Medicine and Health Sciences Commons^™

Understanding Community Health Volunteer Incentive Preferences In Kenya, Frontline Health Project, Johns Hopkins Bloomberg School Of Public Health

Reproductive Health

In Kenya, community health services are implemented through community health units. Community health volunteers (CHVs) who serve these units are chosen by the community and trained by community health extension workers. This brief summarizes qualitative and quantitative findings from the Frontline Health project’s discrete choice experiment study in Kenya, which aimed to understand incentive preferences of CHVs with the aim of improving motivation, performance, and retention of CHVs.

Identifying Factors That Support Community Health Worker Motivation, Job Satisfaction, And Retention In Haiti, Frontline Health Project, Johns Hopkins Bloomberg School Of Public Health

Reproductive Health

Community health workers (CHWs) play a critical role in Haiti’s health system, by connecting communities—particularly rural and hard-to-reach populations—to healthcare services. The Frontline Health project conducted a study to better understand the types of incentive structures that can best support the CHWs in Haiti and this brief summarizes those findings.

Frontline Health Achievements In Harmonizing Measurement And Generating Evidence On Community Health System Performance, Frontline Health Project

Reproductive Health

As the global health community demonstrates an increasing commitment to investing in community health workers (CHWs) to achieve universal health coverage in lower- and middle-income countries, the need to effectively measure community health system performance is paramount. Embedded in the Integrating Community Health partnership (2017–2021), with support from the Bill & Melinda Gates Foundation, the Population Council and Last Mile Health co-led the Frontline Health (FLH) project, a four-year research, policy, and advocacy initiative aimed at developing core metrics and CHW reform processes, advancing their adoption, and promoting institutionalization of robust community health policies. This brief describes the Population Council’s …

Preferred Incentives For Improving Community Health Worker Satisfaction And Retention In Bangladesh, Frontline Health Project, Johns Hopkins Bloomberg School Of Public Health

Reproductive Health

Community health workers (CHWs) are critical actors within community health systems, providing a range of reproductive, maternal, child, and primary health information, counseling, and services. To better understand factors that influence CHWs’ work motivation and satisfaction in Bangladesh, the Frontline Health project, implemented with collaborators from Johns Hopkins Bloomberg School of Public Health, and supported by the government of Bangladesh’s Directorate General of Health Services and the Directorate General of Family Planning, conducted a discrete choice experiment (DCE) study. This brief presents key qualitative findings from the DCE study in Bangladesh and implications for program and policy stakeholders.

Exploring Community Health Worker Roles, Support, And Experiences In The Context Of The Covid-19 Pandemic In Kenya, Frontline Health Project

Reproductive Health

This brief presents quantitative results from a mixed-methods study conducted by Population Council Kenya which explores the experiences and roles of community health workers (CHWs) during COVID-19. The results indicate that CHWs are carrying out their routine work at higher levels, with increased responsibilities due to COVID-19.

Évaluation De La Performance Des Agents De Santé Communautaires En Haïti: Principales Conclusions D’Une Étude À Méthodologie Mixte, Frontline Health Project, Zanmi Lasante

Reproductive Health

Ce document résume les principales conclusions qualitatives et quantitatives de l'étude de référence du projet Frontline Health en Haïti. Les résultats révèlent que les ASC en Haïti sont des membres hautement fiables et appréciés de leurs communautés et fournissent des liens cruciaux vers les services d'orientation ; cependant, davantage de formation et de soutien concernant les références sont nécessaires.

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This brief summarizes key qualitative and quantitative findings from the Frontline Health project's referral study in Haiti. Findings reveal that CHWs in Haiti are highly trusted and valued members of their communities and provide crucial links to referral services; however, …

Assessing The Performance Of Community Health Workers In Haiti: Key Findings From A Mixed-Methods Study, Frontline Health Project, Zanmi Lasante

Reproductive Health

This brief summarizes key qualitative and quantitative findings from the Frontline Health project's referral study in Haiti. Findings reveal that CHWs in Haiti are highly trusted and valued members of their communities and provide crucial links to referral services; however, more training and support around referrals is needed.

