RESUMO
Background Community health workers play an important role in delivering health-care services, especiallyto underserved populations in low- and middle-income countries. They have been shown to be successfulin providing a range of preventive, promotive and curative services. This qualitative study investigated thefactors motivating or demotivating community health workers in urban settings in Delhi, India.Methods In this sub-study of the ANCHUL (Ante Natal and Child Healthcare in Urban Slums) implementationresearch project, four focus-group discussions and nine in-depth interviews were conducted with communityhealth workers and medical officers. Utilizing a reflexive and inductive qualitative methodology, the data setwas coded, to allow categories of motivating and demotivating factors to emerge.Results Motivating factors identified were: support from family members for their work, improved self-identity,job satisfaction and a sense of social responsibility, prior experiences of ill health, the opportunity to acquirenew skills and knowledge, social recognition and status conferred by the community, and flexible workand timings. Negative experiences in the community and at health centres, constraints in the local healthsystem in response to the demand generated by the community health workers, and poor pay demotivatedcommunity health workers in this study, even causing some to quit their jobs.Conclusion Community-health-worker programmes that focus on ensuring the technical capacity of theirstaff may not give adequate attention to the factors that motivate or discourage these workers. As efforts getunder way to ensure universal access to health care, it is important that these issues are recognized andaddressed, to ensure that community health worker programmes are effective and sustainable.
Assuntos
Agentes Comunitários de Saúde , Índia , Satisfação no Emprego , MotivaçãoRESUMO
The present study was designed to evaluate the independent and interactive effects of a once-a-day yoghurt drink providing 2 g plant sterols/d and capsules providing 2 g fish oil n-3 long-chain (LC) PUFA/d on plasma lipids, apolipoproteins and LDL particle size. Following a 2-week run-in period, 200 mildly hypercholesterolaemic Indian adults aged 35-55 years were randomised into one of four groups of a 2 x 2 factorial, double-blind controlled trial. The 4-week treatments consisted of (1) control yoghurt drink and control capsules, (2) control yoghurt drink and fish oil capsules, (3) plant sterol-enriched yoghurt drink and control capsules, or (4) plant sterol-enriched yoghurt drink and fish oil capsules. Blood was drawn before and after the 4-week intervention. Changes in health status, lifestyle and dietary habits, and daily compliance were recorded. The main effects of plant sterols were a 4.5 % reduction in LDL-cholesterol and a 15 % reduction in TAG without a significant change in HDL-cholesterol. Overall, fish oil n-3 LC-PUFA did not significantly affect cholesterol concentrations but reduced TAG by 15 % and increased HDL-cholesterol by 5.4 %. The combination significantly lowered TAG by 15 % v. control. No significant interaction between plant sterols and n-3 LC-PUFA was observed on plasma cholesterol concentrations. In conclusion, once-a-day intake of 2 g plant sterols/d in a yoghurt drink, 2 g fish oil n-3 LC-PUFA/d in capsules, and their combination had beneficial effects on the lipid profile of mildly hypercholesterolaemic Indian adults. The potent hypotriacylglycerolaemic effect of plant sterols observed in the present study and this population warrants additional investigation.
