CITATION: Care Groups I: An Innovative Community-Based Strategy for Improving Maternal, Neonatal, and Child Health in Resource-Constrained Settings
Henry Perry, Melanie Morrow, Sarah Borger, Jennifer Weiss, Mary DeCoster, Thomas Davis, Pieter Ernst
doi: 10.9745/GHSP-D-15-00051
Glob Health Sci Pract September 10, 2015 vol. 3 no. 3 p. 358-369
http://www.ghspjournal.org/content/3/3/358
‘Care Groups use volunteers to motivate mothers to adopt key MCH behaviors. The volunteers meet as a group every 2–4 weeks with a paid facilitator to learn new health promotion messages. Key ingredients of the approach include: peer-to-peer health promotion, selection of volunteers by the mothers, a manageable workload for the volunteers (no more than 15 households per volunteer), frequent (at least monthly) contact between volunteers and mothers, and regular supervision of the volunteers.’
ABSTRACT:
In view of the slow progress being made in reducing maternal and child mortality in many priority countries, new approaches are urgently needed that can be applied in settings with weak health systems and a scarcity of human resources for health. The Care Group approach uses facilitators, who are a lower-level cadre of paid workers, to work with groups of 12 or so volunteers (the Care Group), and each volunteer is responsible for 10–15 households. The volunteers share messages with the mothers of the households to promote important health behaviors and to use key health services. The Care Groups create a multiplying effect, reaching all households in a community at low cost. This article describes the Care Group approach in more detail, its history, and current NGO experience with implementing the approach across more than 28 countries. A companion article also published in this journal summarizes the evidence on the effectiveness of the Care Group approach. An estimated 1.3 million households—almost entirely in rural areas—have been reached using Care Groups, and at least 106,000 volunteers have been trained. The NGOs with experience implementing Care Groups have achieved high population coverage of key health interventions proven to reduce maternal and child deaths. Some of the essential criteria in applying the Care Group approach include: peer-to-peer health promotion (between mothers), selection of volunteers by mothers, limited workload for the volunteers, limited number of volunteers per Care Group, frequent contact between the volunteers and mothers, use of visual teaching tools and participatory behavior change methods, and regular supervision of volunteers. Incorporating Care Groups into ministries of health would help sustain the approach, which would require creating posts for facilitators as well as supervisors. Although not widely known about outside the NGO child survival and food security networks, the Care Group approach deserves broader recognition as a promising alternative to current strategies for delivering key health interventions to remote and underserved communities.
—
Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org
https://www.coursera.org/course/commhealthworkers
Volunteer community health workers (CHWs) are a major strategy for increasing access to and coverage of basic health interventions. Our village health worker training course reviews the process of training and continuing education of CHWs as an important component of involving communities in their own health service delivery. Participants will be guided through the steps of planning training and continuing education activities for village volunteers. The course draws on real-life examples from community-directed onchocerciasis control, village health worker programs, community case management efforts, peer educators programs and patent medicine vendor training programs, to name a few.
Developed in collaboration with Johns Hopkins Open Education Lab.
Course Syllabus
Recommended Background: Some background in community health programs is helpful but not necessary.
Course Format: This course will consist of weekly video lectures and readings. Learning progress will be assessed with weekly quizzes and two peer-graded training matrix exercises.
FAQ
Will I get a Statement of Accomplishment after completing this class? Yes. Students who successfully complete the class will receive a Statement of Accomplishment signed by the instructor.
Do I need to speak English to take this class? Yes. Lectures will be delivered in English, and assessments will be conducted in English.
William Brieger MPH, CHES, DrPH (Atunluse of Idere, Otun Ba’asegun of Igbo-Ora)
The World Health Organization defines a “critical shortage” of health workers as being fewer than 2.28 health workers per 1000 population and failing to attain 80% coverage for deliveries by skilled birth attendants. We aimed to quantify the number of health workers in five African countries and the proportion of these currently working in primary health care facilities, to compare this to estimates of numbers needed and to assess how the situation has changed in recent years.
This study is a review of published and unpublished “grey” literature on human resources for health in five disparate countries: Mali, Sudan, Uganda, Botswana and South Africa.
Health worker density has increased steadily since 2000 in South Africa and Botswana which already meet WHO targets but has not significantly increased since 2004 in Sudan, Mali and Uganda which have a critical shortage of health workers. In all five countries, a minority of doctors, nurses and midwives are working in primary health care, and shortages of qualified staff are greatest in rural areas. In Uganda, shortages are greater in primary health care settings than at higher levels. In Mali, few community health centres have a midwife or a doctor. Even South Africa has a shortage of doctors in primary health care in poorer districts. Although most countries recognize village health workers, traditional healers and traditional birth attendants, there are insufficient data on their numbers.
There is an “inverse primary health care law” in the countries studied: staffing is inversely related to poverty and level of need, and health worker density is not increasing in the lowest income countries. Unless there is money to recruit and retain staff in these areas, training programmes will not improve health worker density because the trained staff will simply leave to work elsewhere. Information systems need to be improved in a way that informs policy on the health workforce. It may be possible to use existing resources more cost-effectively by involving skilled staff to supervise and support lower level health care workers who currently provide the front line of primary health care in most of Africa.
