We need to talk about ‘bad’ resilience

BMJ Global Health, Год журнала: 2024, Номер 9(2), С. e014041 - e014041

Опубликована: Фев. 1, 2024

In this analysis, we argue against seeing health system resilience as an inherently positive concept. The rise in the popularity of has led to its increasingly normative framing. We question widely accepted perspective by examining underlying assumptions associated with framing 'good' resilience. Our focus is on risks accepting assumption, which can lead us ignore social nature systems and overlook consequences change if seen a positive, achievable objective. Finally, suggest that concept be detrimental policy research, encourage critical rethinking these so maintain resilience's usefulness for systems.

Язык: Английский

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The effectiveness of rural community health workers in improving health outcomes during the COVID-19 pandemic: a systematic review

Global Health Action, Год журнала: 2024, Номер 17(1)

Опубликована: Янв. 5, 2024

Background Rural community health workers [CHWs] play a critical role in improving outcomes during non-pandemic times, but evidence on their effectiveness the COVID-19 pandemic is limited. There need to focus rural CHWs and systems as they have limited material human resources rendering them more vulnerable than urban severe disruptions pandemics.

Язык: Английский

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Mobilisation towards formal employment in the healthcare system: A qualitative study of community health workers in South Africa

PLOS Global Public Health, Год журнала: 2024, Номер 4(3), С. e0002226 - e0002226

Опубликована: Март 20, 2024

In low and middle-income countries, community health workers (CHWs) play a critical role in delivering primary healthcare (PHC) services. However, they often receive stipends, function without resources have little bargaining power with which to demand better working conditions. Using qualitative case study methodology, we studied CHWs’ conditions of employment, their struggle for recognition as workers, activities establish labour representation South Africa. Seven CHW teams located semi-urban rural areas Gauteng Mpumalanga Provinces were studied. We conducted 43 in-depth interviews, 10 focus groups 6 observations gather data from CHWs representatives, supervisors PHC facility staff. The was analysed using thematic analysis method. the sites, poorly resourced received meagre remuneration, employment outsourced, benefits protection. As result these challenges, sites established task team represent them. They held meetings caused disruptions facilities. After numerous unsuccessful attempts negotiate improved joined union order participate local Bargaining Council. Though not successful getting government provide permanent negotiated an increase stipend. ended, during height COVID-19 2020, when need motivated effective became more apparent decision makers, semi-urban-based remuneration. protests raised awareness plight CHWs, joining formal enabled them modest salary increase. it emergency created by world-wide pandemic that forced decision-makers acknowledge reliance on this community-based cadre.

Язык: Английский

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Exploring the motivations of female community health volunteers in primary healthcare provision in rural Nepal: A qualitative study

PLOS Global Public Health, Год журнала: 2024, Номер 4(8), С. e0003428 - e0003428

Опубликована: Авг. 1, 2024

Motivating Community Health Workers (CHWs)—many of whom are volunteers—is crucial for achieving Universal Healthcare Coverage (UHC) Primary (PHC) in resource-poor areas. In rural Nepal, PHC is mostly delivered by female CHWs, locally known as Female Volunteers (FCHVs), but little about them. This paper explores experiential factors influencing FCHVs’ motivations, including how motivation intersects with women’s livelihoods and consider what this means Nepal globally. We conducted qualitative research the hill Terai (flatland bordering India) areas Nepal. Data were purposively collected through 31 semi-structured interviews (20 volunteers, 11 paid local health workers) three focus group discussions additional 15 volunteers. All audio-recorded, transcribed verbatim Nepali translated into English. coded using NVivo10, analysed thematically at individual, organisational community levels. motivations to volunteer was affected several ways. At individual level, participants wanted committed voluntary work, yet opportunity costs volunteering, out-of-pocket expenditure inadequate family support strained many women who already overburdened. perceived lack appreciation efforts members, saw volunteers workers, undermined FCHVs volunteer. Finally, organizational a bureaucratic emphasis on recording reporting, respect from workers their work. Our illustrates some poorest backgrounds can be highly motivated volunteer, social economic across levels motivation, security livelihoods, thus wider achieve PHC. Financial investments needed compensate FCHVs, so that they remain deliver global goals

Язык: Английский

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Expanding Community Health Worker decision space: learning from a Participatory Action Research training intervention in a rural South African district

Human Resources for Health, Год журнала: 2023, Номер 21(1)

Опубликована: Авг. 18, 2023

While integral to decentralising health reforms, Community Health Workers (CHWs) in South Africa experience many challenges. During COVID-19, CHW roles changed rapidly, shifting from communities clinics. In the contexts of new and re-engineered primary healthcare (PHC), objectives were to: (a) implement a training intervention support local decision-making capability CHWs; (b) assess learning impacts perspectives CHWs.CHWs three rural villages (n = 9) trained rapid Participatory Action Research (PAR) with peers community stakeholders 33). Training equipped CHWs tools techniques convene groups, raise and/or respond concerns, understand concerns different perspectives, facilitate action public services. CHWs' before after gained through semi-structured interviews. Data collected analysed using decision space framework actors' power affect devolved decision-making.CHWs demonstrated significant resilience commitment face COVID-19. They experienced multiple, intersecting challenges including: limited financial, logistical systems support, poor role clarity, precarious employment, low no pay, unstable organisational capacity, fragile accountability mechanisms belittling treatment Together, these restricted seen reflect valuing cadre system. saw as welcome opportunity assert themselves recognised cadre. Regular, spaces for dialogue mutual supported gain skills rework their agency more empowered ways. The improved management capabilities dialogue, which expanded strengthened mobilisation, facilitation analysis skills. Development speaking was especially valued. reported an overall 'tripe-benefit' training: community-acceptance; peer support; recognition by recommended scale-up authority implementation strategy PHC.Lack is coupled opportunities communication trust-building. find amplify voices strategic partnerships, helped build functionality decision-making.

