Introduction: Ensuring universal access to primary health care (PHC) is a key component of the Ethiopian nationalhealth policy. The policy also emphasises promoting and enhancing national self-reliance in health development bymobilizing and efficiently utilizing resources including community participation. To this end, the government introducedthe accelerated expansion of the PHC strategy through a comprehensive health extension programme (HEP). HEP is afamily and community-based health care delivery system institutionalised at health post level which combines carefullyselected high impact promotive, preventive and basic curative interventions. All HEP interventions are promotive and preventive except the malaria intervention which, in addition, incorporates a curative service. In the country, malaria is a leading disease. Unlike most Sub-Saharan African countries where P. falciparum accounts for almost all malaria infections, in Ethiopia both P. falciparum and P. vivax are co-dominant. Considering this peculiar epidemiological nature, the national guideline recommends alternative diagnosis and treatment strategies. Rationale: The lack of adequate resources and the efficiency with which available resources are being utilised are the main challenges in any health care setting. Therefore, if the HEP which consumes consideral amount of resource desires to reach its intended goal, monitoring and improving its efficiency is of great public heath importance. HEP has been successful in improving access to PHC including the malaria diagnosis and treatment service. Though this is a crucial measure, its quality ought to be considered. For the malaria curative service, studying the cost-effectiveness of the available strategy and patients’ adherence to the treatment regimen can be considered as proxy measures of quality for which local evidence is lacking. However, none of the existing studies in this field of research has addressed the Ethiopian malaria epidemiological context and its diagnosis and treatment guideline. In Tigray, for more than two decades, access to malaria early diagnosis and prompt treatment was facilitated by volunteer community healthworkers (CHWs). However, with the introduction of artemether-lumefantrine (AL) the service was compromised mainly for reasons of cost, safety and logistic. Therefore, it was important to explore the feasibility and the impact of community deployment of AL with rapid diagnostic tests (RDTs). The aim: to explore the overall performance of HEP and particularly the access to and quality of malaria early diagnosis and prompt treatment in the Tigray region of Ethiopia. Methods: Different study designs and populations were used for each of the four specific objectives. Data envelop analysis (DEA) was applied to assess the HEP efficiency. For this, register data for the output variables and primary data for the input and the environmental factors were collected. A health provider perspective cost-effectiveness analysis was used to determine which among the currently available diagnostic and treatment strategies is best for the country. Effectiveness data were generated from a stratified cross-sectional survey and secondary data were used to calculate the cost. For measuring adherence to the six-dose AL regimen, an assessment questionnaire and pill count was employed at patients´ home. To determine whether deploying AL with RDT at community level was feasible and effective, a number of designs were used: longitudinal follow-up, cross-sectional surveys, cost analysis, verbal autopsyquestionnaires and focal group discussions. Main findings: More than three-quarters of the health posts were found to be technically inefficient with an average score of 42%, which implies potentially they could improve their efficiency by 58%. Scale of operation was not a cause of inefficiency. None of the considered environmental factors was associated with efficiency. The Parascreen-based strategy (multispecies RDT-BS) was found to be the most cost-effective strategy, which allowed treating correctly an additional 65% of patients with less cost than the paracheck-BS. Presumptive-BS was highly dominated. Among P.falciparum positive patients to whom AL was prescribed, more than a quarter did not finish their treatment. The main reasons for interrupting the dose were ‘too many tablets’ and ‘felt better before finishing the dose’. The ownership of aradio, the belief that malaria cannot be treated traditionally and a delay of more than one day in seeking treatment after the onset of fever were significantly associated with being adherent. Deploying AL with RDT at community level was demonstrated to be effective and feasible. In the intervention district, almost 60% of suspected cases were managed by CHWs. Malaria transmission was lower at least threefold and malaria mortality risk by around 40% compared to the control district. The use of RDTs reduced cost and possibly the risk of drug resistance development. Conclusion: Though improving access to health care is important, it should be considered a means, not an end. Themore accessible a system is the more people could utilise it to improve their health. Thus, ensuring the access obtainedthrough HEP is maintained, its quality is improved and efficiently utilised to its optimal productivity level is a necessarytask. The DEA study revealed a high level of inefficiency where majority of the health posts needed improvement.This thesis also found parascreen-BS to be the most cost-effective strategy and that there is no epidemiological andeconomical contextual justification to keep both, the presumptive-BS and the RDT-BS specific only to P.falciparum.The high poor adherence levels raises great concern as it leads to recurrent malaria attacks of the patient, speed upthe development and spread of drug resistance strains and reduces the effect of the drug on the transmission. Therefore,providing effective drug alone is not sufficient; assessing and monitoring adherence to the treatment is by faressential. Deployment of AL with RDT through a community-based service has shown an enormous impact in termsof cost, transmission, morbidity and mortality. However, it is worth noting that this results came from an area wherea community-based service has been involved in the PHC system for more than three decades.

