Query: health worker

title: Evidence Based Community Health Worker Program Addresses Unmet Social Needs And Generates Positive Return On Investment.
abstract: Interventions that address socioeconomic determinants of health are receiving considerable attention from policy makers and health care executives. The interest is fueled in part by expected returns on investment. However, many current estimates of returns on investment are likely overestimated, because they are based on pre post study designs that are susceptible to regression to the mean. We present a return on investment analysis that is based on a randomized controlled trial of Individualized Management for Patient Centered Targets (IMPaCT) a standardized community health worker intervention that addresses unmet social needs for disadvantaged people. We found that every dollar invested in the intervention would return $2.47 to an average Medicaid payer within the fiscal year.

title: Prolonged health worker strikes in Kenya perspectives and experiences of frontline health managers and local communities in Kilifi County
abstract: While health worker strikes are experienced globally, the effects can be worst in countries with infrastructural and resource challenges, weak institutional arrangements, underdeveloped organizational ethics codes, and unaffordable alternative options for the poor. In Kenya, there have been a series of public health worker strikes in the post devolution period. We explored the perceptions and experiences of frontline health managers and community members of the 2017 prolonged health workers' strikes.  We employed an embedded research approach in one county in the Kenyan Coast. We collected in depth qualitative data through informal observations, reflective meetings, individual and group interviews and document reviews n 5) and analysed the data using a thematic approach. Individual interviews were held with frontline health managers n 26) and group interviews with community representatives (4 health facility committee member groups, and 4 broader community representative groups) Interviews were held during and immediately after the nurses' strike.  In the face of major health facility and service closures and disruptions, frontline health managers enacted a range of strategies to keep key services open, but many strategies were piecemeal, inconsistent and difficult to sustain. Interviewees reported huge negative health and financial strike impacts on local communities, and especially the poor. There is limited evidence of improved health system preparedness to cope with any future strikes.  Strikes cannot be seen in isolation of the prevailing policy and health systems context. The 2017 prolonged strikes highlight the underlying and longer term frustration amongst public sector health workers in Kenya. The health system exhibited properties of complex adaptive systems that are interdependent and interactive. Reactive responses within the public system and the use of private healthcare led to limited continued activity through the strike, but were not sufficient to confer resilience to the shock of the prolonged strikes. To minimise the negative effects of strikes when they occur, careful monitoring and advanced planning is needed. Planning should aim to ensure that emergency and other essential services are maintained, threats between staff are minimized, health worker demands are reasonable, and that governments respect and honor agreements.

title: COVID 19: the case for health care worker screening to prevent hospital transmission

title: Health policy and system support to optimise community health worker programmes: an abridged WHO guideline.
abstract: Optimising community health worker (CHW) programmes requires evidence based policies on their education, deployment, and management. This guideline aims to inform efforts by planners, policy makers, and managers to improve CHW programmes as part of an integrated approach to strengthen primary health care and health systems. The development of this guideline followed the standard WHO approach to developing global guidelines. We conducted one overview of reviews, 15 systematic reviews (each one on a specific policy question) and a survey of stakeholders' views on the acceptability and feasibility of the interventions under consideration. We assessed the quality of systematic reviews using the AMSTAR tool, and the certainty of the evidence using the GRADE methodology. The overview of reviews identified 122 eligible articles and the systematic reviews identified 137 eligible primary studies. The stakeholder perception survey obtained inputs from 96 respondents. Recommendations were developed in the areas of CHW selection, preservice education, certification, supervision, remuneration and career advancement, planning, community embeddedness, and health system support. These are the first evidence based global guidelines for health policy and system support to optimise community health worker programmes. Key considerations for implementation include the need to define the role of CHWs in relation to other health workers and plan for the health workforce as a whole rather than by specific occupational groups; appropriately integrate CHW programmes into the general health system and existing community systems; and ensure internal coherence and consistency across different policies and programmes affecting CHWs.

