Sustainability: CHW productivity will be determined in large part by the conditions under which they work. Attention to the provision of an enabling work environment for CHWs will be essential for achieving high levels of productivity.

Our model of operation encompasses four essential elements like, workload, supportive supervision/mentorship, supplies and equipment, and respect from the community and the health system, this has greatly improved their productivity. Our project principle, is that if CHWs have a manageable workload in terms of a realistic number of tasks and clients, an organized manner of carrying out these tasks, a reasonable geographic distance to cover, the needed supplies/ equipment, a supportive supervisor, and respect and acceptance from the community and the health system, they can function more productively and contribute to an effective community-based strategy.

Conclusions: As more countries look to scale up CHW programmes or shift additional tasks to CHWs, it is critical to pay attention to the elements that affect CHW productivity during programme design as well as implementation. An enabling work environment is crucial to maximize CHW productivity. Policy-makers, programme managers, and other stakeholders need to carefully consider how the productivity elements related to the work environment are defined and incorporated in the overall CHW strategy. Establishing a balance among the four elements that constitute a CHW’s work environment will help make great strides in improving the effectiveness and quality of the services provided by CHWs.

Muhereza Chrisestome

Community Health Worker Manager,based in Karamoja-Uganda. Qualification: Medical Clinical officer,Social Worker and Public Health and Leadership Specialist. Community Health Worker Program Manager,

UNOPS-MILLENIUM PROMISE ALLIANCE +256783156896.

The WHO website states:

‘Neglected tropical diseases (NTDs) are a diverse group of communicable diseases that prevail in tropical and subtropical conditions in 149 countries and affect more than one billion people, costing developing economies billions of dollars every year…’

http://www.who.int/neglected_diseases/diseases/en/

and the CDC website confirms:

‘Neglected Tropical Diseases (NTDs) are a group of parasitic and bacterial diseases that cause substantial illness for more than one billion people globally…. More than 1 billion people—one-sixth of the world’s population—suffer from one or more Neglected Tropical Diseases (NTDs).’

https://www.cdc.gov/globalhealth/ntd/

I find this figure surprisingly high, don’t you? I looked in vain for evidence to back it up.

I wrote to WHO who kindly pointed me to two publications on NTDs:

http://apps.who.int/iris/bitstream/10665/70809/1/WHO_HTM_NTD_2012.1_eng.pdf?ua=1

http://apps.who.int/iris/bitstream/10665/152781/1/9789241564861_eng.pdf?ua=1

Gauteng health department head Dr Tiego Ephraim Selebano was placed on precautionary suspension by Gauteng Premier David Makhura on Wednesday. Director of mental health Dr Makgabo Manamela was given 48 hours to give reasons why she should not be dismissed.

Makhura suspended Selebano following the recommendations of health ombudsman Prof Malegapuru Makgoba in his report, No guns: 94 silent deaths and counting, on the deaths of 94 psychiatric patients…..more

Finger Infection Overview

Injury or infection to a finger or fingers is a common problem. Infection can range from mild to potentially serious. Often, these infections start out small and are relatively easy to treat. Failure to properly treat these infections can result in permanent disability or loss of the finger.

Early recognition and proper treatment of the following main finger infections will help prevent most of the serious outcomes.

• Paronychia: A paronychia is an infection of the finger that involves the tissue at the edges of the fingernail. This infection is usually superficial and localized to the soft tissue and skin around the fingernail. This is the most common bacterial infection seen in the hand…..more

More resources

Too much cholesterol in the blood can lead to cardiovascular disease. Heart disease is the  No. 1cause of death in the United States.Over 2,100 Americans die of cardiovascular disease each day, an average of one death every 40 seconds.

The good news is, you can lower your cholesterol and reduce your risk of heart disease and stroke.

Working with your doctor is key.  It takes a team to develop and maintain a successful health program. You and your healthcare professionals each play an important role in maintaining and improving your heart health.

Introduction

THIS is, to coin a phrase, (the best and the worst of times) for South African activists seeking to use citizen’s organisations to create a fairer society. It is the best because the opportunities for effective action may never have been greater. It is the worst, because current patterns suggest that it is unlikely that activists and their organisations are able to take advantage.