Este estudo propõe-se a investigar os temas relativos ao trabalho bancário e a saúde mental, tendo como objeto de pesquisa as vivências de prazer dos trabalhadores de um banco privado localizado na cidade de Porto Alegre, no Estado do Rio Grande do Sul. Fundamenta-se na importância da compreensão da dinâmica prazer e sofrimento psíquico encontrada nas relações de trabalho e tem como objetivo investigar a existência de vivências de prazer possíveis de serem vivenciadas por esses trabalhadores, bem como, identificar as estratégias que promovem prazer em suas práticas. Apóia-se teórica e metodologicamente sobre os pressupostos da Psicodinâmica do Trabalho, que se propõe através da escuta e da fala, que nesta pesquisa se deu pelo uso de entrevistas semi-estruturadas, a conhecer a organização do trabalhado na qual os sujeitos estão inseridos. A fim de evitar o sofrimento e o adoecimento psíquico, os bancários entrevistados, fazem uso de estratégias que permitem aos mesmos voltar ao trabalho no outro dia e manter o ritmo acelerado de trabalho, as cobranças por produção e a pressão das metas impostas, baseadas no conformismo e na prática de não pensar. Com este estudo verificou-se que os bancários percebem vivências de prazer em seu trabalho que provém do relacionamento com o cliente, o que lhes proporciona o sentido de utilidade de seu trabalho e o valor do mesmo. Entretanto, nesta pesquisa foi possível identificar, de forma significativa, o prazer que provém do reconhecimento pela meta atingida. Prazer esse, entendido como uma cilada, pois em geral, não provém do reconhecimento da qualidade do trabalho ou do empenho desse sujeito para a organização do trabalho, mas, do julgamento dos resultados, dos números que esse trabalhador “acrescenta” para que as metas sejam alcançadas. Entende-se que esse prazer por resultados não produz emancipação desse sujeito frente à organização do trabalho, podendo contribuir mais para o prejuízo do que para benefício do aparelho psíquico, pois torna os trabalhadores bancários prisioneiros do desejo de ser reconhecido, a qualquer custo, diante de metas que se apresentam, a cada dia, mais altas e desafiadoras. / This study proposes to investigate the issues relating to banking labor and mental health, with the objective of the research being the pleasureful experiences of employees of a private bank located in Porto Alegre, the state of Rio Grande do Sul. It is based on the importance of understanding the dynamic between psychological pleasure and suffering found in working relationships and aims to investigate the possibilities of pleasureful experiences to be enjoyed by these workers, as well as to identify strategies that will promote enjoyment in their activities. It rests on theoretical and methodological assumptions of Labor Psycho dynamics. This research was done using semi-structured interviews with all the employees of the agency with the intention of learning about the labor organization in which they are inserted. To avoid suffering and mental illness, the bank employees interviewed employ strategies which enable them to return day after day to the agency while continuing a productive pace. These are called “conformism” and “the practice of not thinking.” With this study it was established that these workers perceive work related, pleasureful experiences in customer relationships, however, there was also identified, a significantly enjoyable return stemming from the recognition received by achieving proposed goals. This pleasure is not for the recognition of the quality of their work fulfilled but for the realization that stated goals were accomplished. The joy they report for their work is related to the reaching of a goal because only in this way will their efforts become visible in the labor organization. Thus, this study contributes towards identifying how much recognition is touted as an experience of pleasure for these employees. We emphasize the importance of discussing the forms of recognition based only on results, because this may present a "trap" in which the worker is always required to produce more effort, dedication, excellence and thus eventually is lead into increasingly broken relationships due to the growing competition amongst themselves, which in turn serves more for the injury than for the benefit of mental health.