Preferred Incentives For Improving Ugandan Community Health Worker Job Satisfaction And Retention, Frontline Health Project

Reproductive Health

This research brief summarizes key quantitative and qualitative results from the Frontline Health project's discrete choice experiment in Uganda. This study was implemented in two phases, and revealed that community health workers in Uganda are motivated by a mix of financial and non-financial incentives to perform.

Reproductive Health Care In The Time Of Covid-19: Perspectives Of Poor Women And Service Providers From Rahim Yar Khan, Punjab, Iram Kamran, Tahira Parveen, Rehan M. Niazi, Irfan Masood

Reproductive Health

This study was conducted by the Population Council in Rahim Yar Khan district of Punjab, with the support of the United Nations Population Fund (UNFPA), to uncover urgently needed evidence about the challenges and needs of poor women and health care providers during the COVID-19 pandemic. Over 200 poor women—beneficiaries of the Benazir Income Support Programme (BISP), one of the largest social protection programs in the world—and 60 public and private sector health care providers participated in this investigation of BISP beneficiaries’ knowledge of COVID-19, the effects of the pandemic on their lives, mental health and wellbeing, and their access …

Scales To Measure Motivation Among Community Health Workers, And Trust And Empowerment Among Their Clients: A Guide, Frontline Health Project

Reproductive Health

This How-To Guide presents five multi-item scales to measure motivation among community health workers (CHWs), as well as clients' trust in CHWs, and empowerment within community health systems. The scales presented are intended for use in community health programs and in combination with other indicators in the CHW Performance Measurement Framework (published by the Frontline Health project in 2019) for routine data monitoring to improve quality and accountability in community health.

Facing Covid-19: Knowledge, Attitudes, Practices, And Challenges Of Healthcare Providers, Population Council

Reproductive Health

This research brief describes findings from the Population Council study Reproductive Healthcare in the Time of COVID-19: Perspectives of Poor Women and Service Providers from Rahim Yar Khan, Punjab with the support of the United Nations Population Fund (UNFPA). During this study, 60 health care providers that represented 60 unique health facilities in Punjab’s Rahim Yar Khan district were interviewed by telephone, to evaluate how much they know about COVID-19 symptoms, prevention, and treatment, as well as their individual attitudes, practices, and challenges during the ongoing pandemic. To assess how the situation evolved during the critical first three months of …

Poor Women's Reproductive Health And Family Planning Challenges And Needs During The Covid-19 Pandemic, Population Council

Reproductive Health

This research brief describes findings from the Population Council study Reproductive Healthcare in the Time of COVID-19: Perspectives of Poor Women and Service Providers from Rahim Yar Khan, Punjab with the support of the United Nations Population Fund (UNFPA). The study conducted 164 interviews by telephone with beneficiaries of the Benazir Income Support Programme (BISP) in Rahim Yar Khan, Pakistan, previously surveyed in 2019, to determine how much those most vulnerable to the effects of COVID-19 know about the disease and its effects, in addition to understanding the pandemic’s effects on their lives, including their mental health and well-being as …

Best Bets For Accelerating Family Planning In Pakistan: Invest In Community Health Workers, Ali M. Mir, Kiren Khan

Reproductive Health

Integration of trained, equipped, and supported community health workers (CHWs) within a health system is recognized as a proven high impact practice for family planning (FP) services, with evidence from around the world confirming the need to complement facility-based FP services with CHW programs, particularly in areas where people’s access to health care is limited. There is also substantial evidence that delivering essential health services through CHWs can be cost-effective in a diversity of contexts, with a review of FP programs in 10 developing countries revealing that the average cost per couple-year of protection (CYP) was considerably lower among programs …