Ironically, the cause of both the opportunity and (much of) the incapacity are the same: the unpopularity among growing numbers of voters, particularly but by no means only in the major cities, of the governing party’s current leadership. One effect has been to force government – and politicians in general – to take more notice of citizens than they have done in the past. This opens opportunities for citizen influence, particularly where it seeks to give voice to the realities of people who are usually denied a voice. Another has been a strong tendency for activism to centre far less on policy change and far more on the governing party and its actions. Coupled with a sharp decline in organisational strength in important parts of civil society, and a failure thus far to see the new political reality as an opportunity, this has left activists ill equipped to use these opportunities to secure much-need change…..more

More

Re: CITATION: Who is a community health worker? ­ a systematic review of definitions

Abimbola OOlaniran, Helen Smith, Regine Unkels, Sarah Bar-Zeev & Nynke van den Broek

Article: 1272223 | Received 30 Aug 2016, Accepted 08 Dec 2016, Published online: 27 Jan 2017

http://www.tandfonline.com/doi/full/10.1080/16549716.2017.1272223

Thank you again for your paper. I was interested to note the selection of papers for inclusion in the systematic review.

As you state in the paper: ‘Due to resource and time limitations, we only included papers published in English and missed opportunities to review definitions of CHWs included in papers published in other languages (e.g. studies from francophone West Africa or Latin America).’

It is quite understandable that you had to work with available resources. However, there are arguably some kinds of research where the non-English literature could tell us a great deal. This perhaps includes research for objectives such as yours ‘to identify the common themes in the definitions and descriptions of CHWs that will aid delineation within this cadre and distinguish CHWs from other healthcare providers’. I wonder if there is scope for the systematic review team to be expanded to include French, Spanish, Portuguese and other-speaking researchers?

This brings in a wider question about multilingualism and systematic reviews (two subjects that we are planning to explore in depth later this year on HIFA). What are the challenges of multilingualism for systematic reviewers, and how can these challenges be better addressed?

The Cochrane network – with thousands of systematic reviewers across the world – is ideally positioned to enable multilingual systematic reviews, and yet I think most systematic reviews draw only from English-language publications? Can anyone from Cochrane or elsewhere comment on this?

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa.org  

Welcome to our monthly newsletter. Hopefully, in addition to the latest evidence, there are other things of interest for you! The community rapid review system is the one I’m particularly keen to focus on!

Community rapid review system. This is a potentially ground-breaking/disruptive idea and we’d like to invite you to participate and help shape the future. The question we’re looking to answer is ‘Can we use the Trip community to help produce rapid reviews?’. We clearly think we can but read more about it here. We really are at the start of the journey and we’d love you to help us make this a reality. If you’re interested can you send me a new email with the subject ‘Community rapid review’

New upgrades to the site. In case you missed our recent email, we recently rolled out a major new upgrade to the site. For further information click here to find out about the great new changes.

Preventing overdiagnosis. Overdiagnosis is a topic close to the heart of Trip, which is why we’re happy to help publicise this event: The 5th International Preventing Overdiagnosis Conference, which takes place on August 17-19 2017 at the Québec City Convention Centre. And, while on the topic of conferences, don’t forget this year’s Evidence Live.

Latest Evidence. As you know our site has lots of great evidence and we add new content every day. Based on your profile we’ve found the following which should help keep you up to date.

Become a ‘Pro’ user. By subscribing to Trip Pro you get a better search experience (more content and extra features) and it helps support Trip. That’s got to count as a win:win! We’re a small, independent, company and are dependent on support via individuals or organisations purchasing Trip Pro. A personal subscription costs just $40 per year (less than $4/£3 per month) while institutional subscriptions are incredibly cost-effective. So, if you like Trip and want to see it to continue to develop and continue to be independent please consider either option.

Have a great month and if you’re in need of evidence, come and visit Trip – making evidence easy!

Best wishes

Jon

Jon Brassey

Trip Database

WONCA E-Update

Friday 3rd FEBRUARY 2017

WONCA News – February 2017
The latest WONCA News (February 2017) has just been published and is accessible via the WONCA website, with lots of WONCA news, views and events.