The Rawdon Hills Community Health Centre (RHCHC) is a non-profit, integrated health care centre – built, owned and operated by the community and the people in the Rawdon Hills area of Hants County, Nova Scotia….more
Our Vision Remains the Same: A Conversation with Dr. Jack Geiger. Northwest Regional Primary Care Association CEO Bruce Gray had the opportunity to sit down with Dr. Geiger and discuss the storied past of community health centers in America and the opportunities the future presents. NWRPCA is proud to present a series of six featuring Dr. Geiger to commemorate the 50th anniversary of the American CHC movement…..more
The Victorian Healthcare Association (VHA) is an independent, not-for-profit peak body working to improve population health outcomes through the advancement of health service delivery across Victoria. Our members include public hospitals, rural and regional health services, aged care facilities, community health services and primary care providers. Established in 1938, the VHA follows the strategic direction of its board and aims to promote and influence debate on public health policy for the benefit of all Victorians by ….more
Somerset West Community Health Centre (SWCHC) is a non-profit, community-governed organization that provides primary health care, health promotion and community development services, using interprofessional teams of health and social service providers. These teams include physicians, nurse practitioners, nurses, social workers, dietitians, health promoters, early childhood educators, counsellors and others. SWCHC is sponsored and managed by an incorporated non-profit community board made up of members of our community. SWCHC is well known for its excellent community health centre model and its professional health services team, but it has also become a leader in offering a wide range of social services, community-building activities and advocacy programs….more
In September 2014, Canada’s Community Health Centres adopted anational members resolution re-committing to the critical role of Community Health Centres in increasing democratic engagement across Canada. Research demonstrates that there are tangible mental and physical health benefits associated with participation in democratic discourse and processes, including voting…..more
Others speakers at the conference are
Kathy Blois – Manager, Rawdon Hills CHC (Upper Rawdon, NS, Canada)
Naveen Kanithi – Workforce Program Manager, Northwest Regional Primary Care Assoc (Seattle, WA, USA)
Anita Monoian – CEO, Yakima Neibourhood Health Services (Yakima, WA, USA)
Shabir Moosa – Family Physician, Chiawelo CHC (Johannesburg/Soweto, South Africa)
Chris Templin – Policy Advisor, Victorian Healthcare Association (Melbourne, Australia)
Several new medical schools are underway in the United States, with more on the horizon. Many more are sprouting up around the world, especially in areas of extreme need, such as Africa. Commonly, the founding deans and administrators of these new institutions indicate that they are starting their medical schools to help address local disparities in health outcomes. Yet, most of these new schools continue tooveremphasize the same basic biomedically-focused model that has dominated undergraduate medical education for over 100 years. For all our understanding of how social determinants of health (like poverty, racism, and the lack of universal access to health care) contribute to illness, few medical schools have stepped up to adequately address these issues through significant curricular reform. Nothing changes in the quest to prepare future generations of physicians to be socially responsive….more
Abstract
This essay explores the introduction of population-needs-based funding (PNBF) formulae for the provision of health care services in five provinces (Newfoundland and Labrador, Quebec, Ontario, Saskatchewan and Alberta) as part of a larger project examining a range of health reform decisions in those provinces. Based on semi-structured key-informant interviews with civil servants, stakeholder representatives and political actors the paper examines why and how some provinces chose to move ahead with PNBF formulae while others did not. For two of the provinces (Alberta and Saskatchewan) the implementation of the formulae stemmed directly from the process of regionalization carried out shortly before, while Quebec’s particular model of regionalization led to a slower and more gradual adoption of a PNBF formula. Although Newfoundland did implement a regionalized governance structure, it has not attempted to change how services have been traditionally funded, leaving much of the decision making in this area to bureaucratic and political actors. Ontario’s decision to not pursue a full-scale form of regionalization meant that key stakeholders in the acute care sector could effectively block any significant discussion of changes to how health care dollars are allocated…..more
THROUGH a United Nations Children Fund global innovation, Nigeria has achieved a milestone as the first country to reach one million responders on the Short Message Service (SMS) based U-Report platform, designed to strengthen community-led development and citizen engagement. The U-report is a user-centred social monitoring tool based on simple SMS messages, polling opinions on issues that affect communities and sharing useful information and relies on volunteer community members, mostly young people, serving as U-Reporters to provide information on issues that affect their communities….more
Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes.
There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes.
Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.
Hypertension remains one of the most important preventable contributors to disease and death. Abundant evidence from randomized controlled trials (RCTs) has shown benefit of antihypertensive drug treatment in reducing important health outcomes in persons with hypertension.1– 3 Clinical guidelines are at the intersection between research evidence and clinical actions that can improve patient outcomes. The Institute of Medicine Report Clinical Practice Guidelines We Can Trust outlined a pathway to guideline development and is the approach that this panel aspired to in the creation of this report.4
The panel members appointed to the Eighth Joint National Committee (JNC 8) used rigorous evidence-based methods, developing Evidence Statements and recommendations for blood pressure (BP) treatment based on a systematic review of the literature to meet user needs, especially the needs of the primary care clinician. This report is an executive summary of the evidence and is designed to provide clear recommendations for all clinicians. Major differences from the previous JNC report are summarized inTable 1. The complete evidence summary and detailed description of the evidence review and methods are provided online (see Supplement). ….more
What took these creatures, with brains the size of apes’, to the dark chamber 90m from the entrance of the cave might have been an understanding of the finality of death, or even a belief in an afterlife. This is the controversial theory scientists have put forward to explain why a hard-to-reach chamber deep in the Rising Star cave, in Gauteng’s Cradle of Humankind, is filled exclusively with Homo naledi remains. Homo naledi, described as a new species of a previously unknown branch of the human family tree, was revealed to the world at Maropeng, in the Cradle of Humankind yesterday…..more
AfroPHC 