While the concept of the community health worker (CHW) has existed since the mid-20th century, their function as a legitimate branch of the broader workforce in the United States has been tenuous. Their unique roles have the potential to reduce health disparities within marginalized communities, but stakeholder development of this position risks diminishing the crucial skills of these workers. Anthropological research on these workers has typically assessed them in the developing world, while public health research has focused primarily on their ability to impact specific health outcomes through quantitative studies. As a result of the limited and predominantly quantitative assessments of these workers, further research is needed to assess the lived realities of these workers at the grassroots level in the United States. The overarching aim of this project was to document the lived experience of CHWs in Indiana. Additionally, this project assessed their participation in advocacy and the impact of policy development on these workers. A collaborative approach was utilized in this project that embedded the researcher within a CHW organization while also amplifying the voice of the research partners. The project drew on the theoretical lenses of moral economy, deservingness, structural vulnerability, and the “regimes of care” and “politics of care.” The results demonstrate that CHWs face a variety of challenges within the professional workforce but have significant impacts within their communities. These workers emphasize empowerment through advocacy and building client self-sufficiency. Their participation in advocacy is split between impacts at the micro-, macro-, and professional-level. However, legislating the scope and responsibilities of this position by stakeholders unfamiliar with this model risks changing the foundation of the position itself. Steps to incorporate CHWs within the workforce must be collaborative and take into account their lived experience and input in order to allow them agency over the development of their position and to retain the most significant contributions. The contributions of this project are severalfold. First, this project advances theoretical debates within anthropology related to moral economy, regimes of care, politics of care while also addressing the legitimacy of CHWs as a complimentary member of the health care workforce. The findings also illustrate how the political economy of Indiana shapes the moral economy of care within which CHWs operate. Lastly, the project produced applied findings for CHWs, employers, and stakeholders to consider in further development of this position.

Magister Pharmaceuticae - MPharm / The World Health Organisation (WHO) has stated that “there is no health without a workforce” (Campbell et al., 2013). The health workforce is essential for every health care system. The availability, accessibility and quality of health care workers play an important role in improving and overcoming health system challenges, in particular the call to universal health coverage (UHC) as stipulated in sustainable development goal 3. It has been observed that there is limited collaboration between healthcare systems and academic institutions. According to an article by Frenk et al., 2010, this limited collaboration has resulted in a mismatch between health care graduates’ competencies (such as inter-professional collaboration) and the needs of the population that they serve. One of the problems of health education institutions is the emphasis on curriculum content and learning methods as opposed to social purpose and moral obligations. / 2021-08-30

Sensory inputs of hearing and vision during early childhood development support the achievement of language, speech and educational milestones. The early detection of sensory impairment is essential for facilitating early childhood development, socio-emotional well-being and academic success, in addition to obtaining sustainable educational development goals. The majority of children with sensory impairment live in low- and middle-income countries where services are often unavailable or inaccessible, because of the absence of systematic screening programmes for children, prohibitive equipment cost, a shortage of trained personnel and centralised service-delivery models. Therefore, research is needed to investigate whether a community-based mobile health (mHealth) supported service-delivery model for hearing and vision screening can increase access to hearing and vision services for children in resource-constrained settings. This study aimed to describe an implemented hearing and vision screening programme and evaluate its success in terms of acceptability (consent return numbers), coverage (number of eligible children screened), referral rates and quality indicators (duration of tests and number of hearing tests conducted under conditions of excessive noise levels). The study also explored the challenges faced during a community-based screening programme and the strategies developed to address these. Four non-professionals were appointed and trained as community health workers (CHWs) to conduct combined sensory screening using mHealth technology (hearScreen application, hearXGroup, South Africa and Peek Acuity application, Peek Vision, United Kingdom) on smartphones at preschools in low-income communities in Cape Town, South Africa. The consent form return rate was 82.0%, and the coverage rate was 94.4%. An average of 501 children were screened each month, at a cost of US$5.63 per child. The number of children who failed hearing and vision screening was 