Este estudo propõe-se a investigar os temas relativos ao trabalho bancário e a saúde mental, tendo como objeto de pesquisa as vivências de prazer dos trabalhadores de um banco privado localizado na cidade de Porto Alegre, no Estado do Rio Grande do Sul. Fundamenta-se na importância da compreensão da dinâmica prazer e sofrimento psíquico encontrada nas relações de trabalho e tem como objetivo investigar a existência de vivências de prazer possíveis de serem vivenciadas por esses trabalhadores, bem como, identificar as estratégias que promovem prazer em suas práticas. Apóia-se teórica e metodologicamente sobre os pressupostos da Psicodinâmica do Trabalho, que se propõe através da escuta e da fala, que nesta pesquisa se deu pelo uso de entrevistas semi-estruturadas, a conhecer a organização do trabalhado na qual os sujeitos estão inseridos. A fim de evitar o sofrimento e o adoecimento psíquico, os bancários entrevistados, fazem uso de estratégias que permitem aos mesmos voltar ao trabalho no outro dia e manter o ritmo acelerado de trabalho, as cobranças por produção e a pressão das metas impostas, baseadas no conformismo e na prática de não pensar. Com este estudo verificou-se que os bancários percebem vivências de prazer em seu trabalho que provém do relacionamento com o cliente, o que lhes proporciona o sentido de utilidade de seu trabalho e o valor do mesmo. Entretanto, nesta pesquisa foi possível identificar, de forma significativa, o prazer que provém do reconhecimento pela meta atingida. Prazer esse, entendido como uma cilada, pois em geral, não provém do reconhecimento da qualidade do trabalho ou do empenho desse sujeito para a organização do trabalho, mas, do julgamento dos resultados, dos números que esse trabalhador “acrescenta” para que as metas sejam alcançadas. Entende-se que esse prazer por resultados não produz emancipação desse sujeito frente à organização do trabalho, podendo contribuir mais para o prejuízo do que para benefício do aparelho psíquico, pois torna os trabalhadores bancários prisioneiros do desejo de ser reconhecido, a qualquer custo, diante de metas que se apresentam, a cada dia, mais altas e desafiadoras. / This study proposes to investigate the issues relating to banking labor and mental health, with the objective of the research being the pleasureful experiences of employees of a private bank located in Porto Alegre, the state of Rio Grande do Sul. It is based on the importance of understanding the dynamic between psychological pleasure and suffering found in working relationships and aims to investigate the possibilities of pleasureful experiences to be enjoyed by these workers, as well as to identify strategies that will promote enjoyment in their activities. It rests on theoretical and methodological assumptions of Labor Psycho dynamics. This research was done using semi-structured interviews with all the employees of the agency with the intention of learning about the labor organization in which they are inserted. To avoid suffering and mental illness, the bank employees interviewed employ strategies which enable them to return day after day to the agency while continuing a productive pace. These are called “conformism” and “the practice of not thinking.” With this study it was established that these workers perceive work related, pleasureful experiences in customer relationships, however, there was also identified, a significantly enjoyable return stemming from the recognition received by achieving proposed goals. This pleasure is not for the recognition of the quality of their work fulfilled but for the realization that stated goals were accomplished. The joy they report for their work is related to the reaching of a goal because only in this way will their efforts become visible in the labor organization. Thus, this study contributes towards identifying how much recognition is touted as an experience of pleasure for these employees. We emphasize the importance of discussing the forms of recognition based only on results, because this may present a "trap" in which the worker is always required to produce more effort, dedication, excellence and thus eventually is lead into increasingly broken relationships due to the growing competition amongst themselves, which in turn serves more for the injury than for the benefit of mental health.

