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

Abstract

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

E-maintenance leaves clinic in shambles. When the Gauteng portfolio committee visited a state clinic on the West Rand, it found broken equipment galore. The boom and motor gate at the entrance to the clinic remains broken, even though the damage was reported via the e-maintenance system in November last year. Though the clinic was squeaky clean, the glass panels of a door in the main passageway were broken. This, too, had been reported in November…..more

The new Training Resources Bulletin from AIHA is available now at : http://www.hifa2015.org/wp-content/uploads/TrainingResourcesBulletinSept15.pdf

Training Resources Bulletin

September 2015

American International Health Alliance

Knowledge Management Program

www.aiha.com

The Training Resources Bulletin is intended to assist institutions and individuals who are seeking online training options in the field of medicine, public health, social work, and related topics. If this document is to be redistributed or posted on another Web site, we request that it be posted in full/without alteration, and that credit is given to the American International Health Alliance as the source of the document.

Your input (including new sources of online training opportunities) will be greatly appreciated.

Previous issues are available at  http://www.healthconnect-intl.org/resources.html

In This Issue …

ONLINE COURSES

– Health Literacy and Communication for Health Professionals

– Basic course on Evidence Based Medicine (EBM)

– Ethical Challenges in Short-Term Global Health Training

– Finding, organizing and using health information

TRAINING MATERIALS

– Implementation research toolkit

– Introduction to Nursing Part 2

– ORB

– ENGAGE-TB

Irina Ibraghimova, PhD

Library and Information Management Specialist,

HealthConnect International

ibra@zadar.net

http://www.healthconnect-intl.org/

Diana Frymus said: ‘Better data on CHWs would help demonstrate their impact and cost-effectiveness’. This is corroborated by one of the new papers in the open-access journal Human Resources for Health. Below is the citation and abstract. The paper points to a relative lack of evidence / data on the cost-effectiveness of CHWs in the situations where they are most deployed, with the exception of tuberculosis.

Diana again: ‘There are still many policy makers who are skeptical of the value of CHWs. If we can demonstrate their value, we can get CHWs added as a formal member of the health team, with proper support supervision, a career ladder, and a salary.’ Clearly, stronger evidence of their cost-effectiveness would greatly help to convince policymakers to invest more in CHW scale-up.

CITATION: Costs and cost-effectiveness of community health workers: evidence from a literature review

Kelsey Vaughan1*, Maryse C Kok1, Sophie Witter2 and Marjolein Dieleman1

* Corresponding author: Kelsey Vaughan kvaughan@gmail.com

Human Resources for Health 2015, 13:71  doi:10.1186/s12960-015-0070-y

The electronic version of this article is the complete one and can be found online at: http://www.human-resources-health.com/content/13/1/71

ABSTRACT

Objective: This study sought to synthesize and critically review evidence on costs and cost-effectiveness of community health worker (CHW) programmes in low- and middle-income countries (LMICs) to inform policy dialogue around their role in health systems.

Methods: From a larger systematic review on effectiveness and factors influencing performance of close-to-community providers, complemented by a supplementary search in PubMed, we did an exploratory review of a subset of papers (32 published primary studies and 4 reviews from the period January 2003–July 2015) about the costs and cost-effectiveness of CHWs. Studies were assessed using a data extraction matrix including methodological approach and findings.

Results: Existing evidence suggests that, compared with standard care, using CHWs in health programmes can be a cost-effective intervention in LMICs, particularly for tuberculosis, but also – although evidence is weaker – in other areas such as reproductive, maternal, newborn and child health (RMNCH) and malaria.

Conclusion: Notwithstanding important caveats about the heterogeneity of the studies and their methodological limitations, findings reinforce the hypothesis that CHWs may represent, in some settings, a cost-effective approach for the delivery of essential health services. The less conclusive evidence about the cost-effectiveness of CHWs in other areas may reflect that these areas have been evaluated less (and less rigorously) than others, rather than an actual difference in cost-effectiveness in the various service delivery areas or interventions. Methodologically, areas for further development include how to properly assess costs from a societal perspective rather than just through the lens of the cost to government and accounting for non-tangible costs and non-health benefits commonly associated with CHWs.