435 (5.4%) and 170 (2.1%), respectively. Failing of hearing tests was associated with longer test times (odds ratio [OR]: 1.022; 95% confidence interval [CI]: 1.021–1.024) and excessive background noise levels at 1 kHz (e.g. OR for left ear: 1.688; 95% CI: 1.198–2.377). Failing of visual screening tests was associated with longer test duration (OR: 1.003; 95% CI: 1.002–1.005) and younger age (OR: 0.629; 95% CI: 0.520–0.761). The study also aimed to describe and compare the performance of two screening protocols that were used in this preschool hearing screening programme to determine optimal referral criteria that is responsive to available resources. Secondary data analysis was done to compare a protocol using a single-frequency fail criterion (which 2,147 children were screened with between 1 October 2017 and 25 February 2018) with a screening protocol using a two-frequency fail criterion (which 5,782 children were screened with between 26 February 2018 and 30 November 2018). For both protocols, screening was done at a 25 dB hearing level (HL) at 1000, 2000 and 4000 Hz. Both protocols included an immediate rescreen at the frequencies that were failed. The referral rate was 8.7% (n = 186) for the one-frequency fail protocol and 4.3% (n = 250) for the two-frequency fail protocol. Compared to the one-frequency fail protocol, children screened with the two-frequency fail protocol were 52.9% less likely to fail (OR: 0.471; 95% CI: 0.385–0.575). Gender (OR: 0.807; 95% CI: 0.531–1.225) and age (OR: 0.996; 95% CI: 0.708–1.402) had no significant effect on screening outcomes. Maximum permissible ambient noise levels (MPANLs) were exceeded in 44.7% of cases in at least one ear at 1000 Hz across both protocols. There was no significant difference between the protocols for both true positive cases and false positive cases. Protocol (OR: 1.338; 95% CI: 0.854–2.098), gender (OR: 0.807; 95% CI: 0.531–1.225) and age (OR: 0.996; 95% CI: 0.708–1.402) demonstrated no significant effect on the odds of producing true positive results. Average time for conducting the screening was 72.8 s (78.66 SD) for the one-frequency fail protocol and 64.9 s (55.78 SD) for the two-frequency fail protocol. Estimating the prevalence and describing the characteristics of sensory loss in a preschool population in low-income communities are important steps to ensure adequate planning and successful implementation of community-based hearing and vision care in this context. The study therefore also investigated the prevalence and characteristics of hearing and vision loss among preschool children (4 to 7 years) in an underserved South African community after implementing mHealth-supported community-based hearing and vision services. Children who failed hearing and vision screening were seen for follow-up assessments at their preschools. Follow-up assessments were also performed with smartphones and hearing and vision testing applications (hearTest application, hearX Group, South Africa and PeekAcuity app, Peek Vision, United Kingdom). A total of 10,390 children were screened at 298 preschools over 22 months. Of the children screened, 5.6% and 4.4% of children failed hearing and vision screening, respectively. Community-based follow-up hearing tests were done at the preschools on 88.5% (514) of the children, of whom 240 children (54.2% female) presented with hearing loss. A preschool-based follow-up vision test was conducted on 400 children (88.1%). A total of 232 children (46.1% female) had a vision impairment, and a further 32 children passed the test but had obvious signs of ocular morbidity. Logistic regression analysis found that age was a significant predictor of vision loss (p < 0.001): with every 1-year increase in age, participants were 51.4% less likely to have vision loss (OR: 0.49, 95% CI: 0.39–0.60). Age was not a significant predictor for hearing loss (OR: 0.821; 95% CI: 0.667–1.011). Gender was not a significant predictor of hearing loss (OR: 0.850; 95% CI: 0.658–1.099) or vision loss (OR: 1.185; 95% CI: 0.912–1.540). The prevalence of hearing loss at a pure tone average (PTA) of 25 dB HL ranged between 2.3% (240 out of 10,390; assuming none of the non-attenders and children who were unable to be tested had hearing loss) and 3.1% (321 out of 10,390; assuming all the non-attenders and children who were unable to be tested presented with hearing loss). The prevalence of vision loss ranged between 2.2% (232 out of 10,390; assuming none of the non-attenders had vision loss) and 2.8% (286 out of 10,390; assuming all the non-attenders presented with vision loss). Findings of this research project indicate that mHealth-supported CHW-delivered hearing and vision screening in preschools provide a low-cost, efficient and accessible service that can improve the provision of affordable hearing and vision care. This service-delivery model is affordable and scalable, because the same staff, needing minimal training, and the same equipment are used to screen for both vision and hearing. Timely identification of sensory losses is essential to ensure optimal outcomes and can be facilitated through community-based hearing and vision services by trained CHWs using mHealth technology. Future studies should aim to report on outcomes and the uptake and impact of interventions on the children diagnosed with sensory impairments following identification through a decentralised screening programme. / Thesis (PhD (Audiology))--University of Pretoria, 2021. / Sonova AG / Hear the World Foundation / Speech-Language Pathology and Audiology / PhD (Audiology) / Unrestricted

No description available.

