In African countries including Kenya, contraceptive use, fertility rates and other reproductive health indicators in rural areas lag behind urban areas. Even though Kenya's fertility rate declined from 8.1 in 1978 to 4.6 in 2008, the figures are much higher in rural areas, 5.2 compared to an urban rate of 2.9. The persistent high fertility rate has been attributed to many factors including inadequate provision of family planning services.
Angola is undergoing a period of reconstruction, after experiencing a protracted civil war that lasted until 2002. This historical context of violent conflicts has left a legacy of low rates of production and capital accumulation, of severe debt, and extreme dependency on foreign countries, all of which markedly influence the health situation of the Angolan people.
In an attempt to address a complex disease burden, including improving progress towards MDGs 4 and 5, South Africa recently introduced a re-engineered Primary Health Care (PHC) strategy, which has led to the development of a national community health worker (CHW) programme. The present study explored the development of a cell phone-based and paper-based monitoring and evaluation (M&E) system to support the work of the CHWs.
There is robust evidence that community health workers (CHWs) in low- and middle-income (LMIC) countries can improve their clients’ health and well-being. The evidence on proven strategies to enhance and sustain CHW performance at scale, however, is limited. Nevertheless, CHW stakeholders need guidance and new ideas, which can emerge from the recognition that CHWs function at the intersection of two dynamic, overlapping systems – the formal health system and the community. Although each typically supports CHWs, their support is not necessarily strategic, collaborative or coordinated.
Mozambique launched its revitalized community health programme in 2010 in response to inequitable coverage and quality of health services. The programme is focused on health promotion and disease prevention, with 20% of community health workers’ (known in Mozambique as Agentes Polivalentes Elementares (APEs)) time spent on curative services and 80% on activities promoting health and preventing illness. We set out to conduct a health system and equity analysis, exploring experiences and expectations of APEs, community members and healthcare workers supervising APEs.
In recent years, community health workers (CHWs) have received renewed attention in light of critical shortages in the health workforce and emphasis on strengthening primary healthcare systems for achieving global health goals. CHWs are generally assumed to be a less expensive alternative compared with other cadres of health workers, notably with regard to salary and incentives as well as training costs. In parallel, more and more evidence has accumulated in recent years on the effectiveness of CHWs in delivery of essential health services in low- and middle-income countries (LMICs).
Socioeconomic and behavioral factors can negatively influence posthospital outcomes among patients of low socioeconomic status (SES). Traditional hospital personnel often lack the time, skills, and community linkages required to address these factors. During hospital admission, CHWs worked with patients to create individualized action plans for achieving patients’ stated goals for recovery. The CHWs provided support tailored to patient goals for a minimum of 2 weeks.
The Patient Protection and Affordable Care Act (ACA) provides a policy framework to re-imagine a system of care that emphasizes health and wellness through new models of primary care and population health interventions. These new models offer the potential to deliver care services at a lower cost, to detect and treat disease earlier, to deploy data and technology to improve population health outcomes, and to address social and environmental conditions that impede efforts to improve health.
Coherent human resource for health (HRH) policies should be designed to address the challenges faced in recruitment and retention of health workers, particularly in developing countries. In Sierra Leone, there are challenges in providing equitable healthcare for all due in part to the current HRH situation, which includes an unequal distribution of the health workforce between urban and rural areas.