The Community Health System In Mali: An Overview, Frontline Health Project

Reproductive Health

This brief provides an overview of the community health system in Mali. The system is decentralized and operates across five levels: national, regional, district, health area, and community. It relies on two cadres of community health workers to deliver health-care services, primarily to rural populations: agents de santé communautaire (ASCs) and relais communautaire. The National Implementation Guide for Essential Community Health Care is the main document that outlines responsibilities of community health providers and processes for organization, management, and delivery of health services. Although Mali’s maternal, child (under five years), and infant mortality rates have fallen over the past two …

The Community Health System In The Drc: An Overview, Frontline Health Project

Reproductive Health

This brief provides an overview of the community health system in the Democratic Republic of the Congo (DRC). The community health system is decentralized and operates across five levels: national, provincial, health zone, health area, and community. Various policy documents guide DRC’s community health system, including The National Health Development Plan 2016–2020. Relais communautaire (RECOs) are the main cadre of community health workers operating in the DRC. They are volunteers who provide a minimum package of reproductive, maternal, newborn, and child health services, including the provision of family planning; integrated community case management for malaria, diarrhea, and respiratory diseases; nutrition …

Two Implementation Models Of Workers' Health Education Programs In Egypt: What Works? What Doesn't Work?, Nahla G. Abdel-Tawab, Norhan Bader, Elizabeth Tobey, Aparna Jain

Reproductive Health

This brief presents findings from two models of workers’ health education programs implemented by the Evidence Project/Population Council in Egypt. The two interventions aimed to increase family planning (FP) service demand among young people aged 18–35 in Port Said and urban Souhag. In Port Said, male and female factory workers who were trained as peer educators shared family planning/reproductive health (FP/RH) information with fellow factory workers, distributed communication materials, and provided referrals to infirmary nurses trained in FP counseling. In Souhag, male and female peer educators were trained to provide integrated FP/RH and livelihood workshops to job seekers. Results of …

The Community Health System In Haiti: An Overview, Frontline Health Project

Reproductive Health

This brief provides an overview of the community health system in Haiti. In Haiti, the health system is overseen at the national level by the Ministry of Public Health and Population (Ministère de la Santé Publique et de la Population-MSPP) which provides policies and standards for service delivery at all levels, including the community level. Health service delivery is managed and coordinated across three levels: national (level III), health department (level II), and district and community levels (level I). The national level is guided by the MSPP and provides policy guidance for community-level service delivery. The Health Department level is …

The Community Health System In Bangladesh: An Overview, Frontline Health Project

Reproductive Health

This brief provides an overview of the community health system in Bangladesh. Bangladesh is divided into eight administrative divisions, 64 districts, and 545 subdistricts, known as upazilas. Each rural area within an upazila is divided into union parishads and mouzas, which are further divided into villages. The Ministry of Health and Family Welfare has an extensive health infrastructure that is pluralistic and follows the country’s administrative pattern. Union parishads are the smallest administrative unit in rural areas. At the lowest administrative level, traditional healers, nonqualified allopathic practitioners, and community health workers (CHWs) are typically the only providers available. This brief …

Strengthening In-Service Training And Continuing Education (Ist/Ce) For Frontline Health Workers For Bauchi And Cross River States, Ekechi Okereke, Godwin Unumeri, Ibrahim Suleiman, Aisha Jibril

Reproductive Health

This brief details Council efforts to develop effective, and costed, in-service training and continuing education modules for frontline health workers in Bauchi and Cross River states in Nigeria. This project was funded by WHO to aid the training and development of Nigeria's public health worker sector.