Dans de nombreux pays à travers le monde, la délégation de tâches fait partie des stratégies couramment utilisées pour optimiser la performance des organisations de santé. En Haïti, le recours aux Agents de Santé Communautaire Polyvalents (ASCP) dans l’offre des soins de santé primaire en est une application de cette stratégie. L’objectif principal visé par celle-ci est de réduire les pénuries de ressources humaines de la santé et d’améliorer la couverture sanitaire universelle. Afin de contribuer à l’atteinte de cet objectif et à l’avancement des connaissances sur la délégation des tâches aux ASCP, cette thèse aborde des questions de recherche peu étudiées, pourtant essentielles à la compréhension et à l’implantation réussie de cette intervention. Ces questions concernent le fonctionnement de la délégation des tâches aux ASCP, dont les mécanismes à travers lesquels cette intervention parvient à produire des effets positifs sur la performance des organisations de santé. Cette thèse de doctorat évalue également le bien-fondé de l’implantation de la délégation des tâches aux ASCP en Haïti, son niveau d’implantation dans le département sanitaire du nord d’Haïti et les facteurs contextuels qui facilitent ou entravent l’implantation de cette intervention dans ce département. La méthodologie utilisée à cet effet combine trois approches complémentaires. La première est la synthèse réaliste de Pawson et al. (2005). Celle-ci a été choisie pour son potentiel à offrir une compréhension approfondie du fonctionnement des interventions complexes. La seconde approche méthodologique utilisée se rapporte à l’évaluation du bien-fondé de l’implantation de la délégation des tâches aux ASCP en Haïti. Plus spécifiquement, il s’agit d’une analyse logique. Ce type d’analyse permet d’évaluer d’une part la plausibilité des hypothèses sur lesquelles reposent les interventions, et d’autre part, de déterminer l’adéquation des ressources et processus de celles-ci au regard des objectifs visés. Enfin, la troisième approche méthodologique mise en œuvre est une analyse de l’implantation. Cette dernière étudie la façon dont les interventions interagissent avec leur contexte d’implantation, y compris les facteurs contextuels qui déterminent leurs niveaux d’implantation. Pour la mener à bien, tout comme pour réaliser la synthèse réaliste et l’analyse logique de la délégation des tâches aux ASCP en Haïti, des données ont été collectées et analysées. Celles-ci proviennent essentiellement d’une recension des écrits sur la délégation des tâches aux ASCP, de l’examen des documents relatifs à la conception et l’implantation de cette intervention en Haïti et d’entrevues non dirigées réalisées auprès de 35 intervenants dans ce pays. Ce faisant, plusieurs résultats intéressants ont été obtenus. Ils apportent une contribution nouvelle à l’amélioration des connaissances sur la délégation des tâches aux ASCP. Les résultats obtenus peuvent être également utilisés pour favoriser l’implantation réussie de cette intervention en Haïti et éventuellement dans d’autres contextes. Ils incluent notamment une théorie de moyenne portée qui explique le fonctionnement de la délégation des tâches aux ASCP, ainsi que des preuves à l’appui de la plausibilité ou de la validité du modèle logique qui sous-tend l’implantation de cette intervention en Haïti. Les résultats obtenus mettent aussi en lumière plusieurs déficiences dans la conception ou planification de la délégation des tâches aux ASCP en Haïti qui peuvent être corrigées pour accroître les chances d’atteindre les objectifs visés. Parmi celles-ci, il y a l’insuffisance des ressources (financières, matérielles et humaines) planifiées ou engagées et des manquements dans la sélection des ASCP. Par ailleurs, des avancées notables ont été observées dans l’implantation de la délégation des tâches aux ASCP dans le département sanitaire du nord d’Haïti. De plus, cette thèse de doctorat révèle plusieurs facteurs contextuels entravant ou facilitant la mise en œuvre de la délégation des tâches aux ASCP dans ce département. Ceux-ci sont en lien avec la planification et le suivi de l’implantation de l’intervention, le contexte institutionnel, l’environnement politique et autres. En somme, cette thèse apporte une contribution à la compréhension du fonctionnement de la délégation des tâches aux ASCP et à la façon dont cette intervention améliore la performance des organisations de santé. Elle suggère également des pistes de recherche pour l’avancement des