From the WONCA President
“Life as the new President has been quiet geographically but busy online. There is an odd tension between leadership and service, where the responsibility to ‘keep moving and improving’ is set against the ordinary repetitions of daily life. In fact, as family doctors our most important work is that which we do again and again, in our consulting rooms and clinics, with patients and colleagues – or with our students and residents, helping them to gain knowledge and skills in small steps that build to a whole”.
Read more on Amanda Howe’s reflections on her first few weeks in office:

Latest news on WONCA EMR Conference
The latest news from our Eastern Mediterranean colleagues regarding the upcoming conference in Abu Dhabi (2nd to 4th March) can be found on the WONCA website. There is a reduced delegate fee if you register before 15th February, with further reductions for young doctors. For further details, including news of the program and keynote speakers, go to the WONCA website.

WONCA International Classification Committee (WICC)
WICC is the oldest working committee of WONCA and currently has 45 members from 29 countries. Professor Thomas Kühlein of Germany is the new chair of WICC and in this month’s news he outlines the past year’s work of the WICC and also explains all those acronyms relating to classification. Thomas is also one of this month’s Featured Doctors.

“A classification is much more than the annoying outflow of bureaucrats. Instead it is a tool to separate the fuzzy world into disjunctive categories in order to make it countable and statistically describable. The data which emerge can be used for many different purposes. The first and foremost use should be the practising physician’s wish and need to know about the quality of care provided. Furthermore the data can be used for research in primary care (PC). In terms of professionalism both are central issues.”

Read more of WICC and its work on the WONCA website

WONCA Rural Conference – Early Bird deadline extended
We’ve been advised by our Rural Practice colleagues that the deadline for accessing Early Bird registration for the forthcoming Cairns rural health conference (29th April to 2nd May) has now been extended until 28th February. The program for the event is also now available. For all the latest news on the conference, including registration details and the full program, go to the WONCA website.

I was interested to see this paper in the current issue of the WHO Bulletin (February 2017). The full text is freely available here:

http://www.who.int/bulletin/volumes/95/2/16-175513/en/

The paper describes itself as ‘implementation research’. However, my understanding of implementation research (from the discussion we held on HIFA last year) is that implementation research starts by identifying and then exploring one or more research questions that relate to *how* better to implement a proven policy or practice. The current paper is perhaps better described as a health systems intervention (without explicit research question) with before-and-after measurement of health outcomes. Despite several weeks of discussion in 2016 of what is and what isn’t Implementation Research, I am not sure I am yet clear. As we discussed last year, all of us – and especially funders and policymakers – need to be crystal-clear what implementation research is if we are to expect it to be properly supported.

I hope perhaps one of the authors, or IR experts on HIFA, can clarify.

CITATION: Implementation research on community health workers’ provision of maternal and child health services in rural Liberia

Peter W Luckow, Avi Kenny, Emily White, Madeleine Ballard, Lorenzo Dorr, Kirby Erlandson, Benjamin Grant, Alice Johnson, Breanna Lorenzen, Subarna Mukherjee, E John Ly, Abigail McDaniel, Netus Nowine, Vidiya Sathananthan, Gerald A Sechler, John D Kraemer, Mark J Siedner & Rajesh Panjabi

Bulletin of the World Health Organization 2017;95:113-120. doi: http://dx.doi.org/10.2471/BLT.16.175513

ABSTRACT

Objective: To assess changes in the use of essential maternal and child health services in Konobo, Liberia, after implementation of an enhanced community health worker (CHW) programme.

Methods: The Liberian Ministry of Health partnered with Last Mile Health, a nongovernmental organization, to implement a pilot CHW programme with enhanced recruitment, training, supervision and compensation. To assess changes in maternal and child health-care use, we conducted repeated cross-sectional cluster surveys before (2012) and after (2015) programme implementation.

Findings: Between 2012 and 2015, 54 CHWs, seven peer supervisors and three clinical supervisors were trained to serve a population of 12 127 people in 44 communities. The regression-adjusted percentage of children receiving care from formal care providers increased by 60.1 (95% confidence interval, CI: 51.6 to 68.7) percentage points for diarrhoea, by 30.6 (95% CI: 20.5 to 40.7) for fever and by 51.2 (95% CI: 37.9 to 64.5) for acute respiratory infection. Facility-based delivery increased by 28.2 points (95% CI: 20.3 to 36.1). Facility-based delivery and formal sector care for acute respiratory infection and diarrhoea increased more in agricultural than gold-mining communities. Receipt of one-or-more antenatal care sessions at a health facility and postnatal care within 24 hours of delivery did not change significantly.