Estima-se que 52% da população mundial faz uso de álcool, sendo a droga mais consumida no mundo. Ao usuário, o álcool torna-se prejudicial devido às consequências nos níveis biológicos, sociais e funcionais. Assim, a redução do uso abusivo da substância é um dos objetivos da Organização Mundial de Saúde (OMS) e uma das prioridades na agenda de saúde pública mundial. No Brasil, a Política do Ministério da Saúde para a Atenção Integral aos Usuários de Álcool e Outras Drogas teve como objetivo a criação de uma rede de atenção integral a eles - a RAPS (Rede de Atenção Psicossocial). A RAPS é considerada um grande avanço da Reforma Psiquiátrica, já que integra os diversos pontos de atenção disponíveis no Sistema Único de Saúde (SUS). Um dos pontos da RAPS é a Atenção Básica (AB), que através da atuação das equipes da Estratégia Saúde da Família (ESF) tem a possibilidade de monitoração, prevenção do uso e colaboração na reinserção social dos usuários de álcool e outras drogas devido à proximidade e criação de vínculo entre o serviço e usuário. Para que o vínculo seja estabelecido o Agente Comunitário de Saúde (ACS) é a peça fundamental, visto que conhece a comunidade e reconhece suas necessidades, além de ser a figura que medeia as relações entre a equipe de saúde e os usuários. Assim sendo, o objetivo deste estudo foi descrever e analisar o discurso de ACS sobre o uso de álcool e a assistência prestada na AB. Trata-se de um estudo qualitativo de teor descritivo, cuja pesquisa ocorreu em cinco municípios da região central do Estado de Santa Catarina. Foram realizadas entrevistas semiestruturadas, analisadas através do método da Análise de Conteúdo. A análise das entrevistas resultou na formulação de duas categorias e quatro subcategorias empíricas. Os resultados evidenciaram que os ACS percebem o consumo de álcool como inerente a população em virtude da cultura caracterizada pelo consumo habitual e festivo da droga. Eles percebem que o uso do álcool torna-se um problema quanto à definição social atribuída pela comunidade, ressaltando as consequências para a família e outras perdas vivenciadas pelos usuários com base nas repercussões sociais. Quanto à assistência prestada por eles aos usuários de álcool, os resultados indicaram uma prática desprovida de instrumentos ou habilidades para a abordagem adequada do uso, evidenciando uma prática infundada pelos ACS. A prática está pautada também nas crenças em relação aos usuários de álcool, que estão muito ligadas aos estigmas relacionados a estes usuários em geral e não em evidências científicas. Conclui-se que a partir do conhecimento das percepções e práticas deste profissional, é possível direcionar ações que potencialize a prática dos ACS, já que são profissionais com grandes possibilidades de atuação diante da prevenção e tratamento do abuso de álcool e reabilitação social do usuário / It is estimated that 52% of the population uses alcohol, being the most consumed drug in the world. For the user, the alcohol becomes harmful due to the consequences in the biological, social and functional levels. Thus, reducing the alcohol abuse is one of the World Health Organization\'s (WHO) goals and one of the priorities in the global public health agenda. In Brazil, the Health Ministry\'s Policy for Integral Attention to Alcohol and Other Drug Users aimed to create a network care to them - the RAPS (Psychosocial Care Network). The RAPS is considered a major breakthrough of the Psychiatric Reform, as it integrates the various points of care available in the Unified Health System (UHS). One of the RAPS points is the Primary Care (PC), which through the performance of the Family Health Strategy\'s teams (FHS) has the possibility of monitoring, the use prevention and collaboration to the social reintegration of alcohol and other drug users due to proximity and bond between service and the users. So that the link is established the Community Health Workers (CHW) is the keystone, as they know the community and recognize their needs as well as being the figure that mediates the relationship between health staff and users. So, the aim of this study was to describe and analyze the ACS speech on the alcohol use and on the assistance provided in AB. It is a qualitative study of descriptive content, whose research took place in five municipalities of the central region of Santa Catarina State. Semi-structured interviews were conducted, analyzed through the Content Analysis method. The data analysis resulted in the formulation of two empirical categories and four empirical subcategories.The results showed that ACS perceive alcohol consumption as inherent in population due to the culture characterized by the drug\'s customary and festive use. They realize that alcohol use becomes a problem as the social definition given by the community, highlighting the consequences for the family and other losses experienced by users based on their social impact. Regarding the assistance given by them to alcohol users, the results indicated an unprovided practice of tool or skills to the appropriate approach to the consumption, showing an unfounded practice by ACS. The practice is also guided by beliefs concerning to alcohol users, which are closely linked to stigmas generally related to these users and not on scientific evidences. We concluded that by the professional\'s knowledge of perceptions and practices, it\'s possible to direct actions that leverage their practice, since they are professionals with great possibilities of acting on treatment and prevention of alcohol abuse and user\'s social rehabilitation

