To tackle one of the world’s worst maternal, neonatal and child health outcomes and a chronic shortage of human resources for health, the Afghan Ministry of Public Health deployed volunteer Community Health Workers (CHW) in rural areas of Afghanistan in 2003. This thesis documents the Afghan CHW program, exploring organizational and community contexts. The research design in this study is a mixed methods case study. The actual Afghan CHW program was situated with an Afghan complex adapative health system, mainly guided by the policy of the health system but was also largely influenced by the power and gender dynamics of the community context in which it was implemented. The tasks of CHWs were numerous but CHWs role was more than just the sum of their tasks; they occupied a unique location juxtaposed between formal and informal HRH systems. It is important to acknowledge the assembly of so many national and international organizations in achieving a shared goal of providing health services to a large population in an unstable and partially insecure environment. The shared goal in the Afghan context may have been interpreted only in terms availability of services, though the goal carries with it, either explicitly or implicitly, the values of effectiveness, efficiency, timeliness, and costliness – known as quality by some participants of this study. The community component was another layer of the complex adaptive system that made up the Afghan CHW program. Political-ethnic power in the community and legal-rational authority of the health system influenced the way communities were mapped in an inequitable manner, in turn, contributed to the unfair distribution of resources to the populations. Finally, the intersection of the gender equity approach and the gendered nature of the work as a cross-cutting layer added to the complexity of the Afghan health system.

This thesis, 'Living with HIV/AIDS: An ethnography of care in Western Kenya', is based upon 18 months of ethnographic fieldwork carried out in Central Nyanza, Kenya, between 2005-2007. It studies practices of care against the backdrop of the HIV/AIDS epidemic, which has impacted the region severely. The thesis explores how home and hospital are established as domains of care through practice. It draws upon ethnographic material collected from within a District Hospital, a Community-Based Organisation and people's homes. The thesis follows practices of care across divergent domains of social life to consider how practices of care within Luo networks of kinship and relatedness intersect with governmental interventions to manage HIV/AIDS. The thesis describes two governmental projects introduced to administer HIV/AIDS care in this region. It considers Home-Based Care, an HIV/AIDS response in which Community Health Workers are trained to support particular aspects of care at home, focusing on the practices of care employed by Community Health Workers as they visit sick people at home and attend organisational meetings. The thesis also describes the landscape of HIV care in the District Hospital, including the delivery of antiretroviral therapy. The focus here is on the relationships between caring practices in the hospital and at home, and the divergent responsibilities to care experienced by hospital staff and family members. The main argument of the thesis is that care is a particularly useful analytical tool for anthropology because practices of care take place across many different domains of social life, cutting across the boundaries that have formed the traditional focus of anthropological study. Studying practices of care illuminates the production of bounded domains of social life whilst simultaneously drawing attention to similarities of practice across different domains. Care provides a way of understanding the complex social landscape that has developed as people in Western Kenya endeavour to live with HIV/AIDS.

