnerable circumstances. In addition, a photovoice study was conducted with fifteen CHWs comprising four phases: (1) photovoice training; (2) participatory observation with each CHW individually; (3) an individual semi-structured in-depth interview; and (4) three focus group discussions. Results The qualitative results show that the CHWs’ outreaching way of working allows them to reach people living at the crossroads of different vulnerabilities that are intertwined and reinforce each other. They experience complex care needs, while at the same time they face several barriers that interrupt the continuum of access to primary care – as conceptualised in the theoretical access-to-care framework of Levesque and colleagues [1]. Study findings suggest that CHWs adapt their support to the unique interplay between health system barriers and individual barriers people living in socio-economically vulnerable circumstances might experience along the access-to-care continuum. However, important to note is that the qualitative results show that the way in which CHWs support people is also impacted by the broader health system, such as long waiting times and unwelcoming healthcare professionals after referral from a CHW. Discussion CHWs can thus play a valuable bridging role between the Belgian healthcare system and people living in socio-economically vulnerable circumstances who have little to no access to regular healthcare. The conceptual model of CHW-facilitated access to primary care developed in this article explores the way in which CHWs support people living in socio-economically vulnerable circumstances in their access to primary care in Belgium.

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Section: Discussionmentioning

confidence: 99%

Facilitating access to primary care for people living in socio-economically vulnerable circumstances in Belgium through community health workers: towards a conceptual framework

Masquillier,

Cosaert

2023

Preprint

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“…5 The 2000s saw a reorientation and interest in CHWs once again with increased interest in implementing CHW programmes although most recent attempts continue to be plagued by very similar challenges as those faced in the 1970s, including poor implementation and resource challenges. 3 In recent years, several critical questions have arisen on the ongoing role of CHWs and the possibilities for improving public health through their work such as whether they should only work in communities or within facilities, who should select them and to whom they are accountable. [6][7][8] Although CHWs have played a wide range of public health roles, not much attention has been given to their role in public health surveillance.…”

Section: Open Accessmentioning

confidence: 99%

Public health surveillance through community health workers: a scoping review of evidence from 25 low-income and middle-income countries

Alhassan,

Wills

2024

BMJ Open

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BackgroundThe last 3 years have witnessed global health challenges, ranging from the pandemics of COVID-19 and mpox (monkeypox) to the Ebola epidemic in Uganda. Public health surveillance is critical for preventing these outbreaks, yet surveillance systems in resource-constrained contexts struggle to provide timely disease reporting. Although community health workers (CHWs) support health systems in low-income and middle-income countries (LMICs), very little has been written about their role in supporting public health surveillance. This review identified the roles, impacts and challenges CHWs face in public health surveillance in 25 LMICs.MethodsWe conducted a scoping review guided by Arksey and O’Malley’s framework. We exported 1,156 peer-reviewed records from Embase, Global Health and PubMed databases. After multiple screenings, 29 articles were included in the final review.ResultsCHWs significantly contribute to public health surveillance in LMICs including through contact tracing and patient visitation to control major infectious diseases such as HIV/AIDS, malaria, tuberculosis, Ebola, neglected tropical diseases and COVID-19. Their public health surveillance roles typically fall into four main categories including community engagement; data gathering; screening, testing and treating; and health education and promotion. The use of CHWs in public health surveillance in LMICs has been impactful and often involves incorporation of various technologies leading to improved epidemic control and disease reporting. Nonetheless, use of CHWs can come with four main challenges including lack of education and training, lack of financial and other resources, logistical and infrastructural challenges as well as community engagement challenges.ConclusionCHWs are important stakeholders in surveillance because they are closer to communities than other healthcare workers. Further integration and training of CHWs in public health surveillance would improve public health surveillance because CHWs can provide health data on ‘hard-to-reach’ populations. CHWs’ work in public health surveillance would also be greatly enhanced by infrastructural investments.

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“…While both the governments and international health organizations operating in South Africa and Zambia have relied on community health organizations and workers to provide primary and emergency health services in the past, they have provided little support. These resource limitations may restrain community health organizations' ability to support communities' health needs (19,21,34). Given the reliance on community health organizations, the history of limited resources, and the nature of the crisis, it is critical to understand the role of these organizations in promoting public health in South Africa and Zambia.…”

Section: Research-article2023mentioning

confidence: 99%

Exploring the role of community health organizations in promoting public health during a health crisis: a qualitative study of COVID-19 responses in South Africa and Zambia

Johnston,

Zhang Aluri,

Job

et al. 2023

Glob Health Promot

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While the COVID-19 pandemic amplified the need for accurate and actionable health information, uncertainty and the proliferation of misinformation have contributed to significant mistrust in public health messages, especially among marginalized communities. Community health organizations can play an important role in creating trust and providing targeted health information to vulnerable groups. This qualitative study, which is focused on community health organizations supporting vulnerable populations in South Africa and Zambia, finds that during the pandemic, community health organizations expanded their roles and leveraged their established access and trust to support the communities they serve with health education and services. However, the reliance on external support limits the organizations’ ability to respond in an effective and efficient manner during health crises.

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Health by the people, again? The lost lessons of Alma-Ata in a community health worker programme in Zambia

Cited by 8 publications

References 47 publications

Facilitating access to primary care for people living in socio-economically vulnerable circumstances in Belgium through community health workers: towards a conceptual framework

Facilitating access to primary care for people living in socio-economically vulnerable circumstances in Belgium through community health workers: towards a conceptual framework

Public health surveillance through community health workers: a scoping review of evidence from 25 low-income and middle-income countries

Exploring the role of community health organizations in promoting public health during a health crisis: a qualitative study of COVID-19 responses in South Africa and Zambia

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