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Global Health: Science and Practice

Dedicated to what works in global health programs

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Table of Contents

March 2021 | Volume 9 | Number Supplement 1

Communities as the Cornerstone of Primary Health Care: Learning, Policy, and Practice

EDITORIALS

  • Open Access
    Strength in Diversity: Integrating Community in Primary Health Care to Advance Universal Health Coverage
    Charlotte E. Warren, Ben Bellows, Rachel Marcus, Jordan Downey, Sarah Kennedy and Nazo Kureshy
    Global Health: Science and Practice March 2021, 9(Supplement 1):S1-S5; https://doi.org/10.9745/GHSP-D-21-00125

    The supplement highlights a systems approach that recognizes the communities' roles and their interactions with other health system actors to accelerate outcomes and reflect the diversity of the community health ecosystem. Several cross-cutting priorities emerge from the articles, namely coverage, community health financing, policy change, institutionalization, resilience, accountability, community engagement, and whole-of-society efforts.

VIEWPOINTS

  • Open Access
    The Untold Story of Community Mobilizers Re-engaging a Disengaged Community During the Endemic Era of India's Polio Eradication Program
    Roma Solomon
    Global Health: Science and Practice March 2021, 9(Supplement 1):S6-S8; https://doi.org/10.9745/GHSP-D-20-00425

    Although India's polio eradication program began with a flourish in 1995, gradually, the community disengaged from the program as misinformation about the vaccine spread. Vaccination teams faced abuse and even physical aggression. What caused this break in communication? CORE Group Polio Project's mobilizers had to delve deep to uncover untold stories of why communities were disengaged from the government's polio eradication efforts.

COMMENTARIES

  • Open Access
    Mind the Global Community Health Funding Gap
    Angela Gichaga, Lizah Masis, Amit Chandra, Dan Palazuelos and Nelly Wakaba
    Global Health: Science and Practice March 2021, 9(Supplement 1):S9-S17; https://doi.org/10.9745/GHSP-D-20-00517

    Community health workers play a critical role in providing both essential health services and pandemic response. Community health demonstrates a strong return on investment, but funding for this sector is limited and fragmented. Understanding the underlying costs of a community health system is crucial for both planning and policy; the data demonstrate a strong investment case.

  • Open Access
    Liberia's Community Health Assistant Program: Scale, Quality, and Resilience
    Jessica Healey, S. Olasford Wiah, Jannie M. Horace, Dianah B. Majekodunmi and Derry S. Duokie
    Global Health: Science and Practice March 2021, 9(Supplement 1):S18-S24; https://doi.org/10.9745/GHSP-D-20-00509

    Liberia's community health program went from concept to nationwide scale in 4 years due to the Liberian Government's vision and its partnership with implementing organizations and donors. The next community health policy will tackle the unfinished agenda related to quality, resilience, and sustainability. Liberia's experience offers valuable lessons for innovating, and institutionalizing a compensated, effective cadre of community health assistants.

  • Open Access
    Institutionalizing Community Health Services in Kenya: A Policy and Practice Journey
    Salim Hussein, Lilian Otiso, Maureen Kimani, Agatha Olago, John Wanyungu, Daniel Kavoo, Rose Njiraini, Sila Kimanzi and Robinson Karuga
    Global Health: Science and Practice March 2021, 9(Supplement 1):S25-S31; https://doi.org/10.9745/GHSP-D-20-00430

    The process of institutionalizing community health services in Kenya required strong leadership by the Ministry of Health, effective coordination and support of stakeholders, and alignment of community health with the political priorities at the national and decentralized government levels to facilitate adequate prioritization and financing of the community health strategy.

ORIGINAL ARTICLES

  • Open Access
    The Community Health Systems Reform Cycle: Strengthening the Integration of Community Health Worker Programs Through an Institutional Reform Perspective
    Nan Chen, Mallika Raghavan, Joshua Albert, Abigail McDaniel, Lilian Otiso, Richard Kintu, Melissa West and David Jacobstein
    Global Health: Science and Practice March 2021, 9(Supplement 1):S32-S46; https://doi.org/10.9745/GHSP-D-20-00429

    Efforts to scale community health worker programs within primary health care systems in 7 countries illustrated that these efforts are best understood as a complex process of institutional reform. Successful scale up depends on a problem-driven political process; requires that models develop solutions that align with resources, capabilities, and commitments of key stakeholders; and emerges from iterative cycles of learning and improvement.

