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Agricultural migrant workers navigating the health system: Access, continuity of care and the role of community health workers in De Doorns, Western CapeJalal, Nafeesa January 2018 (has links)
Philosophiae Doctor - PhD (School of Public Health) / South Africa has an estimated two million documented and undocumented immigrants. In
addition, Statistics South Africa (2014) notes very significant internal migration. This mobile
population is affected by chronic communicable and non-communicable diseases such as TB,
HIV, and diabetes, although it has a Constitutional right to health and healthcare. Their quality of
healthcare and disease control also affects the general population and the burden on the health
system can be increased by inadequately managed chronic conditions as well as acute health care
needs. Access to healthcare and continuity of care reflect both patient agency and the health
system. Community Health Workers (CHWs) play an important role in linking communities and
patients to health services and vice versa. The aim of this study was to understand how
agricultural migrants in the Cape Winelands District of Western Cape Province of South Africa
navigated the healthcare system to access healthcare services including securing continuity of
care, and in particular the role of CHWs in this process, in order to inform policy and practice.
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Promoção da atividade física no Sistema Único de Saúde tendo como promotores os Agentes Comunitários de Saúde / Physical activity promotion in the Unified Health System through the Community Health WorkersCosta, Evelyn Fabiana 13 April 2015 (has links)
Objetivo: Avaliar uma intervenção para a promoção da atividade física (AF) por meio de Agentes Comunitários de Saúde (ACS) em adultos usuários do Sistema Único de Saúde (SUS) atendidos pela Estratégia de Saúde da Família (ESF). Métodos: Essa tese foi composta por três manuscritos, sendo um de revisão sistemática e dois provenientes de um estudo de intervenção não randomizado e controlado, realizado no distrito de Ermelino Matarazzo, extremo leste de São Paulo, SP, nos meses de abril a dezembro de 2011. Participaram do estudo os ACS e as pessoas atendidas nas áreas de cobertura das equipes de ESF de duas Unidades Básicas de Saúde (UBS). Foi realizada intervenção para promoção da AF por meio de visitas domiciliares composta por um processo de formação em educação profissional, vivências de AF e encontros mensais para acompanhamento. O processo educativo foi realizado em quatro encontros semanais de três horas cada durante um mês, com 30 ACS de uma das UBS (grupo intervenção). Foram sorteados 176 adultos usuários do SUS (18 anos, sendo 90 da UBS/intervenção e 86 da UBS/controle, onde as ACS não receberam treinamento). A efetividade da intervenção nos usuários foi avaliada por meio da aplicação de questionários (níveis de AF no tempo de lazer e como forma de deslocamento e estágios de mudança de comportamento) antes e após seis meses do início do processo educativo. Foram realizados dois grupos focais com os ACS (um após o processo educativo e outro após o término da intervenção). Foi realizada revisão sistemática com fins em verificar o que já havia sido produzido com ACS na promoção da AF. Análise de dados: As análises das variáveis foram realizadas de acordo com o princípio de intenção de tratar. Nas análises bivariadas foram utilizados testes qui-quadrado com correção de Yates, de tendência linear e exato de Fisher. Foram calculadas as razões de prevalências (RP) por meio da Regressão de Poisson para o recebimento de visitas domiciliares considerando variáveis sociais, demográficas e de saúde, estratificadas por grupo. O efeito da intervenção sobre os estágios de mudança de comportamento e dos níveis de AF foram analisados por meio de equações de estimativas generalizadas. Os dados qualitativos coletados nos grupos focais foram gravados, transcritos e analisados por meio da análise temática. Resultados: Manuscrito 1: 27 estudos compuseram a revisão sistemática realizada com fins em recuperar as evidências acerca de intervenções desenvolvidas por ACS na promoção da AF. A maioria dos estudos (63%) apresentou resultados significativos para o aumento do volume total de AF e caminhada ou quantidade de passos por dia. As intervenções tiveram mediana de tempo de cinco meses e foram direcionadas a pessoas acima dos 30 anos, em grupos étnicos específicos, de baixo nível socioeconômico e portadores de doenças. Manuscrito 2: Não foram encontradas diferenças significativas inter ou intragrupos nos níveis de AF e nos estágios de mudança de comportamento nos usuários das UBS onde os ACS receberam a intervenção comparados com os usuários da área do grupo controle. Observou-se que o grupo de ACS da área de intervenção promoveu mais AF nas visitas domiciliares para usuários com menor nível de escolaridade (RP=2,74), que não trabalhavam (RP=3,61) e que possuíam diagnóstico médico de hipertensão arterial ou diabetes (RP=2,86). Manuscrito 3: Duas grandes categorias de temas emergiram do tratamento do material: a) o processo de formação em educação profissional como via de ressignificação da prática de AF e, b) os processos de trabalho das ACS e os limites para as transformações de atitudes. Inseridos nesses temas, constatou-se que o saber adquirido é uma ferramenta de empoderamento, mas que ainda há um limite do conhecimento técnico versus o saber leigo dos ACS para o aconselhamento da AF e que demandas institucionais interferem nas possibilidades de ações, resultando na dificuldade de incorporação da promoção da atividade física na rotina do trabalho. Conclusão: A revisão sistemática mostrou que intervenções realizadas no contexto da atenção primária tendo como promotores os ACS são efetivas para o aumento da AF em adultos. Na intervenção avaliada nesta tese não foram observadas evidências de efetividade para aumento dos níveis de AF e de estágios de mudança de comportamento de usuários do SUS atendidos pelos ACS da intervenção. No entanto, observou-se pelo conteúdo dos grupos focais que a implantação do processo de promoção da AF realizado com os ACS no contexto da ESF em uma região de baixo nível socioeconômico demonstrou ser uma oportunidade de empoderamento para esses profissionais nas ações de promoção à saúde, mas que a incorporação da promoção da AF nas visitas domiciliares para os usuários é dependente de mudanças mais amplas na gestão dos serviços. A partir dos efeitos positivos obtidos no processo de formação dos ACS, aliado as dificuldades de se conseguir mudanças nos níveis de AF dos usuários, recomenda-se que sejam realizadas novas intervenções de promoção da AF com ACS para que modelos de promoção como este desenvolvido nesta tese sejam implementados na rotina de trabalho destes profissionais. / Purpose: To evaluate an intervention to promote physical activity (PA) through Community Health Workers (CHW) to adult users of the Unified Health System (SUS) and served by the Family Health Strategy (FHS). Methods: This dissertation encompasses three manuscripts, one systematic review and two referred to a non-randomized controlled intervention trial conducted in the Ermelino Matarazzo district, eastern end of São Paulo, SP, from April to December 2011. The study included the CHW and the users covered by FHS teams of two Primary Healthcare Centers (PHC). An intervention to promote PA through home visits was carried out, comprising a process of professional continuing education, PA experiences and monthly meetings for following up. The educational process was conducted in four weekly meetings of three hours each during a month, with 30 CHW of one PHC (intervention group). One hundred seventy-six adult users of the SUS were randomly selected (18 years, 90 of the intervention PHC and 86 of the control PHC, where the CHW received no training). The intervention effectiveness on users was evaluated through questionnaires (leisure-time and transport-related PA and the behavior change stages) before and six months after the educational process. Two focus groups were conducted with the CHW (one after the educational process and another after the intervention). A systematic review was performed to verify what had already been produced about PA promotion through CHW. Data analysis: Analysis considered the intention-to-treat principle. Bivariate analysis were conducted using the Chi-square test with Yates correction or linear trend and the Fishers exact test. Prevalence ratios (PR) were calculated through Poisson regressions to analyze home visits according to social, demographic and health variables, stratified by group. The effect of the intervention on behavior change stages and leisure-time and transport-related PA was analyzed using generalized estimating equations. The content of the focus groups was recorded, transcribed and analyzed using thematic analysis. Results: Manuscript 1: 27 studies were included in the systematic review with the purpose of recovering the evidence about interventions using CHW to promote PA. Most studies (63%) found significant results of increase in PA total volume and walking or steps per day. Interventions had a median duration of 5 months and were aimed at people over 30 years old, specific ethnic groups, low socioeconomic status and those diseased. Manuscript 2: There were no significant differences inter- or intra-group in PA levels and behavior change stages between user from intervention and control PHC. The CHW group who received the educational process promoted more PA in home visits to users with lower educational level (PR = 2.74), who did not work (PR = 3.61) and had a medical diagnosis of hypertension or diabetes (PR = 2.86). Manuscript 3: Two broad categories of themes emerged from the material: a) the process of professional continuing education as a mean to reframe the PA practice and, b) the CHWs work processes and the limits of changing attitudes. Within these issues, it was found that acquired knowledge is an empowerment tool, but there is still a limit in the technical versus lay knowledge of the CHW for PA counseling and institutional demands interfere with the action possibilities, resulting in difficult incorporation of PA promotion