Conclusion: We identified significant increases in uptake of child and maternal health-care services from formal providers during the pilot CHW programme in remote rural Liberia. Clinic-based services, such as postnatal care, and services in specific settings, such as mining areas, require additional interventions to achieve optimal outcomes.

—

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa.org  

We have just concluded such ‘re-contextualisation’, we called it localisation, of an integrated, comprehensive, evidence based guide for use by all cadres of clinicians in Primary Health Care in Nigeria. The guide is called PACK (Practical Approach to Care Kit) originally developed by the knowledge Translation Unit of the Lung Institute, University of Cape Town in collaboration with BMJ. We convened a multidisciplinary team that worked over six months to contextualise/localise it for Nigeria. We are starting the Master Trainers training phase of the Pilot of PACK Nigeria Adult guide in three states in Nigeria from February 7th, 2017 in Abuja.

Joseph Ana.  

• Africa Center for Clin Gov Research & Patient Safety
• @ HRI West Africa Group – HRI WA
• Consultants in Clinical Governance Implementation
• Publisher: Health and Medical Journals
• 8 Amaku Street Housing Estate, Calabar
• Cross River State, Nigeria
• Phone No. +234 (0) 8063600642
• Visit Website: www.hriwestafrica.com
• E-mail: hriwestafrica@gmail.com

http://knowledgetranslation.co.za/programmes/pack-adult-wc-sa/

http://pack.bmj.com/

http://www.bmj.com/company/practical-approach-to-care-kit/

World Cancer Day commemorations on 4 February 2017 continue to be under the theme of “We Can, I Can” launched in 2016 as part of a three-year campaign to maximize reach and impact. It is a day to reflect on how cancer affects everyone in different ways, and how collectively or individually, we all, from lunch makers to law makers, can take various actions to reduce the impact of cancer on individuals, families and communities.

And there is urgent reason to do so.

Cancer is a leading cause of death worldwide, with approximately 8.8 million cancer-related deaths in 2015. Within the next 20-30 years, the global death rate due to cancer is expected to double, and African countries are likely to be the most affected.

In the African Region, the most common cancers are cervical, breast, liver and prostate, as well as Kaposi’s sarcoma and non-Hodgkin’s lymphoma. Cancer-causing viral infections such as human papillomavirus infection (HPV) and hepatitis B and hepatitis C (HBV/HCV) significantly contribute to the burden of cervical and liver cancer.

This disturbing prediction of the rise of cancer cases is based on Africa’s ageing population, the persistence of chronic infections and unhealthy lifestyle choices and risk factors such as overweight, low fruit and vegetable intake, lack of physical activity, and tobacco and alcohol consumption. Such choices are greatly influenced by forces outside of people’s control, from unhealthy, cheap food choices at shops and schools, to poor urban planning and marketing of tobacco and alcohol.

The WHO Regional Office for Africa recently released a report which alarmingly found that one-quarter of adults in half of the African countries surveyed had at least three of these risk factors. Tobacco is the most important risk factor for cancer, causing about 70% of lung cancer deaths and 20% of other global cancer deaths. In the African Region, daily tobacco use among adults ranges from 5% to 26% (12% across the Region).

We must do everything we can to reverse these trends which threaten the health gains we have made in other areas. Collectively, governments and societies can inspire and take action through creating healthy schools, workplaces, cities; promote policy change; improve access to people-centred cancer care; establish welfare programmes for patients and families as well as psychosocial and rehabilitation services; invest in surveillance and cancer control; support people undergoing treatment in various ways; challenge myths and perceptions and encourage cancer early detection.

As individuals, we can make healthy lifestyle choices and understand that screening and early diagnosis saves lives, take control of the cancer journey and reach out for support, and use our voices to promote cancer awareness and control. We can protect ourselves and our beloved ones against liver cancer and cervical cancer by being vaccinated against HBV and HPV respectively.

As cancer continues to take millions of lives prematurely, governments need to take urgent action to meet the targets to reduce the burden of cancer and other noncommunicable diseases. Lifestyle changes – while not easy – will achieve so much in reducing the chances of developing cancer and an often slow and painful death. Together we can beat cancer.