  • Open Access
    Galvanizing Action on Primary Health Care: Analyzing Bottlenecks and Strategies to Strengthen Community Health Systems in West and Central Africa
    Aline Simen-Kapeu, Maria Eleanor Reserva and Rene Ehounou Ekpini
    Global Health: Science and Practice March 2021, 9(Supplement 1):S47-S64; https://doi.org/10.9745/GHSP-D-20-00377

    In West and Central Africa, “leaving no one behind” requires strengthening community health systems by increasing health financing, improving supply chain system, and fostering community ownership and partnerships in all settings. Countries with high child mortality rates should improve service delivery through better integration. Galvanizing context-specific country actions is fundamental to improve primary health care services and move toward universal health coverage.

  • Open Access
    Applying the Community Health Worker Coverage and Capacity Tool for Time-Use Modeling for Program Planning in Rwanda and Zanzibar
    Melanie Morrow, Eric Sarriot, Allyson R. Nelson, Felix Sayinzoga, Beatrice Mukamana, Evariste Kayitare, Halima Khamis, Omar Abdalla and William Winfrey
    Global Health: Science and Practice March 2021, 9(Supplement 1):S65-S78; https://doi.org/10.9745/GHSP-D-20-00324

    The C3 Tool supports community health worker (CHW) program planning by making tradeoffs apparent between human resources and the services to be provided at varying levels of population coverage. Governments in Rwanda and Zanzibar used the tool, respectively, to optimize CHW time allocation and to estimate how many CHWs were needed to meet universal health coverage goals.

  • Open Access
    Community Health Worker Program Sustainability in Africa: Evidence From Costing, Financing, and Geospatial Analyses in Mali
    Patrick Pascal Saint-Firmin, Birama Diakite, Kevin Ward, Mitto Benard, Sara Stratton, Christine Ortiz, Arin Dutta and Seydou Traore
    Global Health: Science and Practice March 2021, 9(Supplement 1):S79-S97; https://doi.org/10.9745/GHSP-D-20-00404

    Understanding specific program costs through efficiency analyses and geospatial targeting allows national stakeholders to make strategic, targeted investments, making the first steps toward sustainability. Costs required for community health worker programs can be reduced without sacrificing quality, and spending can be geographically targeted to optimize service use by rural populations. Results from Mali provide an example for other sub-Saharan African countries.

  • Open Access
    Evaluating Vertical Malaria Community Health Worker Programs as Malaria Declines: Learning From Program Evaluations in Honduras and Lao PDR
    Harriet G. Napier, Madeline Baird, Evelyn Wong, Eliza Walwyn-Jones, Manuel Espinoza Garcia, Lizeth Cartagena, Nontokozo Mngadi, Viengxay Vanisaveth, Viengphone Sengsavath, Phoutnalong Vilay, Kenesay Thongpiou, Theodoor Visser and Justin M. Cohen
    Global Health: Science and Practice March 2021, 9(Supplement 1):S98-S110; https://doi.org/10.9745/GHSP-D-20-00379

    Community case management by community health workers has substantially reduced malaria across the Greater Mekong Subregion and Central America. To sustain current and achieve further reductions in malaria, surveillance and delivery platforms must be redesigned to ensure their continued use by key populations.

  • Open Access
    Measuring Knowledge of Community Health Workers at the Last Mile in Liberia: Feasibility and Results of Clinical Vignette Assessments
    Jordan Downey, Anne H. McKenna, Savior Flomo Mendin, Ami Waters, Nelson Dunbar, Lekilay G. Tehmeh, Emily E. White, Mark J. Siedner, Raj Panjabi, John D. Kraemer, Avi Kenny, E. John Ly, Jennifer Bass, Kuang-Ning Huang, M. Shoaib Khan, Nathan Uchtmann, Anup Agarwal and Lisa R. Hirschhorn
    Global Health: Science and Practice March 2021, 9(Supplement 1):S111-S121; https://doi.org/10.9745/GHSP-D-20-00380

    We integrated clinical vignettes into routine programmatic supervision to assess community health worker knowledge of integrated community case management in rural Liberia. Results included higher rates of correct diagnosis and lifesaving treatment for uncomplicated disease than for more severe cases, with accurate recognition of danger signs posing a challenge.

  • Open Access
    Implementation of a Community Transport Strategy to Reduce Delays in Seeking Obstetric Care in Rural Mozambique
    Felizarda Amosse, Helena Boene, Mai-Lei Woo Kinshella, Sharla Drebit, Sumedha Sharma, Prestige Tatenda Makanga, Anifa Valá, Laura A. Magee, Peter von Dadelszen, Marianne Vidler, Esperança Sevene, Khátia Munguambe and the Community Level Interventions for Pre-eclampsia (CLIP) Working Group
    Global Health: Science and Practice March 2021, 9(Supplement 1):S122-S136; https://doi.org/10.9745/GHSP-D-20-00511

    Encouraging local transport programs and transport infrastructure in poorly-resourced communities can help improve community access and strengthen engagement with health systems. Mobilizing community resources and leadership to implement a community-based transport scheme in rural Mozambique to support referrals to health facilities can help improve maternal and child health outcomes.