in their work routine. Conclusion: The systematic review shown that interventions in primary care through CHW are effective for increasing PA in adults. In the intervention evaluated in this dissertation were observed no evidences of effectiveness on PA levels and behavior change stages among user of the SUS served by the CHW of the intervention group. However, it was observed through the analysis of the focus group that the implementation of an educational process aimed to promote PA in the FHE context in a low-socioeconomic area is an empowering opportunity for these professionals for health promotion actions. Nevertheless, the inclusion of PA promotion in the home visits to users depends on broader changes in the services management. From the positive effects obtained in the CHW educational process, combined with the difficulties of achieving changes in PA levels of users, it is recommended that new interventions are carried out to promote PA through CHW in order to implement promoting models like the one developed in this thesis in the routine work of these professionals.
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ACIDENTES COM MATERIAL BIOLÓGICO ENTRE TRABALHADORES DA ÁREA DE SAÚDE EM HOSPITAIS: UMA REVISÃO INTEGRATIVA DA LITERATURACarvalho, Sônia Lucia de 29 September 2016 (has links)
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Previous issue date: 2016-09-29 / Introduction: Health workers are exposed to occupational hazards. Among these
are the biological risks that could lead to illness. This study seeks to clarify the factors
that predispose the accident to biological material, not only for those who act in the
attention to the user, but also for future professionals to know how severe a biological
infection becomes. Objective: to identify and analyze the evidence available in the
literature on accidents with biological material among health workers working in
hospitals. Methodology: This is an Integrative Bibliographic Review on the factors
that predispose work accidents with biological material among health professionals
working in hospitals, held in the Virtual Health Library, in June 2016, The following
descriptors were used Occupational OR occupational exposure OR exposure to
biological agents OR work injury notification AND health personnel OR worker health.
Results and Discussion: After applying the inclusion and exclusion criteria, nine
articles were included in the study. All articles identified the needle as the main
device causing the occupational accident, and blood was the main fluid involved.
When analyzing the professional categories that were injured, the articles pointed to
the nursing category, being the nursing assistant the most affected. In 60% of the
articles, the accident record was addressed, but it is not clear in which system the
accident was recorded, whether SINAN or CAT. Conclusions: It is of fundamental
importance that the professionals are offered permanent education programs on
biosafety, which emphasize the prevention of accidents with biological material,
attention in performing procedures with the patient, care in the disposal of
contaminated materials and compliance with biosafety standards. / Introdução: Os Trabalhadores da área de saúde ficam expostos aos riscos
ocupacionais. Dentre esses estão os riscos biológicos que poderão ocasionar
doenças. Este estudo busca esclarecer os fatores que predispõem o acidente com
material biológico, não somente para aqueles que atuam na atenção ao usuário,
mas para que futuros profissionais tenham conhecimento do quão grave se torna
uma infecção biológica. Objetivo: identificar e analisar as evidências disponíveis na
literatura sobre os acidentes com material biológico entre trabalhadores da área de
saúde que atuam em hospitais. Metodologia: Trata-se de uma Revisão Bibliográfica
Integrativa sobre os fatores que predispõem acidentes de trabalho com material
biológico entre profissionais de saúde que atuam em hospitais, realizada na
Biblioteca Virtual em Saúde, no mês de junho de 2016, Foram utilizados os
seguintes descritores riscos ocupacionais OR exposição ocupacional OR exposição
a agentes biológicos OR notificação de acidentes de trabalho AND pessoal de saúde
OR saúde do trabalhador. Resultados e Discussão: Após a aplicação dos critérios
de inclusão e exclusão, foram incluídos no estudo nove artigos. Todos os artigos
identificaram a agulha como principal dispositivo causador do acidente ocupacional,
e o sangue, foi o principal fluido envolvido. Ao analisar as categorias profissionais
que se acidentaram, os artigos apontaram para a categoria de enfermagem, sendo o
auxiliar de enfermagem o mais acometido. Em 60% dos artigos, o registro dos
acidentes foi abordado, porém não é claro em qual sistema o acidente foi registrado,
se SINAN ou CAT. Conclusões: É de fundamental importância que sejam
oferecidos aos profissionais programas de educação permanente sobre
biossegurança, que enfatizam a prevenção dos acidentes com material biológico,
atenção na realização dos procedimentos com o paciente, cuidados no descarte de
materiais contaminados e cumprimento das normas de biossegurança.