Early cancer diagnosis saves lives, cuts treatment costs

A press release from WHO states:

‘The three steps to early diagnosis are:

– Improve public awareness of different cancer symptoms and encourage people to seek care when these arise.

– Invest in strengthening and equipping health services and training health workers so they can conduct accurate and timely diagnostics.

– Ensure people living with cancer can access safe and effective treatment, including pain relief, without incurring prohibitive personal or financial hardship.’

NEWS RELEASE

3 FEBRUARY 2017 | GENEVA – New guidance from WHO, launched ahead of World Cancer Day (4 February), aims to improve the chances of survival for people living with cancer by ensuring that health services can focus on diagnosing and treating the disease earlier.

http://who.int/cancer/publications/cancer_early_diagnosis/en/

New WHO figures released this week indicate that each year 8.8 million people die from cancer, mostly in low- and middle-income countries. One problem is that many cancer cases are diagnosed too late. Even in countries with optimal health systems and services, many cancer cases are diagnosed at an advanced stage, when they are harder to treat successfully.

“Diagnosing cancer in late stages, and the inability to provide treatment, condemns many people to unnecessary suffering and early death,” says Dr Etienne Krug, Director of WHO’s Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention.

“By taking the steps to implement WHO’s new guidance, healthcare planners can improve early diagnosis of cancer and ensure prompt treatment, especially for breast, cervical, and colorectal cancers. This will result in more people surviving cancer. It will also be less expensive to treat and cure cancer patients.”

All countries can take steps to improve early diagnosis of cancer, according to WHO’s new Guide to cancer early diagnosis.

The three steps to early diagnosis are:

Improve public awareness of different cancer symptoms and encourage people to seek care when these arise.

Invest in strengthening and equipping health services and training health workers so they can conduct accurate and timely diagnostics.

Ensure people living with cancer can access safe and effective treatment, including pain relief, without incurring prohibitive personal or financial hardship…

Media contact

Tarik Jašarevic

WHO Department of Communications

Mobile: +41 79 367 6214

Office : +41 22 791 5099

Email: jasarevict@who.int

From the WHO website www.who.int :

3 February 2017 – Launched ahead of the World Cancer Day (4 February), the new WHO guidance aims to improve the chances of survival for people living with cancer by ensuring that health services can focus on diagnosing and treating the disease earlier. Strategies to improve early diagnosis can be built into health systems at a low cost. In turn, effective early diagnosis can help detect cancer in patients at an earlier stage, enabling treatment that is generally more effective, less complex, and less expensive…

The new guidance is freely available here: http://who.int/cancer/publications/cancer_early_diagnosis/en/

Best wishes,

Neil

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa.org  

Temporary restraining order represents a major setback for Trump’ order that temporarily barred refugees and nationals from seven countries from entering the US.

Seattle/Boston — A Seattle federal judge on Friday put a nationwide block on US President Donald Trump’s week-old executive order that had temporarily barred refugees and nationals from seven countries from entering the United States.

The judge’s temporary restraining order represents a major setback for Trump’s action, though the White House said late Friday that it believed the ban to be “lawful and appropriate” and that the US Department of Justice would file an emergency appeal.

Still, just hours after the ruling, US Customs and Border Protection told airlines they could board travelers who had been affected by the ban…..more

Sweet potatoes are an incredibly healthy source of carbohydrates, and they’re one of my favorite foods. These tubers are not the same as other potatoes – they’re actually part of a completely different plant family.

Sweet potatoes are part of the morning glory family, whereas potatoes are nightshades. Additionally, sweet potatoes are often confused with yams, which are mostly grown in Africa. True yams are starchier and drier with tougher bark-like skin, while sweet potatoes have smooth, edible skin and are either firm or soft when cooked.

There are so many reasons to eat more of this sweet and tasty root vegetable. Here’s the short-list: …more

Can our bodies really transform muscle into fat and fat into muscle?

The short answer is “no.” Muscle and fat are two fundamentally different types of tissue, so muscle never degenerates into fat, and fat cannot be transformed into muscle.

The components your body uses to make each are not the same, so while it can appear that one is morphing into the other, there are actually two processes at work.

So, what’s actually happening when we witness dramatic changes in our body composition over time? ….more