Community healthcare worker response to childhood disorders: Inadequacies and needs

Background: Community healthcare workers (CHWs) play a vital role in linking health facilities and communities where there is a high prevalence of childhood disorders. However, there is limited literature on whether this cadre of workers is adequately prepared for this task. Aim: This study explored the training needs of CHWs working in the field of childhood disorders and disabilities to improve the future training of CHWs and service delivery. Setting: This study was conducted in an urban district in KwaZulu-Natal, South Africa. Methods: This qualitative study used purposive sampling to recruit 28 CHWs and 4 key informants working in health facilities in one district of the KwaZulu-Natal Province in South Africa. Data were collected via semi-structured interviews and focus groups. Interviews were conducted in the first language (isiZulu) of the CHWs. Data were analysed thematically. Ethical clearance was obtained from a Biomedical Science Research Ethics Committee. Results: There was an evident lack of knowledge and skill in managing childhood disorders and disabilities by CHWs. Enablers and restrictors affecting service delivery were highlighted. Moreover, the training needs of CHWs have raised critical concerns because of the variable nature of training and perceived inadequate preparation for service delivery. The challenges raised werealso generic to the holistic role of CHWs and not particularly specific to the CHW role in childhood disorders and disabilities. Conclusion: Training of CHWs in childhood disorders may assist in improving CHWs' competence and confidence in the field, which may enhance service delivery and thus may assist in contributing towards improving healthcare for children at this level of care

Community healthcare workers' satisfaction with ward-based outreach team services in Tshwane district, South Africa

Background: The incorporation of community healthcare worker (CHW) involvement in the management of patients is in line with the 2006 World Health Report, which advocates increased community participation and the systematic delegation of tasks to less specialised cadres. For CHWs to function optimally, satisfaction in their duties is paramount to promote quality healthcare. The health minister included ward-based outreach teams (WBOT) as part of the National Health Insurance. 1 CHWs form an important link between healthcare facilities and the communities. This study aimed to measure the satisfaction level of the CHWs with WBOT services in the Tshwane district of South Africa. Method: A cross-sectional study on CHWs was conducted in seven sub-districts. Data were obtained by trained data collectors using a piloted self-administered structured questionnaire from October 12 to November 3, 2015 in three local official languages. The study population of CHWs was 1 600. Using a 95% confidence level and 5% confidence interval, the sample size was 310. However, we over-sampled to 431 participants. Results: The mean age was 36 years (SD ± 9.46). The majority were females (82.1%); more than three-quarters (77%) had secondary education. The majority were satisfied with the WBOT services whereby 59.8% was the lowest score and 98.4% the highest score. Close to two-thirds (62%) were not satisfied with their monthly stipends. The majority of the younger members of the team (20­40 years) were not valued by their co-workers (70% or 181/255) [p= 0.03]. The overall satisfaction(n= 8593) was 73.4% (p< 0.001).Conclusion: Overall satisfaction of CHWs with WBOT is good news. Dissatisfaction regarding stipend/compensation must be addressed. CHWs should be valued and motivated

Fighting against HIV and AIDS within a resource constrained rural setting: a case study of the Ruvheneko Programme in Chirumhanzu, Zimbabwe

Since reports of the first incidence of the HIV virus in Zimbabwe in 1985, the epidemic has negatively impacted on every facet of human security. Rural areas, by virtue of being the periphery and constrained in terms of resources and health care provision, bear the brunt of the epidemic. In light of the above background, this paper examined how the establishment of Ruvheneko Programme by the people of Chirumhanzu helped in mitigating on the impact of HIV and AIDS in the rural sphere. The paper analyses how the community of Chirumhanzu successfully engaged each other to the extent of coming up with such a vibrant programme. This is raised against the backdrop of failure usually associated with HIV and AIDS engagement projects. The study made use of field interviews and focus group discussions as data collection instruments. Participants were purposively selected on the basis of their knowledge and participation in the establishment and activities of Ruvheneko Programme. Selected were 5 St Theresa's Hospital Staff, 10 Roman Catholic Church members of which, 5 were from the St Anna's woman prayer group and 5 men from St Joseph's men prayer group, 1 village head and 2 elders from the same nearby village constituted key informants. Complementing the use of interviews and focus group discussions was the analysis of secondary data sources on HIV and AIDS in Zimbabwe as well as the Ruvheneko Programme. To understand the collective role of various sectors of the community in establishing Ruvheneko Programme, the paper derives insights from the perspective of social capital theory and its notion of commonality to strengthen communities. Findings from the study show that, unlike other HIV and AIDS programmes that are exported from the urban to the rural areas, Ruvheneko Programme demonstrates a grassroots-level response to HIV and AIDS. Again, social cohesion fostered by aspects such as religiosity, cultural ethos of Ubuntu, and a consultative approach played a key role in unifying people towards fighting HIV and AIDS in Rural Chirumhanzu

Staffing levels at KwaZulu-Natal district hospitals: is the University of KwaZulu-Natal training for the needs of the province?