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Competência do agente comunitário de saúde : subsídio para a avaliação formativa na Estratégia de Saúde da Família / Competencies of community health agent : allowance for formative assessment in family health strategy / Competencias del agente comunitario de salud : asignación para la evaluación formativa en la estrategia de salud de la familiaBandeira, Andrea Gonçalves January 2014 (has links)
Este estudo teve como objetivo desenvolver um instrumento para a avaliação formativa dos Agentes Comunitários de Saúde (ACS) das Unidades de Saúde com Estratégia de Saúde da Família (ESF) no âmbito do projeto Telessaúde/RS. Trata-se de um estudo descritivo, de abordagem mista, realizado no contexto do programa Telessaúde/RS. Foram convidados a participar do estudo 45 enfermeiros e 45 Agentes Comunitários de Saúde. Para a coleta de dados, utilizou-se a técnica Delphi online. Na primeira etapa foi enviado aos participantes um questionário com base no referencial de competências profissionais do ACS do Ministério da Saúde e os mesmos, de acordo com seus conhecimentos e experiências, puderam excluir ou modificar as competências listadas, bem como acrescentar competências. Na segunda etapa o questionário constou dos esquemas de competências resultantes da primeira etapa, adicionadas de uma escala de Likert com valores de 1 (discordo muito) a 5 (concordo muito), para que manifestassem seu grau de concordância. Nesta etapa foram adicionadas ao instrumento questões a respeito da periodicidade para a realização da avaliação e indicação de critérios para a avaliação. Com base nos resultados obtidos na 1ª e 2ª etapas, foi elaborado o instrumento para avaliação formativa dos ACS. Na 3ª etapa o instrumento foi enviado aos participantes para a validação. Em cada etapa do estudo o número de participantes variou, na primeira etapa participaram 40, na segunda 30 e na terceira 35. Em um primeiro momento, realizou-se uma análise qualitativa das modificações, sugestões ou comentários dos participantes e, após, a análise estatística dos dados. Os resultados evidenciaram a preocupação dos participantes com a escolaridade dos ACS, a capacitação para o trabalho, e formação técnica, sua inserção na equipe, a supervisão realizada pela enfermeira, bem como o grau de autonomia, o espaço e a especificidade do seu trabalho e a valorização do ACS como membro da equipe da ESF. A realização deste estudo possibilitou desenvolver um Instrumento de Avaliação Formativa para os ACS, e proporcionou uma avaliação inicial das competências estabelecidas pelo Ministério da Saúde e uma revisitação às atribuições e competências do ACS na ESF. / This study aimed to develop a tool for formative assessment of Community Health of the Health Units with the Family Health Strategy within the Telessaúde/RS project. This is a descriptive study, the mixed approach, carried out in the context of Telessaúde/RS program. Were invited to participate in the study 45 nurses and 45 ACS. To collect data, we used the Delphi technique online. The first stage was a questionnaire sent to participants based on the benchmark of professional skills of the ACS Health Ministry and the same according to their knowledge and experience could delete or modify the powers listed, as well as additional capabilities. In the second stage the questionnaire consisted of schemes resulting powers the first stage, added a Likert scale with values from 1 (strongly disagree) to 5 (strongly agree), to manifest their degree of concordance. This step was added to the instrument questions about periodicity for conducting the assessment and indication criteria for evaluation. With basis of results obtained in 1st phase and 2nd instrument for formative assessment of ACS was prepared. In Step 3 the instrument was sent to the participants for validation. At each stage of the study the number of participants varied in the first stage, 40 in the second 30 and the third 35. At first, we carried out a qualitative analysis of the