Orientador: Ana Maria Aparecida Guaraldo / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-22T08:35:35Z (GMT). No. of bitstreams: 1 Ferreira_GlaucoRogerio_D.pdf: 2964649 bytes, checksum: 7665afd2ae49a0524acb8e13d66e8985 (MD5) Previous issue date: 2013 / Resumo: A Organização das Nações Unidas (ONU) no ano 2000 definiu oito Objetivos do Milênio; dentre eles pode-se destacar o sexto que é Combater o HIV/AIDS, a malária e outras doenças. As doenças parasitárias constituem ainda um sério problema de saúde pública. A erradicação ou controle desses parasitas requer melhorias das condições sócio-econômicas, do saneamento básico e educação. O presente trabalho teve como objetivo avaliar o Ensino a Distância como ferramenta de ensino para agentes de saúde, sobre as temáticas Doenças parasitárias; Criar conteúdo e disseminar conhecimento para capacitar agentes municipais de saúde em medidas profiláticas, transmissão e prevenção de parasitoses intestinais, através do preparo e aplicação de curso a distância (EAD); Analisar a Plataforma TelEduc para difundir essa capacitação a outros agentes. O curso foi montado e realizado em Plataforma TeldEduc, hospedada no Instituto IPES (Instituto de Projetos Especiais), com duração de 180 horas, sendo 148 horas por EAD e 32 presenciais. A maioria das aulas presenciais foi realizada na Faculdade Municipal "Professor Franco Montoro", no município de Mogi Guaçu-SP. O público alvo foi constituído pelos agentes de saúde e profissionais da saúde; 158 alunos se inscreveram no curso e a taxa de evasão foi de 24,8%. As aulas presenciais eram constituídas por aulas práticas, visitas técnicas ou revisão de conteúdo. Foi aplicado um questionário no início e outro no término para avaliar os conhecimentos pré existentes sobre a temática e os adquiridos pelo curso. Foi empregado o teste Qui-Quadrado para avaliar o nível de significância entre as respostas dos questionários. Concluiu-se que o EAD pode e deve ser utilizado, como uma alternativa de educação em doenças parasitárias, como mais uma ferramenta útil para acesso e ampliação do conhecimento / Abstract: The Organization of the United Nations (ONU) in 2000 set eight Millennium Development Goals; among them we can highlight which is the sixth: Combat HIV / AIDS, malaria and other diseases. Parasitic diseases are still a serious public health problem. The eradication or control these parasites requires improvements in socioeconomic conditions, sanitation and education. This study aimed to evaluate the Distance Learning as a teaching tool for health workers, concerning parasitic diseases. Create content and disseminate knowledge to empower local health agents in prophylactic measures, transmission and prevention of intestinal parasites, through the preparation and application of distance learning course (DLC); Analyze Platform TelEduc to disseminate this training to other agents. The course was set up and held in TeldEduc Platform, hosted at the Institute IPES, lasting 180 hours, with 148 hours of classroom and 32 DLC. Most regular classes were held in the Faculty Franco Montoro. The course was facing health workers and health professionals, 158 people enrolled in the course and 115 completed, which generated a dropout rate of 24,8%. The classroom consisted of practical sessions, technical visits or content review. A questionnaire was applied at the beginning and another at the end to assess the pre-existing knowledge on the subject and acquired by the course. It was employed a chi-square test to assess the level of significance between the answers of questionnaire. It was concluded that the DLC can and should be used as an alternative education on parasitic diseases and means a very useful tool to improve the access and knowledge / Doutorado / Relações Antrópicas, Meio Ambiente e Parasitologia / Doutor em Biologia Animal

Magister Scientiae (Physiotherapy) - MSc(Physio) / People with disabilities (PWD) often come from disadvantaged communities and struggle to access health and rehabilitation, education and employment. This leads to poorer health outcomes, lower education achievements, and higher rate of unemployment in comparison to people without disabilities. Therefore there is a need to empower PWD to remove all barriers which prevent them from participating in all aspects of their communities. In South Africa, 5% of the population is disabled and in a worldwide review conducted on access to rehabilitation services, it was reported that South Africa provided 21% to 40% of the disabled population with rehabilitation services. In 2012 the Department of Health (DOH) trained a new cadre of community health worker (CHW) in the field of rehabilitation in order to improve PWDs‘ access to health services. As a result, health professionals in the Western Cape became concerned about the role of this new cadre of rehabilitation care worker in PHC and CBS. The aim of this study was therefore to explore health professionals‘ perceptions of the newly trained rehabilitation care workers (RCWs). Q methodology was selected as an appropriate research design to meet the objectives of this study as it can be used to analyse opinions, perceptions and attitudes. The study population consisted of all the health professionals who engaged with the RCWs in the clinical workplace during their clinical practice module. A convenient sample of sixteen health professionals participated in this study. Ethics approval was obtained to conduct this study and all participants gave written consent to participate in this study. The researcher gathered all the viewpoints of the health professionals regarding the new rehabilitation care workers (RCWs) by conducting focus group discussions and document analysis. Statements were then drawn up based on the health professionals' viewpoints. The participants then ranked these statements from strongly agree to strongly disagree on a Q data score grid, in a process called Q sorting. The completed Q data score grids, called Q sorts, were then entered into PQMethod software programme for statistical and factor analysis. From the results of this Q analysis, two factors emerged which were analysed and interpreted. A factor is representative of participants with similar opinions. The participants loading onto Factor one and Factor two shared similar opinions of the RCWs. The results indicated that the participants were of the opinion that RCWs‘ role would be to strengthen primary health care (PHC) and community-based rehabilitation (CBR) and promote the participation of PWD in society. The results suggested that the RCWs were capable of improving the quality of life of PWD by empowering PWD to become actively involved in all aspects of community life. The participants felt that the RCWs would be included in the health system by working at intermediate care centres (facility-based) and in the community (home-based). However, the participants agreed that the RCWs must work under the direct supervision of qualified health professionals. Participants loading onto Factor one and Factor two further agreed that RCWs worked well in the structured environment of intermediate care health facilities. They felt that it would be beneficial for RCWs to be employed at these health facilities as the RCWs reduced the workload of the health professionals. From the results, it was also found that health professionals were of the opinion that the RCWs displayed positive attitudes and good professional behaviour in the clinical environment. Health professionals however identified gaps in the knowledge of the RCWs and a lack of skills to perform certain tasks. However, health professionals agreed that the RCWs' skills will develop and improve with time and exposure. This study showed that health professionals had positive perceptions of the RCWs and this could indicate that RCWs will be well accepted by health professionals as part of the PHC team. This could lead to the effective utilisation of RCWs in community-based rehabilitation. Recommendations can be made to the developers and implementers of the RCW training curriculum to make adjustments to the curriculum so as to address the lack of knowledge and skills in certain aspects of health and disability. It can further be recommended that South Africa's National DOH capitalise on these positive perceptions and train more RCWs to extend rehabilitation and health services to more underserved communities. This will assist the South African Government in ensuring that more PWD receive rehabilitation and become included in all aspects of their communities as is envisaged in the 2020/2030 health plan.