title: Advocating for the Health Worker
abstract: Health workers in both well resourced and limited income settings face health threats from exposures encountered in their unique and complex work environment. Even before the 2014 Ebola outbreak, preventable harm was routinely felt by health workers, most visibly through the fatal collusion between the HIV/AIDS epidemic and tuberculosis (TB) infection in high endemic countries.  The aim of this paper is to examine the analyses of the health sector workforce by development and public health agencies regarding its sustainability, threats from workers' personal health risks and discussion of protections to address those risks.  Development and public health agency reports assessing the sustainability of and threats to the health workforce both pre and post the 2014 Ebola outbreak were examined with a focus on low and middle income countries (LMICs)  Reviews of the health sector workforce have largely focused on its role as a necessary component of sustainable development. Hence, staff competency, numbers and productivity have been emphasized with little notice of the conditions of work and the highly hazardous environment contributing to worker out migration, illness and death.  Going forward, the 2016 World Health Assembly campaign to advance human resources for health and other UN efforts on health employment may offer some opportunities to address needed health worker protections. However, to these largely competency focused workforce development efforts must first be brought resources for and commitment to protecting the safety of these workers' lives and livelihood. Doing less defeats investments in fragile health systems and is plainly unethical.

title: Outcomes at 18 Months From a Community Health Worker and Peer Leader Diabetes Self Management Program for Latino Adults
abstract: This study evaluated the effectiveness of a community health worker (CHW) diabetes self management education (DSME) program, followed by two different approaches to maintain improvements in HbA1c and other clinical and patient centered outcomes over 18 months.  The study randomized 222 Latino adults with type 2 diabetes and poor glycemic control from a federally qualified health center to 1) a CHW led, 6 month DSME program or 2) enhanced usual care (EUC) After the 6 month program, participants randomized to the CHW led DSME were further randomized to 1) 12 months of CHW delivered monthly telephone outreach (CHW only) or 2) 12 months of weekly group sessions delivered by peer leaders (PLs) with telephone outreach to those unable to attend (CHW+PL) The primary outcome was HbA1c. Secondary outcomes were blood pressure, lipid levels, diabetes distress, depressive symptoms, understanding of diabetes self management, and diabetes social support. Assessments were conducted at baseline and at 6, 12, and 18 months.  Participants in the CHW intervention at the 6 month follow up had greater decreases in HbA1c 0.45% [95% CI 0.87, 0.03] P 0.05) and in diabetes distress 0.3 points [95% CI 0.6, 0.03] P 0.05) compared with EUC. CHW+PL participants maintained HbA1c improvements at 12 and 18 months, and CHW only participants maintained improvements in diabetes distress at 12 and 18 months. CHW+PL participants also had significantly fewer depressive symptoms at 18 months compared with EUC 2.2 points [95% CI 4.1, 0.3] P 0.05) Participants in CHW led DSME had significant improvements in diabetes social support and in understanding of diabetes self management at 6 months relative to EUC, but these intervention effects were not sustained at 18 months.  This study demonstrates the effectiveness of a 6 month CHW intervention on key diabetes outcomes and of a volunteer PL program in sustaining key achieved gains. These are scalable models for health care centers in low resource settings for achieving and maintaining improvements in key diabetes outcomes.

title: Improving health worker performance: an ongoing challenge for meeting the sustainable development goals
abstract: Improving health worker performance is crucial to accelerating progress in helping children to survive and thrive, say Alexander K Rowe and colleagues