Este estudo propõe-se a investigar os temas relativos ao trabalho bancário e a saúde mental, tendo como objeto de pesquisa as vivências de prazer dos trabalhadores de um banco privado localizado na cidade de Porto Alegre, no Estado do Rio Grande do Sul. Fundamenta-se na importância da compreensão da dinâmica prazer e sofrimento psíquico encontrada nas relações de trabalho e tem como objetivo investigar a existência de vivências de prazer possíveis de serem vivenciadas por esses trabalhadores, bem como, identificar as estratégias que promovem prazer em suas práticas. Apóia-se teórica e metodologicamente sobre os pressupostos da Psicodinâmica do Trabalho, que se propõe através da escuta e da fala, que nesta pesquisa se deu pelo uso de entrevistas semi-estruturadas, a conhecer a organização do trabalhado na qual os sujeitos estão inseridos. A fim de evitar o sofrimento e o adoecimento psíquico, os bancários entrevistados, fazem uso de estratégias que permitem aos mesmos voltar ao trabalho no outro dia e manter o ritmo acelerado de trabalho, as cobranças por produção e a pressão das metas impostas, baseadas no conformismo e na prática de não pensar. Com este estudo verificou-se que os bancários percebem vivências de prazer em seu trabalho que provém do relacionamento com o cliente, o que lhes proporciona o sentido de utilidade de seu trabalho e o valor do mesmo. Entretanto, nesta pesquisa foi possível identificar, de forma significativa, o prazer que provém do reconhecimento pela meta atingida. Prazer esse, entendido como uma cilada, pois em geral, não provém do reconhecimento da qualidade do trabalho ou do empenho desse sujeito para a organização do trabalho, mas, do julgamento dos resultados, dos números que esse trabalhador “acrescenta” para que as metas sejam alcançadas. Entende-se que esse prazer por resultados não produz emancipação desse sujeito frente à organização do trabalho, podendo contribuir mais para o prejuízo do que para benefício do aparelho psíquico, pois torna os trabalhadores bancários prisioneiros do desejo de ser reconhecido, a qualquer custo, diante de metas que se apresentam, a cada dia, mais altas e desafiadoras. / This study proposes to investigate the issues relating to banking labor and mental health, with the objective of the research being the pleasureful experiences of employees of a private bank located in Porto Alegre, the state of Rio Grande do Sul. It is based on the importance of understanding the dynamic between psychological pleasure and suffering found in working relationships and aims to investigate the possibilities of pleasureful experiences to be enjoyed by these workers, as well as to identify strategies that will promote enjoyment in their activities. It rests on theoretical and methodological assumptions of Labor Psycho dynamics. This research was done using semi-structured interviews with all the employees of the agency with the intention of learning about the labor organization in which they are inserted. To avoid suffering and mental illness, the bank employees interviewed employ strategies which enable them to return day after day to the agency while continuing a productive pace. These are called “conformism” and “the practice of not thinking.” With this study it was established that these workers perceive work related, pleasureful experiences in customer relationships, however, there was also identified, a significantly enjoyable return stemming from the recognition received by achieving proposed goals. This pleasure is not for the recognition of the quality of their work fulfilled but for the realization that stated goals were accomplished. The joy they report for their work is related to the reaching of a goal because only in this way will their efforts become visible in the labor organization. Thus, this study contributes towards identifying how much recognition is touted as an experience of pleasure for these employees. We emphasize the importance of discussing the forms of recognition based only on results, because this may present a "trap" in which the worker is always required to produce more effort, dedication, excellence and thus eventually is lead into increasingly broken relationships due to the growing competition amongst themselves, which in turn serves more for the injury than for the benefit of mental health.