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Community health workers are essential to front-line health outreach throughout low-income and middle-income countries, including programming for early childhood immunisation. Understanding how community health workers are engaged for successful early childhood vaccination among countries who showed success in immunisation coverage would support evidence-based policy guidance across contexts.
We employed a multiple case study design using qualitative research methods.
We conducted research in Nepal, Senegal and Zambia.
We conducted 207 interviews and 71 focus group discussions with 678 participants at the national, regional, district, health facility and community levels of the health systems of Nepal, Senegal and Zambia, from October 2019 to April 2021. We used thematic analysis to investigate contributing factors of community health worker programming that supported early childhood immunisation within each country and across contexts.
Implementation of vaccination programming relied principally on the (1) organisation, (2) motivation and (3) trust of community health workers. Organisation was accomplished by expanding cadres of community health workers to carry out their roles and responsibilities related to vaccination. Motivation was supported by intrinsic and extrinsic incentives. Trust was expressed by communities due to community health worker respect and value placed on their work.
Improvements in immunisation coverage was facilitated by community health worker organisation, motivation and trust. With the continued projection of health worker shortages, especially in low-income countries, community health workers bridged the equity gap in access to vaccination services by enabling wider reach to underserved populations. Although improvements in vaccination programming were seen in all three countries—including government commitment to addressing human resource deficits, training and remuneration; workload, inconsistency in compensation, training duration and scope, and supervision remain major challenges to immunisation programming. Health decision-makers should consider organisation, motivation and trust of community health workers to improve the implementation of immunisation programming.
by Mahbubur Rahman, Mahbub-Ul Alam, Sharmin Khan Luies, Sharika Ferdous, Zahidul Mamun, Musarrat Jabeen Rahman, Debashish Biswas, Tazrina Ananya, Asadullah, Abul Kamal, Ritthick Chowdhury, Eheteshamul Russel Khan, Dara Johnston, Martin Worth, Umme Farwa Daisy, Tanvir Ahmed
BackgroundThe influx of Forcibly Displaced Myanmar Nationals (FDMNs) has left the Southwest coastal district of Cox’s Bazar with one of the greatest contemporary humanitarian crises, stressing the existing water, sanitation, and hygiene (WASH) resources and services. This study aimed to assess the existing capacity of local institutions involved in delivering WASH services and identify relevant recommendations for intervention strategies.
MethodsWe used a qualitative approach, including interviews and capacity assessment workshops with institutions engaged in WASH service delivery. We conducted five key informant interviews (KII) with sub-district level officials of the Department of Public Health Engineering (DPHE), Directorate General of Health Services (DGHS), Directorate of Primary Education (DPE) and Bangladesh Rural Advancement Committee (BRAC) to have a general idea of WASH service mechanisms. Seven capacity assessment workshops were organized with the relevant district and sub-district level stakeholders from August 2019 to September 2019. These workshops followed three key areas: i) knowledge of policy, organizational strategy, guidelines, and framework; ii) institutional arrangements for service delivery such as planning, implementation, coordination, monitoring, and reporting; and iii) availability and management of human, financial and infrastructural resources. Data were categorized using thematic content analysis.
ResultsThe majority of stakeholders lacked awareness of national WASH policies. Furthermore, the top-down planning approaches resulted in activities that were not context-specific, and lack of coordination between multiple institutions compromised the optimal WASH service delivery at the local level. Shortage of human resources in delivering sustainable WASH services, inadequate supervision, and inadequate evaluation of activities also required further improvement, as identified by WASH stakeholders.
ConclusionResearch evidence suggests that decision-makers, donors, and development partners should consider learning from the WASH implementers and stakeholders about their existing capacity, gaps, and opportunities before planning for any WASH intervention in any particular area.
Objetivo principal: Comprender la experiencia en la atención del parto respetado de una mujer atendida en una unidad de partería profesional. Metodología: Estudio cualitativo fenomenológico llevado a cabo en una usuaria con control de embarazo casi exclusivo en la Unidad de Partería seleccionada a conveniencia. Se realizaron entrevistas en profundidad y análisis de contenido. Resultados principales: Surgieron las siguientes categorías que dan sentido a la experiencia de parir: 1) parir con amor, 2) la partera como vía del empoderamiento de la mujer y su familia e 3) Interculturalidad-respeto a las tradiciones. Conclusión principal: El análisis de las categorías muestra que el parto respetado es una vivencia única, personalizada, con resultados positivos tanto para la madre y el recién nacido como para los familiares.
Objetivo: Determinar la prevalencia del catéter venoso periférico y conocer si su elección es adecuada en función del tratamiento. Metodología: Estudio observacional transversal realizado en la Unidad de Medicina Interna de un hospital de tercer nivel. Análisis descriptivo e inferencial mediante explotación de datos de forma pseudoanonimizada y retrospectiva. Resultados: El 96,6% de pacientes fueron portadores de catéteres venosos periféricos con una media de días de catéter de 3, 62. Los motivos de retirada más frecuentes fueron la extravasación (51,4%), el fin de tratamiento (16,2%) y la flebitis (12,8%). El tratamiento endovenoso fue superior a 6 días en un 40,4% de los pacientes y considerado vesicante y/o irritante en un 56,4%. Conclusiones: Existe un sobre uso del catéter venoso periférico, resultando primordial el diseño e implementación de estrategias con enfoque multidisciplinar que favorezcan una adecuada elección y manejo de los accesos vasculares.
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