changes, suggestions or comments from participants and after the statistical analysis of data. The results showed the concern of the participants with the education of ACS, the job training, and technical training, their inclusion in the team, supervision by the nurse, and the degree of autonomy, the scope and specificity of their work and recovery ACS as a member of the ESF team. / Este estudio tuvo como objetivo desarrollar una herramienta para la evaluación formativa de Salud Comunitaria de las Unidades de Salud de la Estrategia de Salud de la Familia en el proyecto de Telessaúde/RS. Se trata de un estudio descriptivo, el enfoque mixto, llevado a cabo en el contexto del programa de Telessaúde/RS. Fueron invitados a participar en el estudio 45 enfermeros y 45 ACS. Para recopilar los datos, se utilizó la técnica Delphi en línea. La primera etapa consistió en un cuestionario enviado a los participantes en base al índice de referencia de las competencias profesionales del Ministerio de Salud de la ACS y de la misma de acuerdo con sus conocimientos y experiencia podría borrar o modificar los poderes enumerados, así como capacidades adicionales. En la segunda etapa, el cuestionario consta de esquemas resultantes poderes de la primera etapa, añadió una escala Likert con valores de 1 (muy en desacuerdo) a 5 (muy de acuerdo), para manifestar su grado de concordancia. Este paso se añadieron a las preguntas del instrumento sobre la periodicidad de la realización de la evaluación y los criterios de indicación para la base evaluación. Con los resultados obtenidos en la primera fase y la segunda de instrumentos para la evaluación formativa de ACS se preparó. En el paso 3 del instrumento fue enviado a los participantes para su validación. En cada etapa del estudio, el número de participantes varió en la primera etapa, 40 en la segunda 30 y la tercera 35. En primero, se realizó un análisis cualitativo de los cambios, sugerencias o comentarios de los participantes y después del análisis estadístico de datos. Los resultados mostraron la preocupación de los participantes con la educación de ACS, la capacitación laboral y formación técnica, su inclusión en el equipo, la supervisión de la enfermera, y el grado de autonomía, el alcance y la especificidad de su trabajo y la recuperación ACS como un miembro del equipo de la ESF. Este estudio hizo posible el desarrollo de un Instrumento de Evaluación Formativa para ACS, y proporcionó una primera evaluación de las competencias establecidas por el Ministerio de Salud y revisitando los deberes y atribuciones de la ACS en el ESF.
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Avaliação de um programa de capacitação em saúde bucal para agentes comunitários de saúde / Evaluation of a training program in oral health for community health workers.Luz, Luiz Kleber Marconi 25 February 2015 (has links)
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Previous issue date: 2015-02-25 / The different methods that use active learning methodology require consistent evaluation process for a new professional profile. Objectives: This Qualitative and quantitative study aimed to evaluate the training and propose an educational model to be developed by the UBSF- Community Health Agents of Itaoca / SP in an Educational Program in Oral Health. Method: Based on the levels of assessment Miller pyramid was conducted the training of Community Health Agents - ACS, 08 professionals. In practical actions used the scale of Turesky Visual Board index that enabled through their scores to obtain statistical data before and after the action taken by the ACS for 413 students representing the students enrolled in the municipal school units and state, in the age group of 6 to 19, also the performance of each ACS, as well as presentation of the variables according to age, gender. It was later applied questionnaire with an interview guide for the ACS, where even answered 10 questions that resulted in a report of action taken by the ACS vision. Results: It was found through the disclosure