Orientador: Sérgio Roberto de Lucca / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-28T12:15:39Z (GMT). No. of bitstreams: 1 Bezerra_JaironLeiteChaves_M.pdf: 2143572 bytes, checksum: bf18bfcd495c47f3e454991d1429d4f5 (MD5) Previous issue date: 2015 / Resumo: O trabalho em saúde tem sido destacado no meio internacional, devido ao alto nível de adoecimento dos trabalhadores. No Brasil, a Estratégia Saúde da Família configura-se uma reorientação do modelo assistencial de saúde na qual uma equipe multiprofissional acompanha a situação de saúde e promove ações a um número de famílias, dentro de um território. As condições em que estes profissionais vivenciam o seu trabalho podem ser desencadeantes de sofrimento mental, causando o estresse. O agente comunitário de saúde é um dos atores centrais no processo de trabalho em saúde do modelo de atenção à saúde brasileiro. Na cidade de Parnaíba/PI, esses trabalhadores parecem estar expostos a situações de desgaste físico e/ou emocional durante o exercício de suas funções. Isto percebido pelo pesquisador na sua rotina de trabalho no Núcleo de Apoio ao Saúde da Família do município, trouxe o interesse e motivação para realização da pesquisa. Com o objetivo de compreender os fatores psicossociais desencadeadores de estresse no trabalho na percepção dos agentes comunitários, optou-se realizar um estudo epidemiológico de corte transversal. Utilizando-se uma abordagem quanti e qualitativa, buscou-se aplicar um questionário de avaliação de estresse com toda a população pesquisada, além de se realizar um grupo focal para se esclarecer os resultados encontrados. Da amostra final, a sua maioria era de mulheres (73,2%), com idade acima dos 30 anos (74,3%), com formação técnica (26,2%) e pós-graduação (24,4%) e com tempo de exercício na profissão e no SUS superior aos 14 anos. O território do Distrito III (31,55%) foi o mais representado no estudo. Como principais dimensões psicossociais encontradas temos as relacionadas aos relacionamentos, às mudanças e ao controle. As narrativas do grupo focal revelaram que: os agentes entendem bem o cargo que ocupam; o apoio da chefia ocorre menos que o dos colegas; há atribuições excessivas somadas à violência no ambiente de trabalho; a autonomia do agente é limitada ainda à técnica; as carências do serviço e a falta de comunicação prévia promovem descontentamento dos profissionais e da comunidade. A dimensão mais destacada foi a de relacionamentos, pois vínculos estabelecidos com a comunidade a equipe e a gestão municipal não são tão valorizados podendo ser quebrados. Acredita-se que um trabalho mais organizado e pautado na humanização possa trazer espaços de trabalho mais saudáveis, evitando-se o adoecimento e, até mesmo, o Burnout / Abstract: Health work has been featured in the international environment due to the high level of illness of workers. In Brazil, the Family Health Strategy sets up a reorientation of the health care model in which a multidisciplinary team monitors the health status and promotes actions to a number of families within a territory. The conditions under which these professionals have their work may trigger mental suffering causing stress. The Community Health Worker is one of the central actors in the work process in health care to the Brazilian model. In Parnaíba/PI, these workers seem to be exposed to situations of physical and/or emotional stress during the performance of their duties. This perceived by the researcher in his work routine at the municipal Support Center for the Family Health, brought the interest and motivation for the research. In order to understand the psychosocial factors triggering at stress at work in the perception of Community Health Worker, it was decided to conduct an epidemiological cross-sectional study. Using a quantitative and qualitative approach, we attempted to apply a stress assessment questionnaire with all the research population, in addition to conducting a focus group to clarify the results. The final sample, the majority were women (73.2%), over the age of 30 years (74.3%), with technical training (26.2%) and graduate (24.4%) and exercise time in profession and in SUS higher to 14 years. The territory of the Third District (31.55%) was the most represented in the study. The main founded psychosocial dimensions was related to relationships, changes and control. The narratives of the focus group revealed that: workers understand well the position they hold; the support of the head is less than that of colleagues; there excessive assignment added to violence in the workplace; the agent's autonomy is still limited to the technique; the needs of the service and the lack of prior notification promote discontent among professionals and the community. The most prominent was the dimension of relationships beacause the links established with the community, staff and municipal management are not as valued and can be broken. It is believed that a more organized work and guided by the humanization can bring healthier workspaces, avoiding the illness and even the Burnout / Mestrado / Epidemiologia / Mestre em Saude Coletiva