Язык: Английский

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Challenges faced by community health volunteers in offering sexual and reproductive health care services to young women during the COVID-19 pandemic in Khwisero and Nairobi in Kenya

Frontiers in Reproductive Health, Год журнала: 2025, Номер 6

Опубликована: Янв. 7, 2025

Community health volunteers (CHVs) are fundamental in many systems across the globe. In Kenya, CHVs were essential providing sexual and reproductive (SRH) services during COVID-19 pandemic. The study highlights challenges experienced by community Kenya while SRH utilized a qualitative research design to explore offering Dagoretti North South sub-counties Nairobi Khwisero sub-county western pandemic period. We conducted 17 in-depth interviews, 7 focus group discussions, 1 discussion with CHVs. data was collected different periods: Khwisero, November 2022-August 2023, Nairobi, February-April 2023. study's findings show that several services. included distrust as result of interaction between anti-COVID-19 measures other past present interventions such vaccines for diseases, insufficient personal protective gear equipment (PPEs), limited human financial resources address needs, poor training on response misinformation led vaccine hesitancy, mental strain from stigma burnout. During pandemics, governments should provide adequate CHVs' work they deliver under risky conditions. addition, must be trained about relevant medical epidemics pandemics provided psychosocial support mitigate impact psychological distress.

Язык: Английский

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You are just like them: The paradoxical position of Nairobi's community health promoters, a photovoice study

SSM - Health Systems, Год журнала: 2025, Номер unknown, С. 100068 - 100068

Опубликована: Март 1, 2025

Язык: Английский

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Strategies to maintain health service provision during the COVID-19 pandemic in refugee settings in Jordan and Uganda

PLOS Global Public Health, Год журнала: 2025, Номер 5(5), С. e0004484 - e0004484

Опубликована: Май 8, 2025

Health system adaptations were rapidly introduced at the start of COVID-19 pandemic to protect public and maintain access health services. Given specific vulnerabilities forced displacement settings, understanding which used, how they implemented, their success, challenges is important for preparedness response efforts. In this paper, we characterize in service delivery implemented by Ministries Health, UN Refugee Agency, partners services provision refugees Jordan Uganda. We conducted 21 key informant interviews with managerial operational staff across 12 organizations who delivered healthcare Uganda during applied a framework analysis characterized. The results are presented WHO building blocks. Most focused on specifically procedures screening isolation community, community support, facility-level infection prevention measures. not only ensuring capacity patients but adapting mechanisms support those needing regular care. Many worked tandem others as packages achieve this. Workforce included task shifting staffing surges. Modifications related medical products, vaccines, technologies procurement, medication management, supporting vaccine strategies, testing capacity. Adaptations leadership governance, financial information systems identified mainly described essential enablers other adaptations. Key successful adaptation context integration National systems, strong relationships between supportive environment adaptation, existing plans financing. This study highlights scale, scope diversity innovative pandemic.

Язык: Английский

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Community Health Workers Research: Where Are We Now? A Narrative Review of an Expanding Workforce for Mental Health

Harvard Review of Psychiatry, Год журнала: 2025, Номер 33(3), С. 103 - 113

Опубликована: Май 1, 2025

Abstract In an evolving health care landscape, community workers (CHWs) have emerged as invaluable assets, bridging gaps to mental service access and fostering resilience. this article, we explore the multifaceted responsibilities shouldered by CHWs, encompassing outreach, education, support, underscore their unique abilities establish trust within diverse communities. We also highlight recognition of CHWs integral team members examine growing body evidence on CHW effectiveness in enhancing outcomes, reducing disparities, promoting preventative measures. Additionally, review how, wake COVID-19 pandemic, role has shifted with increased demand for services landscape. The pandemic laid bare vulnerabilities existing structures, disproportionately affecting communities limited resource access, including support. Furthermore, six primary research domains that could potentially help expand workforce: standardization training, sustainability retention, integration into systems, impact measurement, cost-effectiveness financing, scaling up adaptation. Last, pandemic’s transformative effects CHWs; shed light resilience adaptability face unprecedented challenges heightened relevance response paradigm post-COVID.

Язык: Английский

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A scoping review of the roles, challenges, and strategies for enhancing the performance of community health workers in the response against COVID-19 in low- and middle-income countries

BMC Primary Care, Год журнала: 2025, Номер 26(1)

Опубликована: Май 14, 2025

Язык: Английский

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