of Action Plaque and brushing Supervised carried out by the Community Health Agents, which they appropriated the proposed content, regarded as prevention and promotion of oral health, which also provided them professional development with changes in vision and work processes, allowing integration into the oral health team, making the education agents in oral health and consolidating the recovery of health education / Os diferentes métodos que utilizam a metodologia ativa de aprendizagem necessitam de processos avaliativos coerentes para um novo perfil profissional. Objetivos: Este estudo Quali-quantitativo teve como objetivos avaliar a capacitação e propor um modelo de educação para ser desenvolvidos pelos dos Agentes Comunitários de Saúde da UBSF- Itaoca/SP em um Programa de Educação em Saúde Bucal. Método: Baseado nos níveis de avaliação da Pirâmide de Miller foi realizado a capacitação dos Agentes Comunitários de Saúde ACS, 08 profissionais. Nas ações práticas utilizou-se a escala do Índice de Placa Visual de Turesky que possibilitou através de seus scores a obtenção de dados estatísticos antes e depois da ação realizada pelos ACS em relação a 413 alunos o que representam os alunos matriculados nas Unidades Escolares municipais e estaduais, na faixa etária de 6 a 19 anos, também a atuação de todos os ACS, bem como, a apresentação das variáveis, segundo idade e gênero. Posteriormente foi aplicado questionário com um roteiro de entrevista para os ACS, no qual estes responderam 10 questões que resultaram em relato da ação realizada através da visão dos ACS. Resultados: Constataram-se, através da Ação de Evidênciação da Placa Bacteriana e Escovação Supervisionada, realizadas pelos os Agentes Comunitários de Saúde, que os alunos apropriaram-se do conteúdo proposto considerado como ações de prevenção e promoção em saúde bucal, o que também lhes proporcionou desenvolvimento profissional com mudanças na visão e nos processos de trabalho, permitindo uma integração com a equipe de saúde bucal, tornando-os agentes de educação em saúde
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Community Health Worker's Perceptions of Integration into the Behavioral Health Care SystemJenkins, Juliette Swanston 01 January 2019 (has links)
Mental illness in the United States is a major public health problem. According to the Substance Abuse and Mental Health Services Administration, in 2017, 18.9% of adults in the United States had a mental illness. The purpose of this study was to gain insight into the perceptions held by community health workers (CHWs) regarding their integration into the behavioral health care system in Maryland. Using a social constructivism paradigm and phenomenological approach, a purposive sample of 11 CHWs who supported patients with behavioral health conditions in 17 counties in the state were interviewed. Howlett, McConnell, and Perl's five stream confluence policy process theory and Lipsky's street level bureaucracy theory provided the foundation to explore the perceptions of the CHWs about their integration into the behavioral health care system; the problems, policies, processes, and programs that impacted their ability to be integrated into the behavioral health team; and their function as a street level bureaucrat to facilitate their integration. A deductive iterative coding approach was used, culminating in the identification of the following 6 themes: health system utilization of CHW behavioral health integration, official policy recognition of the CHW profession, accountability for CHW integration, CHW practice support, integrated health care team management of physical and mental health and behavior, and building the CHW profession. The social change implications of this study are that CHWs' integration into the broadly defined, integrated, physical and mental behavioral health team can support having a more cost-effective way toward having healthy people and communities because they link the community to health and social services and advocate for quality care.