Background: Universities have a social responsibility to ensure that they select and train healthcare professionals (HCPs) who can meet the healthcare needs of local communities. The aim of this study was to assess the extent to which the University of KwaZulu-Natal (UKZN) contributes to the training of HCPs working in district hospitals (DHs) in KwaZulu-Natal Province, and the impact that the funding source for their training has on DH staffing.Methods: This was an observational descriptive study, with all doctors, dentists, dental therapists, pharmacists, physiotherapists and radiographers working at DHs in KZN in November 2016 being invited to participate. Data were collected through a validated questionnaire.Results: A total of 514 HCPs working in 29 DHs participated in the study; over half (57%) of the South African medical graduates had trained at UKZN, as had 62% of pharmacists, 64% of physiotherapists and 92% of dental therapists. Some 87% of the HCPs had worked in DHs for five years or less, 65% planned to leave in the near future, and 29% planned to leave at the end of 2016.Discussion: UKZN plays a significant role in training for the short-term needs of DHs in KZN. Much of the workforce is young and transient, which has implications for service provision and expanding the teaching platform to DHs. The lack of long-term staff retention suggests that UKZN needs to continually monitor the selection of students, as well as the content and context of the training, if it is to contribute to the province's long-term staffing needs

Individual versus community-level measures of women decision-making involvement and child survival in Nigeria

Background. Although decision-making authority is associated with maternal healthcare utilisation, the evidence on the relative importance of individual-level v. community-level decision-making participation for child survival in sub-Saharan Africa is limited. Objectives. To assess the net effects of individual- and community-level measures of decision-making involvement (DMI) on under-5 mortality in Nigeria. Methods. Data on a nationally representative sample of 31 482 children in the 2013 Nigeria Demographic and Health Survey were analysed. Mothers who reported involvement in decision-making on own healthcare, major household purchases and visits to friends and relatives were categorised as having high DMI. Community-level measures of DMI were derived by aggregating the individual measures at the cluster level. Kaplan-Meier estimates of childhood mortality rates were computed. Multilevel discrete-time hazard models were employed to investigate the net effect of individual- and community-level DMI on childhood mortality. Results. Childhood mortality, at 59 months, was higher among children of women with low DMI (120 per 1 000) compared with those with high DMI (84 per 1 000). The full multilevel model showed that there was no difference in the risk of childhood death between children whose mothers had high v. low DMI (hazard ratio (HR) 1.01, CI 0.90 - 1.12). However, mortality risk was found to be lower among children in communities with medium DMI (HR 0.84, CI 0.74 - 0.96). Maternal age at child's birth, education, household wealth index and preceding birth interval were significantly associated with under-five mortality. Conclusion. Besides socioeconomic and biodemographic characteristics, community- and not individual-level DMI was associated with under-5 mortality. Women's empowerment programmes targeting maternal and child health outcomes should also focus on communities

Analyse de la prise en charge communautaire des orphelins et enfants rendus vulnerables (OEV) par le VIH/SIDA : experience de l'organisation communautaire de base (OCB) Jammixale yi Thies (Senegal)

Introduction: le VIH/SIDA ne cesse de provoquer de multiples difficultes avec l'accroissement du nombre d'orphelins et enfants vulnerables (OEV). Au Senegal; 3193 OEV etaient recenses en 2008. L'objectif etait d' analyser la prise en charge communautaire des OEV par l'organisation communautaire de base (OCB) JammiXale Yi (JXY) de Thies afin de mieux apprecier les effets psychologiques du VIH sur les enfants; les parents. Population et methode: Il s'agissait d'une etude transversale faite en 2009 aupres des agents de sante; des OEV et de leurs parents. Des entretiens individuels et des focus groups ont permis de recueillir des donnees. Selon la source et la cible; une triangulation des informations avait ete faite Resultats : 61 OEV etaient suivis. L'age moyen etait de 9;82 ans; variant entre 2 mois et 17 ans. Le sex- ratio etait de 1;08 (filles = 48).Dans cet OCB; 99 des enfants etaient a l'ecole publique; 20 avaient une bourse scolaire ; 92 n'etaient pas depistes. Parmi ceux depistes; 8 etaient seropositifs.Selon la cible; les principaux effets psychosociaux du VIH/SIDA etaient pour les enfants: l'utilisation de l'alcool; de la drogue; la prostitution. Pour les parents venaient au premier rang : la discrimination; le non depistage des enfants; les difficultes d'acces aux soins de qualite; l'attitude d'indiscretion du personnel de la sante. Les agents de sante avaient surtout souligne le manque de formation sur la prise en charge psychologique des OEV. Conclusion : on note l'importance des effets psychosociaux du VIH/SIDA sur les enfants; leurs parents et la difficulte de la prise en charge communautaire de cette maladie dans les pays a ressources limitees