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-02T12:15:03Z No. of bitstreams: 1 Alessandro Fábio de Carvalho Oliveira.pdf: 2044062 bytes, checksum: 87977064b3d976aef7ad543713a9fe6b (MD5) / Made available in DSpace on 2015-12-02T12:15:03Z (GMT). No. of bitstreams: 1 Alessandro Fábio de Carvalho Oliveira.pdf: 2044062 bytes, checksum: 87977064b3d976aef7ad543713a9fe6b (MD5) Previous issue date: 2013 / Mestrado Profissional em Enfermagem Assistencial / Situação-problema: A automedicação é uma prática comum pelos trabalhadores de enfermagem e podem acarretar riscos a saúde quando não realizada de forma segura. O objeto de pesquisa é o uso da automedicação pelos trabalhadores de enfermagem no contexto da terapia intensiva oncológica. Objetivo geral: Conhecer os motivos e valores que levam os trabalhadores de enfermagem em terapia intensiva oncológica a utilizarem a automedicação. Objetivos específicos: Identificar as concepções sobre o uso da automedicação pelos trabalhadores de enfermagem em terapia intensiva oncológica; Analisar no discurso do sujeito coletivo o significado da adoção da automedicação; Criar estratégias de comunicação que atendam ao trabalhador e orientem o uso seguro da automedicação. Método: Pesquisa qualitativa, exploratória e descritiva, com apoio da técnica de Análise do Discurso do Sujeito Coletivo. Os dados foram coletados na Unidade de Terapia Intensiva do Hospital do Câncer II – INCA-RJ. Os participantes foram 25 trabalhadores de enfermagem. A coleta de dados se deu a partir de um roteiro de entrevista e um questionário e os dados organizados através do software Qualiquantisoft. Resultados: A automedicação é realizada pelos trabalhadores de enfermagem e os medicamentos mais utilizados são os analgésicos e os anti-inflamatórios, apresentando reações adversas e revelando ainda o uso de drogas psicoativas. O acesso se dá entre outros pela facilidade de uso de medicamentos disponíveis no setor, uso de prescrições cedidas por médicos que trabalham nos hospitais ou com medicamentos cedidos por conhecidos. Aparecem como motivos para uso da automedicação o excesso de carga horária, o conhecimento desenvolvido com as medicações, a facilidade de obter os medicamentos além do hábito cultural da população brasileira, afirmando que trabalhar na enfermagem está diretamente relacionado com a prática da automedicação. Conclusão: Faz-se necessário uma revalidação do autocuidado, haja vista que a negligência do cuidado de si, abdicar do tempo para si em prol do trabalho, remete a preocupação com o uso indiscriminado da automedicação. Os fatores educacionais podem contribuir para a automedicação mais segura e para a redução dos riscos. Vemos a necessidade de desenvolver projetos de educação em saúde para redução dos agravos decorrentes da automedicação / Problem situation: Self-medication is a common practice by the nursing staff and may cause health risks if not held securely. The object of research is the use of self-medication by nursing staff in the context of oncology intensive care. Overall Objective: To know the reasons and values that lead workers in oncology nursing to use self-medication intensive care. Specific Objectives: To identify the conceptions of self-medication by nursing staff in oncology intensive care; Analyze the collective subject discourse the significance of the adoption of self-medication; Create communication strategies that meet the employee and guide the safe use of self-medication. Method: A qualitative, exploratory and descriptive study, with support from technical analysis of the Collective Subject Discourse. Data were collected in the Intensive Care Unit of the Cancer Hospital II - INCA - RJ. Participants were 25 nursing workers. Data collection occurred from a structured interview and a questionnaire and data organized by Qualiquantisoft software. Results: Self-medication is carried out by nursing staff and medicines are the most widely used analgesic and anti -inflammatory, with adverse reactions and also revealing the use of psychoactive drugs. Access is among others the ease of use of medicines available in the industry, use of prescriptions sold by doctors working in hospitals or transferred by known drugs. Appear as reasons for self-medication excess workload, the knowledge developed with medications, the ease of obtaining drugs beyond the cultural habits of the population, claiming to work in nursing is directly related to self-medication. Conclusion: It is necessary revalidation of self-care, given that the neglect of self-care, time for you to abdicate in favor of labor, leads to concern about the indiscriminate use of self-medication. Educational factors may contribute to self-medication safer and to reduce risks. We see the need to develop projects in health education to reduce injuries resulting from self-medication