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Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

STEPH Vermeulen, pioneer in EQ — emotional intelligence — has spent the century so far studying research on brains. Now, in one short book, she’s turning the approach to grey matter upside down. We no longer talk about EQ versus IQ, says Vermeulen, whose book on emotional intelligence, published 15 years ago was a bestseller. “But, we realise now we need both our intelligent and emotional quotients to innovate, to create new technology and carve out new worlds and lives.” Hence her latest book, Personal Intelligence: Future Fit Now, which she describes as “EQ all grown up”….more

With not a single lawsuit decided in their favour, the Gauteng Health Department is haemorrhaging money – and it seems this isn’t about to stop. Health MEC Qedani Mahlangu revealed this week in the Gauteng Legislature that her department had forked out R544 million to date for medical negligence claims. These claims date back to 2010. According to information from the MEC, 168 cases had been lost in court while eight had been settled out of court. The individual cases make for harrowing reading. DA shadow MEC for Health in Gauteng Jack Bloom, who posed the questions to Mahlangu, carries a dossier on these claims. Many of them point to negligence of a shocking nature…..more

CTCs are defined as ‘health workers who carry out promotional, preventive and/or curative health services and who are often the first point of contact at community level in countries in the global south… usually have at least a minimum level of training in the context of the intervention that they carry out and include a broad variety of health workers, including community health workers (CHWs) and auxiliary health workers.’

For the benefit of those who may not have immediate web access, below is the preamble. There are several interesting-looking case studies, reviews and research articles. If anyone can provide comments on the collection as a whole, or on individual papers, please send a message to hifa2015@dgroups.org

‘CTC providers are strategically placed as the interface between health systems and the communities they serve. National and international decision-makers are once again turning to (CTC) services in order to strengthen health systems in the context of the momentum generated by strategies to support universal access, delivery of the Millennium Development Goals (MDGs) and the post-MDG agenda. However there are a number of flaws in current systems that need to be better understood. We are at a critical stage in the development of CTC programming and policy which requires the creation and communication of new knowledge to ensure the safety, sustainability, quality and accessibility of services, and their links with both the broader health system and the communities that CTC’s serve.

‘The series covers a range of topics on close to community providers for health systems development, including, but not limited to, the following:

‘Conceptualising the range of CTC providers in different contexts

Methods and tools for analysing CTC programmes

Cost effectiveness of CTC programmes

Challenges and opportunities CTC providers face in reaching and supporting marginalised groups

Diverse community perspectives and ownership of CTC programmes

Opportunities for CTC providers to act as champions for social change

The interface between health systems and CTC programmes

Strategies to motivate, retain and sustain CTC providers

Integrating vertical programmes using CTC providers within national programmes’

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

I have been following with interest the first few days of the debate on “CHW data for decision making”. Some of the contributions go to the heart of the matter, which is that at present unfortunately community health workers and other types of community-based practitioners sit at the margin of health systems: not formally recognized, not adequately trained, not properly incentivized, supervised or managed, not adequately counted or monitored.

There are clearly some missed opportunities in this, as the potential of these cadres in some settings to contribute to expand access to some essential health services and improve health outcomes is by now well recognized. Recent research, coordinated by the Global Health Workforce Alliance, has focused on assessing the cost-effectiveness of health programmes led by various types of community-based practitioners, finding that these cadres can represent a cost-effective policy options in some contexts (Mc Pake et al, WHO Bull 2015 http://www.who.int/bulletin/volumes/93/9/14-144899.pdf?ua=1). The case for investment in these cadres in some contexts has therefore a stronger empirical basis now.

However, support for community based practitioners should not take the form of one-off vertical initiatives disjointed from the rest of the health system: national governments that consider community-based practitioners a relevant policy option for their country contexts should invest – and be supported by the international community – in order to ensure that these cadres are adequately supported by and integrated in the health system. As Campbell et al note in a recent editorial (http://www.who.int/bulletin/volumes/93/9/15-162198.pdf?ua=1), maximizing the impact of community-based practitioners entails that (i) national policy-makers move towards the full integration of community-based practitioners in public health strategies, allowing these cadres to benefit from formal employment, education, health system support, regulation, supervision, remuneration and career advancement opportunities; (ii) development partners and funding agencies see the value of investing in these cadres and contribute to the capital and recurrent costs incurred when expanding this workforce; (iii) normative agencies such as WHO and ILO address the evidence and classification gaps by developing more precise definitions and categories for these cadres.

Related to this last point, which some of you already commented on, WHO is planning on developing guidelines on the role, education and integration of community-based practitioners for publication in 2017.

Many of the participants in this conversation have also commented on the need to ensure that we have better data on community health workers and other types of community-based practitioners. Efforts at developing better metrics for these important cadres should take place in the context of broader initiatives to enhance health workforce information systems.

