Multilevel determinants of community health workers for an effective maternal and child health programme in sub-Saharan Africa: a systematic review

Gebremeskel, Akalewold T; Omonaiye, Olumuyiwa; Yaya, Sanni

doi:10.1136/bmjgh-2021-008162

Cited by 17 publications

(24 citation statements)

References 60 publications

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“…This upgrade simplifies CHWs’ work methods, thereby empowering them. This empowerment motivates CHWs, improves their abilities, and enhances work efficiency [ 56 ]. This empowerment is crucial for sustaining CHW programs and improving healthcare delivery in underserved areas.…”

Section: Discussionmentioning

confidence: 99%

Barriers and benefits of mHealth for community health workers in integrated community case management of childhood diseases in Banda Parish, Kampala, Uganda: a cross-sectional study

Kansiime,

Atusingwize,

Ndejjo

et al. 2024

BMC Prim. Care

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Background Low-quality data presents a significant challenge for community health workers (CHWs) in low and middle-income countries (LMICs). Mobile health (mHealth) applications offer a solution by enabling CHWs to record and submit data electronically. However, the barriers and benefits of mHealth usage among CHWs in informal urban settlements remain poorly understood. This study sought to determine the barriers and benefits of mHealth among CHWs in Banda parish, Kampala. Methods This qualitative study involved 12 key informant interviews (KIIs) among focal persons from Kampala City Council Authority (KCCA) and NGOs involved in data collected by CHWs, and officials from the Ministry of Health (MOH) and two mixed-sex Focused Group Discussions (FGDs) of CHWs from Banda parish, Kampala district. Data analysis utilised Atlas Ti Version 7.5.7. Thematic analysis was conducted, and themes were aligned with the social-ecological model. Results Three themes of institutional and policy, community and interpersonal, and individual aligning to the Social ecological model highlighted the factors contributing to barriers and the benefits of mHealth among CHWs for iCCM. The key barriers to usability, acceptability and sustainability included high training costs, CHW demotivation, infrastructure limitations, data security concerns, community awareness deficits, and skill deficiencies. Conversely, mHealth offers benefits such as timely data submission, enhanced data quality, geo-mapping capabilities, improved CHW performance monitoring, community health surveillance, cost-effective reporting, and CHW empowering with technology. Conclusion Despite limited mHealth experience, CHWs expressed enthusiasm for its potential. Implementation was viewed as a solution to multiple challenges, facilitating access to health information, efficient data reporting, and administrative processes, particularly in resource-constrained settings. Successful mHealth implementation requires addressing CHWs’ demotivation, ensuring reliable power and network connectivity, and enhancing capacity for digital data ethics and management. By overcoming these barriers, mHealth can significantly enhance healthcare delivery at the community level, leveraging technology to optimize resource utilization and improve health outcomes. mHealth holds promise for transforming CHW practices, yet its effective integration necessitates targeted interventions to address systemic challenges and ensure sustainable implementation in LMIC contexts.

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Section: Discussionmentioning

confidence: 99%

Barriers and benefits of mHealth for community health workers in integrated community case management of childhood diseases in Banda Parish, Kampala, Uganda: a cross-sectional study

Kansiime,

Atusingwize,

Ndejjo

et al. 2024

BMC Prim. Care

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“…Our study was guided by different theoretical frameworks which informed the research processes and research questions. First, we used the socio-ecological model (SEM) to inform the description of the multilevel determinants of the CHWs program’s effectiveness [ 16 , 38 ]. The socio-ecological framework posits that factors at various levels uniquely and jointly contribute to health interventions.…”

Section: Theoretical Frameworkmentioning

confidence: 99%

“…The health program has overwhelmingly failed to address the quantity and quality of health workers [ 18 , 20 ]. The CHWs program continues to experience multiple challenges to enhance health outcomes [ 10 , 13 , 15 , 16 , 21 – 23 ].…”

Section: Introductionmentioning

confidence: 99%

Unpacking the challenges of fragmentation in community-based maternal newborn and child health and health system in rural Ethiopia: A qualitative study