Assessment of Community Pharmacists' Willingness to become Tuberculosis DOTS Services Providers in Lagos State

"Background: Hospital based Directly Observed Therapy Short course (DOTS) for the treatment of tuberculosis though effective has constraints to its effectiveness e.g. restricted timings of TB clinics; long distance to travel by tuberculosis patients to TB DOTS clinics; etc. Community pharmacy based TB DOTS services under thesupervision of community pharmacists can address these constraints. Objectives: To assess community pharmacists' willingness to become Tuberculosis Directly Observed TherapyShort course (TB DOTS) service providers in Lagos state; Nigeria. Methods: A 25 item self completion questionnaire was administered to 120 community pharmacists spreadacross three; Association of Community Pharmacists zones of Ikotun; Iyana-Ipaja; as well as Festac zones in Lagos state; Nigeria respectively. These community pharmacists' zones were formed in Lagos state to ensure theease of administration and prevention of the operation of illegal premises in Lagos state and the twelve zones inLagos state are duly recognized by both the Pharmaceutical Society of Nigeria and the State Chapter of the Association of Community Pharmacists. Data was collected on a scale that ranged from 8 to 40 with an assumedneutral point of 24 and statistically analysed. Results: Community pharmacists in Lagos state Nigeria were willing to be TB DOTS services providers as shownby a mean score of 30.53+ 6.71 in 77 of the respondents. On the 5-point rating scale; ""5"" represented thehighest mean score while ""1"" represented the lowest mean score. On the 8 item scale; the lowest mean score is 8and the highest mean score is 40 with a neutral point of 24. The percentage performance was the number of respondents that scored above the critical or neutral point on the rating scale. Statistically not significant association was observed between having heard of TB DOTS services and their willingness (X2 =0.66; P=0.3485;P0.05). Association between training in the provision of TB DOTS services and the willingness observed was2statistically also not significant (X =2.08; P=0.2525; P0.05).So also for the association between number of yearsof community pharmacy practice and their willingness to be TB DOTS service providers (X2=1.18; p=0.371;P0.05). Conclusion: Community pharmacists in Lagos state Nigeria are willing to be TB DOTS services providers. Howevertheir willingness to be TB DOTS services providers is not associated with the level of training that they have hadon TB DOTS services provisions; neither is it associated with their level of awareness about TB DOTS services.Their years of community pharmacy practice experience also had no influence on their willingness to be TB DOTSservices providers."

A model for mentorship of newly qualified professional nurses employed in community health care services

The purpose of this study was to develop a model for mentorship of newly qualified professional nurses (NQPNs) employed in community health care services. A triangulation of qualitative and quantitative designs was used for data collection. The experiences of NQPNs employed in community health care services were explored through focus group interviews. Based on the findings of the interviews; three questionnaires for different categories were developed to determine the self-care deficiencies that required mentorship of NQPNs. The findings revealed that NQPNs experienced self-care deficiencies regarding the performance of specific competencies related to dealing with psychiatry; midwifery practice; adaptation; organizational culture; health practice culture and interaction with the community they serve. It was recommended that adaptation/adjustment; health and nursing practice culture; development of skills and competencies; improvement of good relationships between NQPNs and community should be emphasised during training of nursing students to become professional nurses

Willingness to Practice Basic First Aid Care among Community Pharmacists in Lagos Nigeria