Master of Public Health - MPH / Community health workers (CHWs) are integral to improve Primary health care (PHC) coverage, utilising their unique skills within the community to make services accessible and equitable. PHC is the cornerstone of the National Health Insurance (NHI) Bill for the provision of Universal Health Care (UHC). The Department of Health (DOH) in the Western Cape, South Africa, has set priorities and requirements for the provision of funding to Non-profit organisations (NPOs) for forming coalitions with the Health Department to deliver various aspects of health care. The post-2015 agenda of the Sustainable Development Goals (SDGs) are underscored by a strong sense of intersectoral collaboration to work together to attain sufficient and sustainable progress. Collaboration between CHWs and PHC facilities is important in aligning goals and activities to ensure a comprehensive and sustainable approach to ensuring UHC

The South African National Development Plan (NDP) (National Planning Commission, 2011, p. 1) provides the road map for a reformed public health system by 2030. The proposed health system will be facilitated by, amongst others, training an appropriate balance of healthcare professional s including a cadre of community health workers (CHWs) that have a broad skills mix suited to reaching a larger number of people with first level intervention. With this in mind, a pilot group of CHWs were up-skilled as Rehabilitation Care Worker s (RCWs). The training program was a joint project between the Division of Disability Studies and the Departments of Occupational Therapy, Physiotherapy and Speech and Language Therapy at UCT. Problem: Little is known about the perspectives of RCWs on the benefits and challenges of additional training in rehabilitation and disability related skills. Rationale: To inform the curriculum for a rehabilitation care worker (RCW) training program and the Western Cape Department of Health (WCDoH) of ways in which this cadre of worker could contribute to the realization of the 2030 Healthcare Plan. Aim: To describe the outcomes of a pilot RCW training program from the perspective of the pilot group of graduates. The objectives were to identify the areas of practice where RCWs feel competent/incompetent, to identify aspects of the health services where RCWs believe they can contribute the most/the least and to identify the facilitators/barriers they experienced when deployed in the health field. Methodology: A qualitative descriptive study was conducted. Method: Focus groups were carried out with three groups of six participants. Findings: The plot that permeated the participants’ perspectives revolved around how the RCWs were pioneers in breaking new ground for the Western Cape Department of Health (WCDoH). Two themes informed the plot: "we move health services to a new level" and "we manage change in new ways". Discussion: It is argued that the pilot RCW curriculum achieved its’ objective of equipping a cadre of worker with basic rehabilitation, care and disability inclusion skills. While the envisaged role of RCWs in the health service and in making the NDP a reality is supported, it is argued that attention needs to be given to supervision structures and to training of all other health workers in order to promote inter professional practice. Conclusions: The pilot group of RCWs believe that they have acquired a new and large variety of skills that have enabled them to make a broad and positive impact in their places of work, at home and in the broader community.