title: Continuation of injectable contraception when self injected vs. administered by a facility based health worker: a nonrandomized, prospective cohort study in Uganda
abstract: The purpose of this study was to compare 12 month continuation rates for subcutaneous depot medroxyprogesterone acetate (DMPA SC) administered via self injection and DMPA IM administered by a health worker in Uganda. Study design Women seeking injectable contraception at participating health facilities were offered the choice of self injecting DMPA SC or receiving an injection of DMPA IM from a health worker. Those opting for self injection were trained one on one. They self injected under supervision and took home three units, a client instruction guide and a reinjection calendar. Those opting for DMPA IM received an injection and an appointment card for the next facility visit in 3 months. We interviewed participants at baseline (first injection) and after 3 (second injection) 6 (third injection) and 9 (fourth injection) months, or upon discontinuation. We used Kaplan Meier methods to estimate continuation probabilities, with a log rank test to compare differences between groups. A multivariate Cox regression identified factors correlated with discontinuation.  The 12 month continuation rate for the 561 women self injecting DMPA SC was .81 [95% confidence interval (CI) .78 .84] and for 600 women receiving DMPA IM from a health worker, it was .65 (95% CI .61 .69) a significant difference at the .05 level. There were no differences in pregnancy rates or side effects. The multivariate analysis revealed that, controlling for covariates, self injecting reduced the hazard for discontinuing by 46% A significant interaction between injection group and age suggests that self injection may help younger women continue injectable use.  The significant difference in 12 month continuation between women self injecting DMPA SC and women receiving DMPA IM from a health worker which remains significant in a multivariate analysis suggests that self injection may improve injectable contraceptive continuation.  While injectable contraceptives are popular throughout much of sub Saharan Africa, they have high rates of discontinuation. This study is the second from an African country to demonstrate that self injection may improve injectable continuation rates and may do so without increasing the risk of pregnancy or adverse events.

title: ENDO ECHO IMPROVES PRIMARY CARE PROVIDER AND COMMUNITY HEALTH WORKER SELF EFFICACY IN COMPLEX DIABETES MANAGEMENT IN MEDICALLY UNDERSERVED COMMUNITIES.
abstract: To determine whether participation in a multidisciplinary telementorship model of healthcare delivery improves primary care provider (PCP) and community health worker (CHW) confidence in managing patients with complex diabetes in medically underserved regions.  We applied a well established healthcare delivery model, Project ECHO (Extension for Community Healthcare Outcomes) to the management of complex diabetes (Endo ECHO) in medically underserved communities. A multidisciplinary team at Project ECHO connected with PCPs and CHWs at 10 health centers across New Mexico for weekly videoconferencing virtual clinics. Participating PCPs and CHWs presented de identified patients and received best practice guidance and mentor ship from Project ECHO specialists and network peers. A robust curriculum was developed around clinical practice guidelines and presented by weekly didactics over the ECHO network. After 2 years of participation in Endo ECHO, PCPs and CHWs completed self efficacy surveys comparing confidence in complex diabetes management to baseline.  PCPs and CHWs in rural New Mexico reported significant improvement in self efficacy in all measures of complex diabetes management, including PCP ability to serve as a local resource for other healthcare providers seeking assistance in diabetes care. Overall self efficacy improved by 130% in CHWs P<.0001) and by 60% in PCPs P<.0001) with an overall large Cohen's effect size.  Among PCPs and CHWS in rural, medically underserved communities, participation in Endo ECHO for 2 years significantly improved confidence in complex diabetes management. Application of the ECHO model to complex diabetes care may be useful in resource poor communities with limited access to diabetes specialist services. ABBREVIATIONS CHW community health worker; CME Continuing Medical Education; ECHO Extension for Community Healthcare Outcomes; FQHC federally qualified health center; PCP primary care provider.

title: How to do (or not to do) Measuring health worker motivation in surveys in low and middle income countries
abstract: A health system's ability to deliver quality health care depends on the availability of motivated health workers, which are insufficient in many low income settings. Increasing policy and researcher attention is directed towards understanding what drives health worker motivation and how different policy interventions affect motivation, as motivation is key to performance and quality of care outcomes. As a result, there is growing interest among researchers in measuring motivation within health worker surveys. However, there is currently limited guidance on how to conceptualize and approach measurement and how to validate or analyse motivation data collected from health worker surveys, resulting in inconsistent and sometimes poor quality measures. This paper begins by discussing how motivation can be conceptualized, then sets out the steps in developing questions to measure motivation within health worker surveys and in ensuring data quality through validity and reliability tests. The paper also discusses analysis of the resulting motivation measure/s. This paper aims to promote high quality research that will generate policy relevant and useful evidence.