Background: The growing incidence of terrorism and/or disasters across the world makes it important that all healthcare professionals get empowered with the skills to offer first aid to selfor others when the need arises. Objectives: The objectives of this study were to assess the knowledge and willingness to practice basic life saving first aid care (FAC) among community pharmacists in a metropolitan city; South West Nigeria Methods: This study was conducted with the aid of structured interview and questionnaires among registered community pharmacists in two Local Government Areas (LGAs) of Lagos State and thereports obtained were subjected to descriptive and inferential statistical analysis. Results: The feedback showed that almost all (136; 96.1) of the respondents could correctly define first aid care and also gave the correct aim of the provision of first aid care. Majority 126 (88.1) had been involved in the practice of life saving first aid care though only very few (13; 9.1) attended arecent training on FAC. However; their practice of FAC was affected by lack of adequate FA skills; the inability of most clients to pay for their bills; lack of cooperation from other members of the healthteam regarding referral of FAC cases in Lagos state; and lack of standardized skills acquisition protocols for the training of community pharmacists in the provision of FA. Conclusion: The community pharmacists in the two study areas demonstrated good knowledge offirst aid care but few applied this knowledge in their daily practice. The pharmacists indicated willingness to practice first aid effectively if properly trained. There is a need to sensitize all stakeholders to ensure that good quality first aid care services are made available in the community pharmacies

Community-directed interventions for priority health problems in Africa: results of a multicountry study

Objective To determine the extent to which the community-directed approach used in onchocerciasis control in Africa could effectively and efficiently provide integrated delivery of other health interventions.Methods A three-year experimental study was undertaken in 35 health districts from 2005 to 2007 in seven research sites in Cameroon; Nigeria and Uganda. Four trial districts and one comparison district were randomly selected in each site. All districts had established ivermectin treatment programmes; and in the trial districts four other established interventions - vitamin A supplementation; use of insecticide-treated nets; home management of malaria and short-course; directly-observed treatment for tuberculosis patients - were progressively incorporated into a community-directed intervention (CDI) process. At the end of each of the three study years; we performed quantitative evaluations of intervention coverage and provider costs; as well as qualitative assessments of the CDI process. Findings With the CDI strategy; significantly higher coverage was achieved than with other delivery approaches for all interventions except for short-course; directly-observed treatment. The coverage of malaria interventions more than doubled. The district-level costs of delivering all five interventions were lower in the CDI districts; but no cost difference was found at the first-line health facility level. Process evaluation showed that: (i) participatory processes were important; (ii) recurrent problems with the supply of intervention materials were a major constraint to implementation; (iii) the communities and community implementers were deeply committed to the CDI process; (iv) community implementers were more motivated by intangible incentives than by external financial incentives. Conclusion The CDI strategy; which builds upon the core principles of primary health care; is an effective and efficient model for integrated delivery of appropriate health interventions at the community level in Africa

Scaling up community-based services and improving quality of care in the state psychiatric hospitals: the way forward for Ghana

Objective: This paper aims to explore the options available for developing community-based care and improving the quality of care in psychiatric hospitals in Ghana. Method: Semi-structured interviews (SSIs) and focus group discussions (FGDs) were conducted with a cross-section of stakeholders including health professionals; researchers; policy makers; politicians; users and carers. The SSIs and FGDs were recorded digitally and transcribed verbatim. Apriori and emergent themes were coded and analysed with NVivo version 7.0; using a framework analysis. Results: Psychiatric hospitals in Ghana have a mean bed occupancy rate of 155. Most respondents were of the view that the state psychiatric hospitals were very congested; substantially compromising quality of care. They also noted that the community psychiatric system was lacking human and material resources. Suggestions for addressing these difficulties included committing adequate resources to community psychiatric services; using psychiatric hospitals only as referral facilities; relapse prevention programmes; strengthening psychosocial services; adopting more precise diagnoses and the development of a policy on long-stay patients. Conclusion: There is an urgent need to build a credible system of community-based care and improve the quality of care in psychiatric hospitals in Ghana

A Rapid Assessment of District Health Systems in Six Countries of the WHO African Regions