WHO’s emerging Global Strategy on Human Resources for Health: Workforce 2030 (http://www.who.int/hrh/resources/online_consult-globstrat_hrh/en/), to be considered by the World Health Assembly in May 2016, calls for investments in strengthening country analytical capacities of HRH and health system data on the basis of policies and guidelines for standardization and interoperability of HRH data. The GSHRH puts forward the adoption of a National Health Workforce Account (NHWA) as a harmonized, integrated approach for annual and timely collection of health workforce information (http://www.who.int/hrh/documents/brief_nhwfa/en/). This approach, or related ones to strengthen health workforce metrics, should be extended to cover also community-based practitioners.

Best wishes,

Giorgio

HIFA profile: Giorgio Cometto is a Technical Officer at the World Health Organization in Switzerland. Professional interests: Human resources for health.      comettog AT who.int

Reproductive Health Matters: Special Issue on knowledge, evidence, practice and power

Editors: Shirin Heidari & Marge Berer

Reproductive Health Matters, Vol. 23, Issue 45, May 2015

http://www.rhm-elsevier.com/issue/S0968-8080%2815%29X0003-6

‘In this issue, “Reproductive Health Matters” is proud to publish a diverse range of findings from research projects and perspectives that highlight the complexities, strengths and weaknesses of the process of knowledgecreation and uncover the frequent disconnect between research, policies and practices, elaborating on its implications. The theme of this issue extends beyond knowledge production and engages with the domain of evidence-based policy and practice. As Johann Wolfgang von Goethe has said, “Knowing is not enough, we must apply; willing is not enough, we must act.”‘

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

CITATION: What research tells us about knowledge transfer strategies to improve public health in low-income countries: a scoping review

by Stéphanie Siron, Christian Dagenais, Valéry Ridde

International Journal of Public Health -First online: 23 August 2015

http://link.springer.com/content/pdf/10.1007%2Fs00038-015-0716-5.pdf

Contact: S. Siron. e-mail: stephanie.siron@umontreal.ca

‘This study describes the current state of research on knowledge transfer strategies to improve public health in low-income countries, to identify the knowledge gaps on this topic. The review provides specific elements for understanding the transfer processes in low-income countries and highlights the need for systematic evaluation of the conditions for research results utilization.’

ABSTRACT

Objectives: This study describes the current state of research on knowledge transfer strategies to improve public health in low-income countries, to identify the knowledge gaps on this topic.

Methods: In this scoping review, a descriptive and systematic process was used to analyse, for each article retained, descriptions of research context and methods,

Results: 28 articles were analysed. They dealt with the evaluation of transfer strategies that employed multiple activities, mostly targeting health professionals and women with very young children. Most often these studies used quantitative designs and measurements of instrumental use with some methodological shortcomings. Results were positive and suggested recommendations for improving professional practices, knowledge and health-related behaviours. The review highlights the great diversity of transfer strategies used, strategies and many conditions for knowledge use.

Conclusions: The review provides specific elements for understanding the transfer processes in low-income countries and highlights the need for systematic evaluation of the conditions for research results utilization.

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

ABSTRACT

The increased demand for evidence-based practice in health policy in recent years has provoked a parallel increase in diverse evidence-based outputs designed to translate knowledge from researchers to policy makers and practitioners. Such knowledge translation ideally creates user-friendly outputs, tailored to meet information needs in a particular context for a particular audience. Yet matching users’ knowledge needs to the most suitable output can be challenging. We have developed an evidence synthesis framework to help knowledge users, brokers, commissioners and producers decide which type of output offers the best ‘fit’ between ‘need’ and ‘response’. We conducted a four-strand literature search for characteristics and methods of evidence synthesis outputs using databases of peer reviewed literature, specific journals, grey literature and references in relevant documents. Eight experts in synthesis designed to get research into policy and practice were also consulted to hone issues for consideration and ascertain key studies. In all, 24 documents were included in the literature review. From these we identified essential characteristics to consider when planning an output – Readability, Relevance, Rigour and Resources—which we then used to develop a process for matching users’ knowledge needs with an appropriate evidence synthesis output. We also identified 10 distinct evidence synthesis outputs, classifying them in the evidence synthesis framework under four domains: key features, utility, technical characteristics and resources, and in relation to six primary audience groups—professionals, practitioners, researchers, academics, advocates and policy makers. Users’ knowledge needs vary and meeting them successfully requires collaborative planning. The Framework should facilitate a more systematic assessment of the balance of essential characteristics required to select the best output for the purpose.