In in low-and middle-income countries (LMIC), where there are very few trained physicians and nurses, community health workers (CHWs) are often the only providers of healthcare to millions of people. Such LMIC are countries that are classified, based on their geographic region and Gross National Income (GNI), as low-middle income by the World Bank Group, the worlds largest development bank. Research has shown digital health tools to be an effective strategy to improve the performance of frontline line health workers. The aim of this review was to systematically examine the literature on digital health tools that are used for decision support in LMIC and describe what we can learn from studies that have used these tools. As part of a larger parent study the following databases were searched: PubMed, Embase, Scopus, CINAHL, Global Health Ovid, Cochrane and Global Idex Medicus, to find ariticles in the following domains: training tools, decision support, data capture, commodity tracking, provider to provider communication, provider to patient communication and alerts, reminders, health information content. These domains were selected based on the World Health Organisation (WHO) framework for classifying digital health interventions. Content from all seven of these domains informed a series of reviews however this review focuses on how digital tools are used to provide decision support to FLHWs. Included studies were conducted in LMIC in Africa, Asia, North America and South America with the most common users of the tools being CHWs. Most tools for FLHW decision-support used in the interventions described in included articles were in either the pilot or prototype phases, and offered maternal and child health care services. Although decision support was the primary digital health function of all these studies, there was considerable variation in the number of digital health functions of each tool with most studies reporting decision support and data capture as their primary and secondary functions respectively. All the studies found their intervention to have beneficial effects on one or more of the following outcomes: beneficiary engagement, provider engagement, health effects and process/outputs. These findings show great potential for the use of decision support digital health tools as a means of improving the outcomes of health systems through; reducing the work load of FLHWs, reducing the costs of health care, improving the efficiency of service delivery and/or improving the overall quality of care.

The purpose of the study is to contribute to the development of a tool that can support the rehabilitation care worker towards intervention planning and the monitoring of their clients. The National Health Insurance and the Framework and Strategy for Disability and Rehabilitation of the South African Department of Health are strategies to work towards accessible, affordable, equitable and quality health care, which includes health promotion, disease prevention, curative, rehabilitation and palliative services for all South Africans. Both strategies emphasise the use of community health workers and mid-level workers as a key component of primary health care. In the Western Cape provincial Department of Health a new cadre, namely the rehabilitation care worker has been introduced as a member of the rehabilitation team. The introduction of the rehabilitation care worker is still in the pilot phase. The rehabilitation care workers face many barriers to providing effective care. One such challenge is the lack of a contextually relevant resource tool to collect information on the rehabilitation and health needs of persons with disabilities. The aim of the study was to develop a contextually relevant resource tool that would support the rehabilitation care worker in understanding and documenting how the rehabilitation and related health needs of persons with disabilities are met in home- and community-based settings. Three specific objectives were defined: i) to develop the content and domains of the rehabilitation and health information tool; ii) to establish the validity (face and content) of the rehabilitation and health information tool; and, iii) to test the application of the rehabilitation and health information tool on a sample of persons with disabilities. This study was an exploratory descriptive study adopting a sequential mixed methods design. There were two phases in this study. Phase 1 involved qualitative research methods in the development of the rehabilitation and health information tool through the use of document review and a focus group discussion with experts. Phase 2 of the study involved quantitative research methods in the field testing of the rehabilitation and health information tool by the rehabilitation care workers on a sample of persons with disabilities. The results of phase 1 included the development of the rehabilitation and health information tool, which was deemed by the experts to be a comprehensive, contextually relevant tool with face and content validity and could be easily administered by the rehabilitation care worker. The conceptual framework of the International Classification of Functioning, Disability and Health provided domains that could comprehensively document the multidimensional needs of persons with disabilities. The result was a draft rehabilitation and health information tool with 17 questions ranging across the domains of activities of daily living, sexual health, health behaviours, barriers and facilitators to good health, finance and understanding of disability. Changes were proposed to the wording, layout and flow of the tool and the persons with disabilities’ goals were included as an element . The inclusion of the end users as experts in the development resulted in a richer understanding needed for the shaping of this tool. The results of phase 2 highlighted that the rehabilitation and health information tool was able to describe the rehabilitation and health needs of persons with disabilities. Additionally the tool was able to document the specific goals of the persons with disabilities which is useful to plan and monitor intervention. The rehabilitation care workers reported the tool to be useful, easy to use, and provided a structured manner to collect information. They also reported that it was useful in stimulating conversations on sensitive topics. However, it was indicated that it took too long to complete and there were components that were incomplete. The rehabilitation and health information tool requires further refinement, validation and further follow-up testing before it can be formally adopted and implemented as part of the rehabilitation care worker’s standard practice.

No description available.