Objectives: This paper reviews the adequacy of inputs and processes at district level to support outputs and outcomes of service delivery at district level using a rapid assessment. The outputs included in this study are those considered essential for the attainment of the Health related Millennium Development Goals(MDGs). Data sources: A questionnaire based rapid District Health Systems assessment was conducted among six African countries during the year 2007. Study selections: The study took place in a random sample of six out of 19 eng speaking countries of the WHO African region. These countries are Ghana; Liberia; Namibia; Nigeria; Sierra Leone and Uganda. Data extraction: The data was extracted from the questionnaires; entered and analysed in Excel spreadsheet. Data synthesis: In spite of the variability in quality and completeness of reporting on the selected parameters; this paper does indicate that according to country norms and standards; the inputs and processes are insufficient to lead to acceptable outputs and outcomes; especially those related to the MDGs. An important point to note is that comparability across countries is made on the basis of individual country norms and standards. Implicit in this assessment is that country norms and standards are reasonable and are appropriate for the attainment of the MDGs. However reasonable the country norms and standard are; it is unlikely that the low resource base as well as weak organisational and managerial capacities in most countries will support effectively the attainment of the MDGs. Conclusion: Most countries manage to offer the essential health services at all levels of care despite the relatively low level of inputs. However; their level of quality and equity is debatable. The general trend is that provision of the essential health services is more at the higher levels of care prompting concerns for the populations served at lower levels of care. There is also a tendency to have wide variations in the performance of service delivery geographically as well as at the different levels of the health systems. This paper recommends further exploration of the impact of focusing on improving quality of existing health services while increasing quantity of service delivery points to achieve higher coverage of essential health services

Effectiveness of Community Health Workers (CHWS) in the Provision of Basic Preventive and Curative Maternal; Newborn and Child Health (MNCH) Interventions: A Systematic Review

Due to a shortage of health workers; many low income countries rely on community health workers (CHWs) for the provision of a wide range of primary health care services; both curative and preventive; including maternal newborn and child health (MNCH) interventions. Several systematic reviews have analysed the contribution of CHWs although none has specifically focused on their role in relation to MNCH. This review was designed to find evidence of the effectiveness of CHWs in providing basic preventive and curative MNCH interventions; and to identify the factors that are crucial to their performance. It was restricted to articles published from 1998-2008 in the eng language. It included studies with qualitative and quantitative designs. Six electronic databases were searched and data was extracted using a pretested data extraction form designed basing on the Centre for Reviews and Dissemination (CRD) guidelines (2008). A narrative synthesis approach was used. The quality of included studies was assessed using pretested validity assessment tools and the applicability of interventions was evaluated using the RE-AIM framework. After the filtering; 14 studies were critically appraised; and the majority (12/14) demonstrated that CHWs were effective at reducing neonatal/child mortality rates; promoting breastfeeding practices; increasing sulfadoxine-pyrimethamine (SP) coverage for intermittent preventive treatment of malaria in pregnancy (IPTp); they provided depot medroxy-progesterone acetate (DMPA) injections as safely as qualified staff; and treated malaria in children effectively; thereby reducing workload of health professionals at peripheral health facilities. Crucial factors to their performance included training; remuneration; inadequate medical supplies; and lack of career development structure. The review shows that CHWs can be effective at providing basic curative and preventive MNCH interventions. Developing country health systems can make use of this available resource to increase access of MNCH interventions

Capacity of Healthcare Facilities in the Implementation of Direct Observed Treatment Strategy for Tuberculosis in Arumeru and Karatu Districts; Tanzania

Directly Observed Treatment Short course strategy (DOTS) has proved to have potential improvement in tuberculosis (TB) control in Tanzania. The objective of this cross sectional study was to assess the capacity of health facilities in implementing DOTS; in Arumeru and Karatu districts; Tanzania. Information sought included the capacity to offer TB service and availability of quali?ed staff and equipment for TB diagnosis. Information on availability and utilization of TB registers and treatment outcome for the year 2004 were also collected. A total of 111 health facilities were surveyed; 86 (77.5) in Arumeru and 25 (22.5) in Karatu. Only 23.4(26/111) facilities were offering TB treatment services in the two districts. Majority 17/26 (65.38) of them were government owned. Thirty eight (44.7) facilities were offering TB laboratory services. All facilities with TB services (TB laboratory investigation and treatment) had TB registers. Seventy two (85.0) of health facilities which do not provide any TB services had qualifed clinical offcers and at least a microscopy. Of the 339 cases notified in Arumeru in 2004; 187 (60.7) had treatment outcome available; 124 (66.3) were cured and 55 (29.4) completed treatment. In Karatu 638 cases were noti?ed in 2004; 305 (47.8) had treatment outcome available; 68 (22.3) cured and 165 (54.1) completed treatment. In conclusion; the overall capacity for implementing DOTS among the facilities surveyed is found only in about 20and 30for clinical and laboratory components of DOTS; respectively. The capacity to provide TB diagnosis and treatment in Karatu district was relatively lower than Arumeru. It is important that capacity of the facilities is strengthened concurrently with the planned introduction of community-based DOTS in Tanzania