This article presents an evaluation of the role of a link-worker trained in health promotion and aspects of chronic disease management. A shift in workload occurred from the practice nurse to link-worker, and there were improvements in asthma and diabetes care. A link-worker can be successfully trained to do traditional nursing tasks, which permits a change of role for the practice nurse and can have a beneficial effect on the processes of chronic disease management.
Community mobilisation through participatory women's groups might improve birth outcomes in poor rural communities. This study assessed this approach in a largely tribal and rural population in three districts in eastern India. The intervention group worked with a facilitator every month to support participatory action and learning for women, and facilitated the development and implementation of strategies to address maternal and newborn health problems. The primary outcomes were reductions in neonatal mortality rate (NMR) and maternal depression scores.
Depressive and anxiety disorders (common mental disorders) are the most common psychiatric condition encountered in primary healthcare. This article discusses the effectiveness of an intervention led by lay health counsellors in primary care settings (the MANAS intervention) to improve the outcomes of people with common mental disorders. Results showed that trained lay counsellors working within a collaborative-care model can reduce prevalence of common mental disorders, suicidal behaviour, psychological morbidity and disability days among those attending public primary care facilities.
This article examines the workload and determinants of good performance of female health workers in 2 districts of West Bengal, India. Results indicated that female health workers spent excessive time in documentation which left less time for service delivery. Infrastructure, planning and supervision affected performance and these areas must be strengthened to improve primary healthcare services.
This article presents findings from a study of female peer facilitators involved in a community-based maternal and newborn health intervention in urban slum areas of Mumbai. Using qualitative methods we explore their role perceptions and experiences. Our findings focus on how the facilitators understand and enact their role in the community setting, how they negotiate relationships and health issues with peer groups, and the influence of credibility.
This review of the National Rural Health Mission (NRHM) and the Integrated Child Development Scheme (ICDS) III which highlights lack of supervision, poor worker motivation, and related issues as critical challenges. It shows that programs often focus on training but other performance factors such as supportive supervision, clear performance expectations and motivation and recognition are often neglected. These factors may be constraints against improving health and nutrition programs in India.
This literature review provides an overview of the concepts and practices among CHWs from across a range of developing and developed countries. The authors review various ways that CHWs have been used in different settings and analyze the role, management, and other factors that influence performance of CHWs. They also illustrate some of the policy challenges that exist in designing effective CHW programs in the Indian context.
This report analyzes the BRAC model in Bangladesh for Tuberculosis (TB) control and offers an alternate model, a community-based model that relies heavily on community health workers. The importance of utilizing community health workers to reduce the burden of TB is discussed throughout the report. It also speaks to the financial management of TB control programs and the implementation experiences of other developing countries such as India.
CHW programs throughout the world vary in structure and emphasis. This literature review addresses the challenge of making connections among inputs, processes and outcomes of these diverse community programs. Completed as part of the USAID-funded project of the same name, it analyses 78 of the most useful documents on CHW programs with components of family planning and selective reproductive health services, as well as community-based distribution.
This paper reviews recently published literature on community health worker programs, primarily focusing on maternal and newborn child health. Eighteen CHW programs and eleven relevant articles were included. It identifies key components of successful CHWs programs, reviews past successes and failures of CHW program implementation and summarizes important lessons learned.