Feasibility And Acceptability Of Community Health Extension Workers To Identify And Treat Hypertension Associated With Pregnancy: Implementation Research Report, Emmanuel Nwala, Udochisom Anaba, Pooja Sripad, Salisu Mohammed Ishaku, Charlotte E. Warren

Reproductive Health

Hypertensive disorders in pregnancy, experienced by 10 percent of women globally, are major contributors to maternal and newborn mortality, morbidity, and disability. Task shifting essential health services to mitigate insufficient human resources is recommended to strengthen and expand the health workforce and rapidly increase access to quality services. Nigeria’s task-shifting policy recommends that community health extension workers administer a loading dose of magnesium sulphate for severe pre-eclampsia or eclampsia prior to referral to a higher-level facility. This study tested the feasibility and acceptability of community health extension workers at primary health care facilities in Ebonyi state in detecting and managing …

Population Council's Support For Nigeria's Third National Human Resources For Health Conference And Efforts To Institutionalize Hrh Conferences In Nigeria, Ekechi Okereke, Godwin Unumeri, Ibrahim Suleiman, Aisha Jibril

Reproductive Health

This project brief describes the Population Council's partnership efforts with public health stakeholders in Nigeria to plan and host a third national conference for provision of necessary and relevant information on critical health issues to health staff and stakeholders throughout Nigeria.

The Rationale And Relevance Of Existing Cadres Of Frontline Health Workers And Potential For New Mid-Level Cadres, Oladimeji Oladepo, Ekechi Okereke, Akinwumi Akinola

Reproductive Health

Front-line health workers (FLHWs) are expected to perform necessary maternal, newborn, and child (MNCH) services appropriately and effectively; however, few studies have investigated the extent to which FLHWs perform requisite primary health care (PHC) services. This study seeks to better understand not only FLHWs’ knowledge and performance of MNCH services, but the factors promoting and inhibiting their services in selected rural local government areas of Nigeria’s Bauchi and Cross River states. It also investigates the potential for a new PHC worker cadre, soliciting stakeholders’ perceptions about its feasibility for addressing maternal and newborn disease burdens in rural communities. The study’s …

Engaging Community Women's Groups For Improved Uptake Of Antenatal Care Services In Cross River State, Nigeria: An Analysis Of Post-Intervention Findings, Salisu Mohammed Ishaku

Reproductive Health

The Ending Eclampsia project seeks to understand the potential of underutilized and promising interventions that increase access to services, particularly improving community referral systems. This brief reports on a study in Nigeria’s Cross River state that aimed to test the feasibility of women’s group leaders delivering health information for pre-eclampsia and eclampsia (PE/E), referral, and other antenatal care (ANC) services to their peers, to increasing access to quality maternal and newborn health services. Women’s group findings suggest that community engagement is a critical model for information sharing and is an adaptable, acceptable model for increasing PE/E prevention and danger-sign recognition …

Assessing The Feasibility And Acceptability Of Community Health Extension Workers To Treat Hypertension Associated With Pregnancy: An Analysis Of Post-Intervention Findings, Salisu Mohammed Ishaku

Reproductive Health

This brief reports on a study that tested the feasibility of tasking community health extension workers (CHEWs) with detecting and managing hypertension, and prescribing an oral antihypertensive drug at primary health care (PHC) facilities in Nigeria as part of a package of care for women with pre-eclampsia and eclampsia (PE/E). This evaluation measured improvements in knowledge retention and increases in early detection, prevention, and management of PE/E. Findings indicate that trained CHEWs working at intervention PHCs can correctly identify, differentiate, and manage normal, mild, moderate, and severe hypertension. These findings are important contributions to implementing Nigeria’s national task-shifting policy at …

Charity: A Health Volunteer Success Story, Amy Dempsey

Reproductive Health

Results from Ending Eclampsia’s landscape analysis of seven states in Nigeria served as the catalyst for a training with Community Health Extension Workers (CHEWs) in Nigeria. Researchers conducted observations of client–provider interactions during antenatal care (ANC) visits and assessed healthcare providers’ knowledge of proven risk factors for pre-eclampsia, including chronic hypertension, previous history of PE/E, obesity, pre-existing diabetes or diabetes in pregnancy, advanced maternal age, sickle cell diseases, and connective tissue diseases. The training’s objective was to teach CHEWs how ANC providers can prevent pregnancy-related complications like pre-eclampsia and eclampsia (PE/E). Following the training the CHEWs felt that they can …