KEY MESSAGES

The increased demand for evidence-based health policy in recent years has provoked a parallel increase in diverse evidence-based outputs designed to translate knowledge from researchers to policy makers and practitioners, yet matching users’ specific knowledge needs to the most suitable output, while essential, can be challenging.

We have developed an evidence synthesis framework classifying 10 distinct evidence synthesis outputs under four domains: key features, utility, technical characteristics and resources, in relation to six primary groups of users: professionals, practitioners, researchers, academics, advocates and policy makers.

We propose a process for matching users’ knowledge needs with an appropriate evidence synthesis output, using essential characteristics to consider when planning an output: Readability, Relevance, Rigour and Resources. [Resources available for production (including time, funding and personnel]

When used in combination, the framework and process should facilitate a more systematic assessment of the balance of essential characteristics required to select the best output for the purpose and help knowledge users, brokers, commissioners and producers decide the best ‘fit’ between ‘need’ and ‘response’.

The full text is freely available here: http://heapol.oxfordjournals.org/content/early/2015/08/31/heapol.czv079.full?papetoc

CITATION: Taking knowledge users’ knowledge needs into account in health: an evidence synthesis framework

Deepthi Wickremasinghe, Shyama Kuruvilla, Nicholas Mays and Bilal Iqbal Avan,*

Health Policy Plan. (2015)

doi: 10.1093/heapol/czv079

Corresponding author. E-mail: bilal.avan@lshtm.ac.uk

SUMMARY

‘Both research and consultations over the last decades have identified sexuality-related communication as an issue that requires urgent attention. While clients would like their health-care providers to discuss sexual health concerns, health workers lack the necessary training and knowledge to feel comfortable addressing such issues. This guideline provides health policy-makers and decision-makers in health professional training institutions with advice on the rationale for health-care providers’ use of counselling skills to address sexual health concerns in a primary health care setting.

The publication makes two main recommendations:

1. BSC [Behavioural and Social Change] is recommended for the prevention of sexually transmitted infections among adults and adolescents in primary health services

Quality of evidence: low – moderate

Strength of recommendation: strong

2. Training of health-care providers in sexual health knowledge and in the skills of brief sexuality-related communication is recommended.

Quality of evidence: low – very low

Strength of recommendation: strong

SELECTED EXTRACTS (selected by Neil PW)

‘The ability of people to achieve sexual health and well-being depends, among other things, on their access to comprehensive information about sexuality, their knowledge about the risks they face, and their vulnerability to the adverse consequences of sexual activity. To achieve sexual health, people also need opportunities for social support, access to good-quality sexual health care (i.e. addressing all elements of sexual health according to the WHO working definition, including products and materials), and an environment that affirms and promotes sexual health for all. These include counselling and communication programmes.’

‘Adolescents have the right to seek and receive information. In the absence of the information, support and skills needed to promote and protect their health and well-being, adolescents can suffer harms such as stigma, sadness, shame, guilt and anxiety, as well as STIs and unintended pregnancies.’

The full text is freely available here:

http://apps.who.int/iris/bitstream/10665/170251/1/9789241549004_eng.pdf?ua=1

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Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

I’m delighted to announce to HIFA members our new journal – BMJ Global Health – gh.bmj.com

The journal’s aims are to achieve a world in which every person and country has access to the information about health, health care and social determinants of health that they need to protect their own health and the health of the people for whom they take responsibility.

Everything that we do at BMJ is driven by our vision of “A Healthier World”. The journal will appeal to anyone working in global health – from doctors, nurses, healthcare workers, policy makers, researchers, NGOs and funders – as we work together to achieve this vision.

Please read the introductory Editorial from our Editor-in Chief Dr Seye Abimbola  http://goo.gl/yP5ZTp

Access to the journal will be free to everyone – wherever they are in the world. In order to achieve this we need to work with funders which are willing to support our vision and to contribute to underwriting the costs of publishing a top quality journal. We welcome the opportunity to discuss how we can work together, so please spread the word.

The journal is accepting submissions now and the first content will go live in early 2016.

If you have any questions, want to submit an article or want to discuss supporting the journal, please contact me or Dr Seye Abimbola.

We hope that you agree that this is an important step forward in achieving a healthier world.

Sincerely

Peter Ashman

Publishing Director – BMJ