Gebremeskel,

Udenigwe,

Etowa

et al. 2023

PLoS ONE

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Introduction In Ethiopia, country-wide community-based primary health programs have been in effect for about two decades. Despite the program’s significant contribution to advancing Maternal Newborn and Child Health (MNCH), Ethiopia’s maternal and child mortality is still one of the highest in the world. The aim of this manuscript is to critically examine the multifaceted fragmentation challenges of Ethiopia’s Community Health Workers (CHWs) program to deliver optimum MNCH and build a resilient community health system. Methods We conducted a qualitative case study in West Shewa Zone, rural Ethiopia. A purposive sampling technique was used to recruit participants. Data sources were two focus group discussions with sixteen CHWs, twelve key informant interviews with multilevel public health policy actors, and a policy document review related to the CHW program to triangulate the findings. Thematic analysis of the qualitative data was conducted. The World Health Organization’s health systems framework and socio-ecological model guided the data collection, analysis, and interpretation. Results The CHWs program has been an extended arm of Ethiopia’s primary health system and has contributed to improved health outcomes. However, the program has been facing unique systemic challenges that stem from the fragmentation of health finance; medical and equipment supply; working and living infrastructures; CHWs empowerment and motivation, monitoring, supervision, and information; coordination and governance; and community and stakeholder engagement. The ongoing COVID-19 and volatile political and security issues are exacerbating these fragmentation challenges. Conclusion This study emphasized the gap between the macro (national) level policy and the challenge during implementation at the micro (district)level. Fragmentation is a blind spot for the community-based health system in rural Ethiopia. We argue that the fragmentation challenges of the community health program are exacerbating the fragility of the health system and fragmentation of MNCH health outcomes. This is a threat to sustain the MNCH outcome gains, the realization of national health goals, and the resilience of the primary health system in rural Ethiopia. We recommend that beyond the current business-as-usual approach, it is important to emphasize an evidence-based and systemic fragmentation monitoring and responsive approach and to better understand the complexity of the community-based health system fragmentation challenges to sustain and achieve better health outcomes. The challenges can be addressed through the adoption of transformative and innovative approaches including capitalizing on multi-stakeholder engagement and health in all policies in the framework of co-production.

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“…Furthermore, this present review has shown that CHWs can deliver a range of services for patients requiring physical rehabilitation services as long as training or orientation is given. The need for standardisation of training and integration is emphasized as there is evidence of CHWs' effectiveness in service delivery taking into consideration that there is a chronic shortage of human resources for health, especially in SSA countries [71].…”

Section: Implications For Practicementioning

confidence: 99%

Community health workers’ provision of physical rehabilitation services in sub-Saharan Africa: a scoping review

Mapulanga

Kgarosi

Maluleke

et al. 2023

Preprint

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Background The increase in the prevalence of non-communicable diseases as a result of increasing life expectancy and changing lifestyles from active to sedentary has increased the demand for physical rehabilitation. Due to this increased demand, services are required as close to people as possible through task-shifting physical rehabilitation services thereby strengthening services at primary health care level. We systematically mapped evidence and described the scope of physical rehabilitation services delivered by CHWs, their mode of physical rehabilitation services delivery, and the barriers and facilitators experienced by CHWs in delivering physical rehabilitation services in SSA.Methods We used the framework of Arksey and O'Malley and Levac et al’s to guide this scoping review. We searched PubMed, Scopus, Cochrane Central, and databases within the EBSCOhost platform using a mix of Medical Subject Heading terms and a combination of keywords for relevant literature without applying language restrictions. We included articles presenting evidence on CHWs’ provision of physical rehabilitation services in SSA from January 1978 to December 2022. Two independent reviewers screened articles at the abstract and full-text screening guided by the inclusion or exclusion criteria and the PCC elements. All relevant data were extracted using a google form and organized into themes and a summary of the results was reported narratively. The methodological quality of included studies was assessed using the mixed methods appraisal tool.Results A total of 6996 were identified through database search and other sources of which 29 met the included criteria and were included for data extraction. The included 29 studies were conducted in eight countries with the majority 16/29 from South Africa followed by 5/29 from Malawi, 3/29 from Uganda and 2/29 from Ethiopia. Of the 29 articles, each one was conducted in Eritrea, Kenya, Namibia and Mauritius. The review revealed the scope of practice for CHWs to be palliative care, disability, non-communicable diseases, HIV/AIDS, assistive devices, neurology, community-based rehabilitation, speech and language, and general rehabilitation while the modes of delivery are community-based, home-based, health facilities, community with health facilities and community with home-based. The review also revealed that the barriers experienced by CHWs in the delivery of physical rehabilitation services are transport and distance, societal and community attitudes, supplies, finance, weather, delivery capacity and governance while the facilitators were proximity to the community, personal attitude, knowledge and technology.Conclusion The review shows that CHWs are involved in physical rehabilitation service delivery in sub-Saharan Africa. It is therefore necessary to develop a training model for CHWs in physical rehabilitation services. Moreover, the review shows that there is need for the integration of CHWs into the national healthcare system as a sustainable solution to curb the chronic human resources for health shortage in SSA.

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Multilevel determinants of community health workers for an effective maternal and child health programme in sub-Saharan Africa: a systematic review

Cited by 17 publications

References 60 publications

Barriers and benefits of mHealth for community health workers in integrated community case management of childhood diseases in Banda Parish, Kampala, Uganda: a cross-sectional study

Barriers and benefits of mHealth for community health workers in integrated community case management of childhood diseases in Banda Parish, Kampala, Uganda: a cross-sectional study

Unpacking the challenges of fragmentation in community-based maternal newborn and child health and health system in rural Ethiopia: A qualitative study

Community health workers’ provision of physical rehabilitation services in sub-Saharan Africa: a scoping review

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