Latest Articles
- Factors Associated With Community Health Worker Performance Differ by Task in a Multi-Tasked Setting in Rural Zimbabwe
Programs should consider specific tasks and how they relate to health worker factors, community support, and the work context. In a setting where community health workers were responsible for multiple tasks, those who referred more pregnant women were female, unmarried, under 40 years old, and from larger households, and they felt they had adequate work resources and positive feedback from supervisors and the community. In contrast, workers with high scores on delivering household behavior change lessons were from smaller households and received more supportive supervision.
- Enhancing the Supervision of Community Health Workers With WhatsApp Mobile Messaging: Qualitative Findings From 2 Low-Resource Settings in Kenya
CHWs used WhatsApp with their supervisors to document their work, spurring healthy competition and team building between CHWs in the 2 pilot sites. While there was considerable variation in the number of times each participant posted messages—from 1 message to 270 messages—in total they posted nearly 2,000 messages over 6 months. 88% of messages corresponded to at least 1 of 3 defined supervisory objectives of (1) creating a social environment, (2) sharing communication and information, or (3) promoting quality of services.
- Investing in Family Planning: Key to Achieving the Sustainable Development Goals
Voluntary family planning brings transformational benefits to women, families, communities, and countries. Investing in family planning is a development “best buy” that can accelerate achievement across the 5 Sustainable Development Goal themes of People, Planet, Prosperity, Peace, and Partnership.
- Family Planning Counseling in Your Pocket: A Mobile Job Aid for Community Health Workers in Tanzania
Using mobile job aids can help CHWs deliver integrated counseling on family planning and HIV/STI screening by following a step-by-step service delivery algorithm. Lessons learned during the pilot led to the development of additional features during scale-up to exploit the other major advantages that mHealth offers including:
Better supervision of health workers and accountability for their performance
Improved communication between supervisors and workers
Access to real-time data and reports to support quality improvement
- mHealth for Tuberculosis Treatment Adherence: A Framework to Guide Ethical Planning, Implementation, and Evaluation
Promising mHealth approaches for TB treatment adherence include:
Video observation
Patient- or device-facilitated indirect monitoring
Direct monitoring through embedded sensors or metabolite testing
To mitigate ethical concerns, our framework considers accuracy of monitoring technologies, stigmatization and intrusiveness of the technologies, use of incentives, and the balance of individual and public good.
- School Distribution as Keep-Up Strategy to Maintain Universal Coverage of Long-Lasting Insecticidal Nets: Implementation and Results of a Program in Southern Tanzania
A school-based net distribution program, piloted in the Southern Zone of Tanzania to sustain ≥80% universal net coverage previously attained through mass campaigns, successfully issued nets to nearly all eligible students and teachers. Keys to success included:
Effective collaboration between the Ministry of Health, local government, and implementing partners
Social mobilization to sensitize the community about the importance of net use
Development of a mobile application to facilitate data collection and analysis
- Leading With LARCs in Nigeria: The Stars Are Aligned to Expand Effective Family Planning Services Decisively
Despite years of family planning effort in Nigeria, the modern contraceptive prevalence (mCPR) has reached only 10%. Yet a few recent seminal, well-executed programs have been outstandingly successful providing long-acting reversible contraceptives (LARCs)—both in the public and private sector, and in the North and South. Remarkably, the LARCs they provided were equivalent to 2% mCPR in 2015 alone.
Accordingly, we advocate markedly increased support for: (1) private-sector approaches such as social franchising, particularly in the South, (2) mobile outreach, and (3) support to public clinical facilities, including expanding access through community health extension workers (CHEWs), particularly in the North. Success will require system support, quality, and concerted engagement from a variety of partners including the Government of Nigeria.
Without significant progress in Nigeria, the global FP2020 goal appears unattainable. Fortunately, leading with LARCs along with wide choice of other methods provides a clear avenue for success.
- Handwashing With a Water-Efficient Tap and Low-Cost Foaming Soap: The Povu Poa “Cool Foam” System in Kenya
The new handwashing system, designed with end user input, features an economical foaming soap dispenser and a hygienic, water-efficient tap for use in household and institutional settings that lack reliable access to piped water. Cost of the soap and water needed for use is less than US$0.10 per 100 handwash uses, compared with US$0.20–$0.44 for conventional handwashing stations used in Kenya.
- Feasibility and Effectiveness of mHealth for Mobilizing Households for Indoor Residual Spraying to Prevent Malaria: A Case Study in Mali
Sending voice and/or text messages to mobilize households for spraying was more costly per structure and less effective at preparing structures than traditional door-to-door mobilization approaches supplemented with radio and town hall announcements. Challenges included:
Lack of familiarity with mobile phones and with public health mobile messaging
Lack of face-to-face communication with mobilizers, making it easier to ignore mobilization messages and preventing trust-building
Low literacy levels
Gender differentials in access to mobile phones