  • Open Access
    Volunteer Community Health and Agriculture Workers Help Reduce Childhood Malnutrition in Tajikistan
    Roman Yorick, Faridun Khudonazarov, Andrew J. Gall, Karah Fazekas Pedersen and Jennifer Wesson
    Global Health: Science and Practice March 2021, 9(Supplement 1):S137-S150; https://doi.org/10.9745/GHSP-D-20-00325

    Paired agricultural and health interventions led by volunteer community health workers and community agricultural workers through home visits, community events, and peer support groups proved successful in improving nutrition of children and may be applicable in other contexts.

METHODOLOGIES

  • Open Access
    Using Human-Centered Design to Adapt Supply Chains and Digital Solutions for Community Health Volunteers in Nomadic Communities of Northern Kenya
    Sarah R. Andersson, Sarah Hassanen, Amos M. Momanyi, Danielson K. Onyango, Daniel K. Gatwechi, Mercy N. Lutukai, Karen O. Aura, Alex M. Mungai and Yasmin K. Chandani
    Global Health: Science and Practice March 2021, 9(Supplement 1):S151-S167; https://doi.org/10.9745/GHSP-D-20-00378

    Investing the time and effort to use human-centered design (HCD) approaches is beneficial to designing supply chains and digital solutions for complex sociocultural settings. HCD enables users to be engaged in cocreating solutions that address their challenges, are appropriate for their context and capacity, and build local ownership.

FIELD ACTION REPORTS

  • Open Access
    Early Lessons From Launching an Innovative Community Health Household Model Across 3 Country Contexts
    Daniel Palazuelos, Lassana M. Jabateh, Miry Choi, Ariwame Jimenez, Matthew Hing, Mariano Matias Iberico, Basimenye Nhlema and Emily Wroe
    Global Health: Science and Practice March 2021, 9(Supplement 1):S168-S178; https://doi.org/10.9745/GHSP-D-20-00405

    Community health worker programs can contribute substantively to health systems working to implement universal health coverage, but there is no one-size-fits-all model. Program leaders should anticipate needing to adapt their plans as local realities demand, but lessons learned in other contexts can provide guidance on how to best proceed.

  • Open Access
    Learnings From a Pilot Study to Strengthen Primary Health Care Services: The Community-Clinic-Centered Health Service Model in Barishal District, Bangladesh
    Md. Eklas Uddin, Joby George, Shamim Jahan, Zubair Shams, Nazmul Haque and Henry B. Perry
    Global Health: Science and Practice March 2021, 9(Supplement 1):S179-S189; https://doi.org/10.9745/GHSP-D-20-00466

    The community-clinic-centered health service model piloted in Bangladesh strengthened community and local government engagement, harmonized the work of different community health worker cadres, and improved client satisfaction. The approach has the potential to strengthen the delivery of close-to-community primary health care services and accelerate progress toward achieving universal health coverage.

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In this issue

Global Health: Science and Practice: 9 (Supplement 1)
Global Health: Science and Practice
Vol. 9, No. Supplement 1
March 15, 2021
  • Table of Contents
  • About the Cover
  • Index by Author
  • Complete Issue (PDF)

Issue highlights

  • Strength in Diversity: Integrating Community in Primary Health Care to Advance Universal Health Coverage
  • The Untold Story of Community Mobilizers Re-engaging a Disengaged Community During the Endemic Era of India's Polio Eradication Program
  • Mind the Global Community Health Funding Gap
  • Liberia's Community Health Assistant Program: Scale, Quality, and Resilience
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Uptake and Short-Term Retention in HIV Treatment Among Men in South Africa: The Coach Mpilo Pilot Project
What Distinguishes Women Who Choose to Self-Inject? A Prospective Cohort Study of Subcutaneous Depot Medroxyprogesterone Acetate Users in Ghana
COVID-19 Partners Platform—Accelerating Response by Coordinating Plans, Needs, and Contributions During Public Health Emergencies: COVID-19 Vaccines Use Case
Beyond Institutionalization: Planning for Sustained Investments in Training, Supervision, and Support of Community Health Worker Programs in Bangladesh
Global Research Priorities for Understanding and Improving Respectful Care for Newborns: A Modified Delphi Study
US AIDJohns Hopkins Center for Communication ProgramsUniversity of Alberta

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