connaissances dans ce domaine, ainsi que des voies d’améliorations pour favoriser l’atteinte des objectifs visés par la délégation des tâches aux ASCP en Haïti ou ailleurs. / In many countries around the world, delegation of tasks is one of the commonly used strategies to optimize the performance of healthcare organizations. In Haiti, the use of Polyvalent Community Health Agents (ASCP) in the provision of primary health care is an application of this strategy. Its main objective is to reduce shortages of health human resources and improve universal health coverage. In order to contribute to the achievement of this objective and to the advancement of knowledge on the delegation of tasks to ASCPs, This thesis addresses understudied research questions, yet essential to the understanding and successful implementation of this intervention. These questions concern the functioning of the delegation of tasks to the ASCPs, including the mechanisms through which this intervention succeeds in producing positive effects on the performance of the organizations. This doctoral thesis also assesses the well-founded of the implementation of the delegation of tasks to the ASCPs in Haïti, its level of implementation in the northern health department of Haïti and the contextual factors that facilitate or hinder the implementation of this intervention in this department. The methodology used for this purpose combines three complementary approaches. The first one is the realistic synthesis of Pawson et al. (2005). This was chosen for its potential to provide an in-depth understanding of how complex interventions work. The second methodological approach used relates to the assessment of the well-founded of implementing the delegation of tasks to the ASCPs in Haïti. More specifically, it is a logical analysis. This type of analysis allows to evaluate, on the one hand, the plausibility of the hypotheses on which the interventions are based, and, on the other hand, to determine the adequacy of the resources and processes of these regarding the objectives targeted. Finally, the third methodological approach implemented is an analysis of the implementation. This approach studies how interventions interact with their implementation context, including the contextual factors that determine their levels of implementation. To carry it out, as well as to carry out the realistic synthesis and the logical analysis of the delegation of tasks to the ASCPs in Haïti, data was collected and analyzed. These come mainly from a review of the literature on the delegation of tasks to the ASCPs, an examination of the documents relating to the design and implementation of this intervention in Haiti and unstructured interviews conducted with 35 stakeholders in this country. In doing so, several interesting results were obtained. They bring a new contribution to improving knowledge about delegation of tasks to ASCPs. The results obtained can also be used to support the successful implementation of this intervention in Haiti and possibly in other contexts. They include a middle range theory that explains how delegation of tasks to ASCPs works, as well as evidences supporting the plausibility or validity of the logic model underlying the implementation of this intervention in Haiti. The results obtained also highlight several shortcomings in the design or planning of the delegation of tasks to ASCPs in Haiti that can be corrected to increase the chances of achieving the intended objectives. Among these are the lack of resources (financial, material, and human) planned or committed and the shortcomings in the selection of ASCPs. In addition, notable progress has been observed in the implementation of the delegation of tasks to the ASCPs in northern health department of Haïti. This doctoral thesis reveals also several contextual factors hindering or facilitating the implementation of the delegation of tasks to the ASCPs of this department. These relate to the planning and monitoring of the implementation of the intervention, the institutional context, the political environment, and others. In sum, this thesis contributes to the understanding of how delegation of tasks to ASCPs works and how this intervention improves performance for healthcare organizations. It also suggests avenues of research for the advancement of knowledge in this field and recommends some improvement pathways to foster the achievement of the objectives targeted by the delegation of tasks to ASCPs in Haïti or elsewhere.