Enhancing Frontline Health Workers' Abilities To Improve Mnch Services In Cross River State Through Task Shifting/Sharing, Sylvia Adebajo, Ekechi Okereke, Friday Joseph

Reproductive Health

There is a shortage of qualified and skilled health professionals providing cost-effective maternal, newborn, and child health (MNCH) services in Cross River State, Nigeria. Frontline health workers (FLHWs) have the potential to learn new skills as part of a task-shifting and sharing (TSS) policy. This brief highlights the results of the TSS policy in Cross River state: village health workers identify and refer pregnant women in their communities to antenatal clinics and provide oral medications; community health workers perform initial case management and ensure quick referrals to secondary facilities for specialized care; nurses and midwives deliver MNCH interventions that are …

Enhancing Frontline Health Workers' Abilities To Improve Mnch Services In Bauchi State Through Task Shifting/Sharing, Sylvia Adebajo, Ekechi Okereke, Friday Joseph

Reproductive Health

Frontline health workers (FLHWs), including nurses, midwives, community health extension workers, and community health officers, are healthcare providers with the greatest access to clients and patients, and provide initial care to persons in need of health services. In 2014, Nigeria’s 57th National Council on Health approved a task-shifting and sharing (TSS) policy for essential healthcare services as a promising strategy for improving access and efficiency in Nigeria’s health system. Subsequently, FLHWs in Nigeria have been trained for new roles and functions traditionally reserved for mid- or high-level cadres, to optimize available providers and their capacities. This brief reviews the strategy …

Promoting Respectful Maternity Care Resource Package: Community Flipchart, Population Council

Reproductive Health

Progress toward the reduction of maternal and newborn morbidity and mortality has been slow because improvements require overcoming financial and geographical barriers to accessing skilled care, as well as the poor quality of care in maternity units. A little-understood component of the poor quality of care experienced by women during facility-based childbirth is the disrespectful and abusive behavior of healthcare providers and other facility staff. Acknowledgment of these behaviors by policymakers, program staff, civil society groups, and community members indicates the problem is widespread. This is a teaching aid for community health workers and other community-level resource persons to conduct …

Strengthening The Role Of Patent Medicine Vendors In The Provision Of Injectable Contraception In Nigeria, Population Council, The Evidence Project

Reproductive Health

The majority of contraceptive services in Nigeria are offered in private settings, including Patent Medicine (PM) shops. PM shops are informal businesses owned by Patent Medicine Vendors (PMVs) licensed to sell patent or proprietary drugs. Injectable contraception is the most popular modern contraceptive method in Nigeria. However PMVs are not regulated to sell or administer injectable contraceptives because the businesses do not receive formal training. Despite this, some PMVs are selling and administering injectable methods in response to high demand. The Evidence Project, in collaboration with the Federal Ministry of Health, conducted implementation research to: demonstrate the feasibility of PMVs …

Union Health And Family Welfare Centers In Chittagong And Munshiganj: Are They Ready To Provide 24-Hour Normal Delivery Services?, Md. Noorunnabi Talukder, Ubaidur Rob, A.K.M. Zafar Ullah Khan, Forhana Rahman Noor, Shongkour Roy, Afsana Fatema Noor

Reproductive Health

To date, the Directorate General of Family Planning (DGFP) of Bangladesh’s Ministry of Health and Family Welfare has established approximately 3,900 Union Health and Family Welfare Centers (UHFWCs) in rural areas providing: family planning; menstrual regulation; vaccinations; and general, reproductive, and maternal health services six days a week. About 1,500 UHFWCs have been upgraded with the necessary staff and equipment to provide normal delivery services round-the-clock in rural areas. Yet, Family Welfare Visitors (FWVs) posted at UHFWCs perform only 0.3 percent of deliveries. This means that UHFWCs and FWVs are not optimally utilized to increase the rate of institutional deliveries. …