Magister Artium (Medical Anthropology) - MA(Med Ant) / Women are the principle providers of their families when it comes to issues of health care, even though their health needs and efforts are neglected. The contributions that they make to health development seem to be undervalued, and their working conditions ignored. Societies depend heavily on women as role players in the welfare of their families and of national economics together with their physical well-being which determines the ability to be productive. The study has provided an overview of the experiences of women concerning primary health care and the quality of service in Nolungile PHC Khayelitsha, Cape Town. Primary health care (PHC) forms an integral part both of the country‘s health system and the overall social and economic development of the community. Central to the PHC approach is full community participation in the planning, provision, control and monitoring of services. Priority has to be given to the improvement of women‘s social and economic status.A much neglected perspective in health issues is that, a number of questions arise from the provision of PHC. Does PHC rely on the contribution of women and if so, why women? Women in their communities have joined their hands together as community health workers, educating community members on issues of health. The study has provided an insight of the work that women are doing in their communities, and how do they give meaning to their experiences in PHC. The study also answered questions that raise fundamental issues on gender stereotyping and disparities in PHC. The study gave me an opportunity to work closely with the women while observing the challenges that they are facing and how to they overcome them in the daily lives.Changes are called towards the attitudes of health care providers working in the formal and nonformal sectors. The provision of health education for women ultimately empowers them as health educators for the community.

African American women have significantly higher mortality rates from heart disease and stroke than White women despite advances in treatment and the management of risk factors. Community health workers (CHWs) serve important roles in culturally relevant programs to prevent disease and promote health. This article describes the Pine Apple Heart and Stroke Project's activities to (1) revise the Women's Wellness Sourcebook Module III: Heart and Stroke to be consistent with national guidelines on heart disease and stroke and to meet the needs of African American women living in rural southern communities; (2) train CHWs using the revised curriculum; and (3) evaluate the training program. Revisions of the curriculum were based on recommendations by an expert advisory panel, the staff of a rural health clinic, and feedback from CHWs during training. Questionnaires after training revealed positive changes in CHWs' knowledge, attitudes, self-efficacy, and self-reported risk reduction behaviors related to heart disease, stroke, cancer, and patient-provider communication. This study provides a CHW training curriculum that may be useful to others in establishing heart disease and stroke programs in rural underserved communities.

Magister Artium (Psychology) - MA(Psych) / While community health workers possess valuable insight into health care delivery in South Africa, their voices and experiences are seldom sought in the acquisition of knowledge surrounding relevant social concerns. This research aimed to explore community health workers’ perspectives of mother–infant bonding within the first 1000 days of life. The first 1000 days of a child’s life are a delicate yet highly consequential period affecting future physical, cognitive, and socio-emotional growth. The bond between mother and infant within the first 1000 days is especially critical as it is within the bounds of this relationship that a child is fed, cared for, and kept safe. Furthermore, mother–infant bonding lays an essential foundation for future development. However, there is a paucity of contextualized literature, particularly regarding mother–infant bonding in the first 1000 days. In practice, mother–infant interventions are often delivered by community health workers. Through their work, community health workers gain a wealth of knowledge and information about the experiences and practices of bonding within their community. Their insights are a potentially untapped resource which could be used to supplement research and interventions with local, contextualized wisdom. The aim of this research was to explore community health workers’ perspectives of mother–infant bonding within the first 1000 days in Khayelitsha, South Africa. The study utilized a qualitative methodological framework and an exploratory research design. Semi-structured individual interviews were conducted with 15 experienced community health workers, who were purposively selected from a non-governmental organization located in Khayelitsha, South Africa. Data were thematically analysed, and five primary themes emerged from the analysis, namely: (1) the importance of the first 1000 days; (2) the centrality of mother–infant bonding within the first 1000 days; (3) effective approaches to bonding are simple, natural, and free; (4) the inhibitors of mother–infant bonding; and (5) the need for support. Trustworthiness and researcher reflexivity practices were integrated throughout the research process. Ethics considerations were prioritized, and included providing informed consent, ensuring confidentiality and anonymity, and informing participants of their rights as stipulated by the University of the Western Cape Biomedical Research Ethics Committee.

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