The ever-increasing prevalence of diabetes mellitus and its associated healthcare costs in the United States has led to our healthcare system's need for cost-effective health resources and chronic disease management. The interventions of Community Health Workers (CHWs) can cost-effectively improve population health and prevent the unnecessary utilization of some medical services especially in rural, low-income, minority populations, where there is often limited access to healthcare. The purpose of this study is to investigate the relationship between the number of total CHWs in rural counties and the mean diabetes-related preventable hospitalization rates in Latino patients diagnosed with diabetes in those rural counties. The main goal of this research study is to contribute to the existing literature about the importance of CHWs especially in rural counties and the effect their presence has on diabetes-related preventable hospitalizations. Quantitative rural county data sets were analyzed to determine the correlation between the number of CHWs per rural county and the rate of diabetes-related preventable hospitalizations per rural county. Due to the COVID-19 pandemic outbreak, this research project was modified to be completed in a timely manner. A statistically insignificant moderately negative linear relationship was found between the two variables. Therefore, there was not enough statistical evidence in the sample to say that this correlation exists in the rural America population. Future research is needed to investigate this relationship more thoroughly.

Agriculture is the backbone of the Haitian economy and provides employment 80% employment to the Haitian population (Lundahl, 1992). Also 85% of people in rural areas generate money from agricultural activities (IFAD, 2008). In the rural areas, men and women participate in agricultural production. However, the women play a vital role in the whole process starting from land preparation to crop sale (Gaspard, 2013). The Haitian women, despite of their function in crop productions (Dor, 2016), face different health issues, which have influence over Haitian agricultural system. Therefore, the research purposed was to investigate the impact of women heath issues on agricultural production Fondwa. A qualitative case study was used to investigate ten women farmers in the community of Fondwa, which is a small farming area in southwest part of Haiti. An interview questionnaire was used for data collection. Findings of the study showed that the women's contribution to farming is vital for promoting agricultural production, and they face different health issues that are linked to the environment and water pollution. Lastly, the women health problems influence agricultural production in the Fondwa area by preventing them from doing their daily agricultural activities, which have a direct impact over family and country's income. / MSLFS

Early diagnosis and prompt treatment is one of the malaria control strategies used to minimize malaria morbidity and mortality. One of the mechanisms to implement early diagnosis and prompt treatment is community access to diagnostic services and effective antimalarial drugs. However, in Ethiopia the health system is underdeveloped and much of the rural population has limited access to modern health services. Therefore, the Ethiopian government introduced the Health Extension Programme(HEP) which is a community-based health care delivery system aimed at accessing essential health services through its health extension workers (HEWs). Involvement of the HEWs in prescribing and dispensing antimalarial drugs is shown to have improved community access to antimalarial drugs. However, there is insufficient knowledge of HEWs compliance to malaria treatment guidelines and patient adherence of patients treated by HEWs. The objectives of this study has been to describe the HEWs practice in malaria treatment, to evaluate adherence of patients to antimalarial drugs, to explore the factors influencing the HEWs malaria treatment practice and patient adherence, and to develop the guidelines to support the HEWs in malaria treatment practice. A qualitative study design was used to study the HEWs practice in malaria treatment along with patient adherence. Data were collected using in-depth face-to-face interviews, focus group discussion and patient medical record review and were analysed according to Tesch’s steps. The study revealed that the HEWs adequately comply with malaria treatment guidelines during diagnosis of malaria, as well as during the prescribing and dispensing of antimalarial drugs. However, there are some factors influencing the performance of HEWs. These are: shortage of diagnostic kit/RDT, shortage of antimalarial drugs, patient pressure to obtain coartem, work load, and community beliefs with regard to antimalarial drugs effectiveness. This study also revealed that the HEWs follow up after treatment of patients and good community support systems improved patient adherence to antimalarial drug use. Factors negatively influencing patient adherence were identified to include: forgetfulness, fear of shortage of drugs, adverse drug effects, duration of treatment, rapid relief of malaria symptoms and inadequate awareness of the consequence of incomplete dosage. Guidelines were developed to support the HEWs in malaria treatment practice with the aim to improve patient adherence to antimalarial drugs / Health Studies / D. Litt. et Phil. (Health Studies)