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Assessing the implementation of the government funded community health worker programme in selected clinics of the Eastern Cape Province, South Africa.Matwa, Princess Nonzame. January 2007 (has links)
<p>From 2004 the Eastern Cape Department of Health (ECDoH) started implementing the new community health worker (CHW) programme in all its clinics, but so far little is known about its implementation process, its successes and challenges. The aim of this study was to assess the implementation of the new government funded CHW programme at three clinics of the Eastern Cape Province.</p>
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Impact of the expansion of the health surveillance assistants programme in Nkhatabay District of North MalawiNtopi, Simon Willard January 2010 (has links)
<p>This study investigated the challenges facing a category of community health workers (Health Surveillance Assistants) in rural Malawi district of Nkhatabay following the expansion of their programme funding from the Global Funding to fight AIDS, Tuberculosis and Malaria (GFATM). The study has noted that HSAs are facing serious accommodation problems due to the lack of involvement of communities in their selection and that many HSAs are recruited from outside their catchment areas. The study has put forward some recommendations to the Ministry of Health and other stakeholders like United Nations Children&rsquo / s Fund (UNICEF) and the World Health Organization (WHO) to consider in making the HSAs programme in Nkhatabay district effective. Some of the recommendations made are that supervision of the HSAs by the EHOs and the ECHNs should be intensified and that infrastructure support should be provided to the HSAs for them to be able to deliver the EHP. Infrastructure like buildings and equipment like refrigerators and bicycles should be provided to HSAs and ensure that there is a plan for their maintenance.</p>
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Assessment of the uptake of referrals by community health workers to public health facilities in Umlazi, Kwazulu-NatalNsibande, Duduzile January 2011 (has links)
<p>Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens & / Zupan, 2005). Early  / detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing  / countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking  / behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home  / visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit,  / community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing  / community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured  / questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers&rsquo / home or at the study  / offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis.  / Descriptive analysis was  / conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant  / associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were  / enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the  / highest number of which occurred within  / the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking  / their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW.  / Conclusion: This study found  / high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South  / African National Department of Health (SANDOH) which will involve the establishment of family health worker teams  / including community health workers. A key function of these workers will  / be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with  / non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by  / community health workers. Most of the referrals in this study were  / neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal  / and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater  / realization of a team approach to PHC.</p>
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Stakeholder perceptions of human resource requirements for health services based on primary health care and implemented through a national health insurance schemeLloyd, Bridget January 2010 (has links)
<p>In 2007, at its 52nd Conference in Polokwane, the African National Congress (ANC) called for the implementation of a National Health Insurance (NHI) scheme. The announcement resulted in much debate, with critics voicing concerns about the state of the public health system, lack of consultation and the expense of a NHI scheme. However, little attention has been paid to the  / human resource (HR) needs, despite the fact that 57% of recurrent expenditure on health1 is on HR. This research aimed to identify the HR requirements to support the implementation of an effective and equitable health system funded by a NHI in South Africa. An overview of the current burden of disease and distribution of HR is provided. Through interviewing key stakeholders the study attempted to elicit information about factors which will hamper or assist in developing such a health system, specifically looking at the HR situation and needs. The research explores HR  / odels and proposes key HR requirements for implementation of a health system funded by a NHI in South Africa, including skills mix and projected numbers of health workers and  / proposes ways to improve the deficient HR situation. Exploratory qualitative research methods were used comprising in-depth individual interviews, with a purposive sample of key informants, including: public health professionals and health managers (working in rural and urban areas) / researchers / academics and NGO managers. The contents of the interviews were analysed to identify common responses about and suggestions for HR requirements within the framework of a NHI. 1 Personal communication Dr Mark Blecher, Director Social Services (Health), National Treasury, 17 July 2009 The literature review includes policy documents, position papers and articles from journals and bulletins. Key informants were asked to identify literature and research material to support recommendations. The research findings indicate that despite the South African Government&rsquo / s expressed commitment to Primary Health Care (PHC), the National Department of Health has continued to support and sustain a clinical model of health service delivery (Motsoaledi, 2010), primarily utilising doctors and nurses. The clinic based services are limited in their ability to reach community level, and, being focused on curative aspects, are often inadequate with regard to prevention, health promotion and rehabilitation services. While the curricula of health professionals have been through some changes, the training has continued to be curative in focus and the clinical training sites have not been significantly expanded to include peripheral sites. While there are many Community Health Workers in the country, they remain disorganised and peripheral to the public health system. The mid level worker category  / has not been fully explored. Finally there are no clear strategies for recruitment and retention of health workers in rural and under-resourced areas. In addition to the continued use of a clinical model, transformation of the health system hasbeen hampered by inadequate numbers of health workers, particularly in the rural and periurban townships and informal settlements. There is no clear strategy for addressing the critical  / health worker shortage in under-resourced areas, particularly rural areas. The last section makes recommendations, which will be submitted to the relevant task teams working on the NHI. It is intended that recommendations arising out of the research will influence the process and decisions about HRH within a NHI funded health system.</p>
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