Thesis (MPA (School of Public Management and Planning))--Stellenbosch University, 2008. / The role of Community Health Workers (CHWs) in the HIV/AIDS Programme is directly dependent on the support systems provided by nurses, NGOs, the community, institutional frameworks, and government funding and stress management institutions. The Home-based caregivers that work in the HIV/AIDS Programme are CHWs who need maximum support from the above- mentioned institutions. The community is also reeling with the aggravating consequences of HIV/AIDS. CHWs play a role in trying to take care of the HIV patients within the home environment. People are cared for by the people they associate with and people who live with them. In order for CHWs to maximise their contribution to the HIV/AIDS Programme, there should be commitment from all stakeholders involved in the programme. Forty-one people from formal and non-formal structures took part in the study. The formal structures refer to clinics and hospitals, whereas informal structures refer to Home-based care (HBC) groups, volunteers, NGOs and international donor agencies. The study was conducted over a period of eight weeks. The study was conducted at Cork, Calcutta and Mkhuhlu clinics, and Mkhuhlu Home-based care and on USAID field officers. The results of the study suggested that with support systems from the relevant institutions, CHWs are able to carry their community obligations in an effective and efficient manner. These findings have positive relationship implications towards the reduction of HIV infections in the community. Hospitals that are faced with overcrowding also benefit in a way, when terminally ill patients are cared for at HBC centres.

Studies of MHWs, (social workers, social auxiliary workers, trauma counsellors, and telephone counsellors), who work with trauma and stress, often focus on pathological symptoms and on the need to develop psycho-education programmes (Figley, 2002; Johnson & Hunter, 1997; Mac Ritchie & Leibowitz, 2010; Mikulincer, 1994; Stiles, 2002). A gap was identified how MHWs, who continuously intervene with traumatised children, cope with the stressors associated with their work. The purpose of this research was to explore the coping strategies of Mental Health Workers (MHWs) exposed to Secondary Trauma (ST)as a result of having to deal day to day with children (younger than 18) who have experienced trauma, including sexual, physical and emotional abuse, as well as the witness of violence. The MHWs’ coping responses were investigated using a qualitative case study approach. The investigation showed how MHWs constructed their realities by examining their coping strategies and the individual meanings they assigned to these. A convenience sample, based on the availability of participants, was selected. Nine women and one man, ranging in age from 26 to 57 years, employed at Childline Gauteng, participated in the research. The Mmogo-Method®, a projective visual research technique, explored the MHWs’ coping experiences through qualitative data collection methods. Visual and textual data were gathered and analysed thematically. It was found that the MHWs at Childline Gauteng displayed two main coping styles, namely intrapersonal and relational coping strategies. In the face of their daily stressors, MHWs managed to cope successfully by using strategies that are embedded in their daily activities. Their ability to find alternative ways to cope, despite continuous exposure to children’s trauma, allowed the MHWs to fulfil their work obligations. Their intrapersonal coping strategies reflected an ability to draw on their inner resources. Being aware of their environment and how it affects them, MHWs were able to regulate themselves and their environments by adopting positive attitudes. These attitudes, and the MHWs’ dispositions, positively affected their outlook on life. Moreover, MHWs maintained a healthy distance from their stressful environment by means of meaningful disengagement. Meaningful disengagement was fundamental to creating solitude as a coping strategy. Personal and professional boundaries, self-care and being able to draw on spirituality were further coping resources. MHWs’ discussions about finding meaning in their work revealed that they would not be able to do their work if they did not experience it as spiritually significant. Drawing on external resources, relational coping strategies included supportive relationships with family, friends and colleagues. Reciprocal unconditional acceptance significantly contributed to coping because it was important for MHWs to experience family and friends' attitudes as supportive and non-judgemental. MHWs encountered an organisational culture of care in the form of freedom to interact with colleagues and managers and sharing experiences. This interaction contributed to successful coping because MHWs felt comfort in the knowledge that they were not alone when dealing with children's trauma. This interaction facilitated coping because MHWs were able to interface successfully with their environment, even in difficult circumstances. In conclusion, the MHWs provided nuanced descriptions of the ways in which they experienced coping strategies. They coped with the demands of their profession by using internal and external resources, including intrapersonal and relational coping. / MA (Research Psychology), North-West University, Potchefstroom Campus, 2014