Search

BackgroundMobile health (mHealth) technologies provide many potential benefits to the delivery of health care. Medical decision support tools have shown particular promise in improving quality of care and provider workflow. Frontline health workers such as Community Health Workers (CHWs) have been shown to be effective in extending the reach of care, yet only a few medicine dosing tools are available to them. ObjectiveWe developed an mHealth medicine dosing tool tailored to the skill level of CHWs to assist in the delivery of care. The mHealth tool was created for CHWs with primary school education working in rural Mexico and Guatemala. Perceptions and impressions of this tool were collected and compared to an existing paper-based medicine dosing tool. MethodsSeventeen Partners In Health CHWs in rural Mexico and Guatemala completed a one-day training in the mHealth medicine dosing tool. Following the training, a prescription dosing test was administered, and CHWs were given the choice to use the mHealth or paper-based tool to answer 7 questions. Subsequently, demographic and qualitative data was collected using a questionnaire and an in-person interview conducted in Spanish, then translated into English. The qualitative questions captured data on 4 categories: comfort, acceptability, preference, and accuracy. Qualitative responses were analyzed for major themes and quantitative variables were analyzed using SAS. Results82% of the 17 CHWs chose the mHealth tool for at least 1 of 7 questions compared to 53% (9/17) who chose to use the paper-based tool. 93% (13/14) rated the phone as being easy or very easy to use, and 56% (5/9) who used the paper-based tool rated it as easy or very easy. Dosing accuracy was generally higher among questions answered using the mHealth tool relative to questions answered using the paper-based tool. Analysis of major qualitative themes indicated that the mHealth tool was perceived as being quick, easy to use, and as having complete information. The mHealth tool was seen as an acceptable dosing tool to use and as a way for CHWs to gain credibility within the community. ConclusionsA tailored cell phone-based mHealth medicine dosing tool was found to be useful and acceptable by CHWs in rural Mexico and Guatemala. The streamlined workflow of the mHealth tool and benefits such as the speed and self-lighting were found to be particularly useful features. Well designed and positioned tools such as this may improve effective task shifting by reinforcing the tasks that different cadres of workers are asked to perform. Further studies can explore how to best implement this mHealth tool in real-world settings, including how to incorporate the best elements of the paper-based tool that were also found to be helpful.

Sexually Transmitted Infections (STIs) are a critical global health concern, with low- and middle-income countries carrying the highest burden. The development of rapid point-of-care STI tests has enabled screening in settings without laboratory access. Yet, high-need settings face unique challenges that may influence the implementation and uptake of STI screening. This piece discusses lessons learned from the implementation of STI screening in a rural, low-resource setting in Chiapas, Mexico. Despite minimal privacy and a low staff-to-patient ratio, a streamlined approach was developed to destigmatize and maximize STI screening. The clinic team developed strategies through practice, including incorporating screening into triage procedures and offering screening to family members. This protocol led to an average screening rate of 37% within three months and acceptance of screening by family units. It was observed that access to treatment was necessary to alleviate patient hesitation to screening due to fears of a positive result. As STI screening increases globally, healthcare systems must develop robust access to treatment to effectively prevent and treat STIs worldwide. [ABSTRACT FROM AUTHOR]

Objective To estimate the level and trend of development assistance for community health worker-related projects in low- and middle-income countries between 2007 and 2017. Methods We extracted data from the Organisation for Economic Co-operation and Development's creditor reporting system on aid funding for projects to support community health workers (CHWs) in 114 countries over 2007-2017. We produced estimates for projects specifically described by relevant keywords and for projects which could include components on CHWs. We analysed the pattern of development assistance by purpose, donors, recipient regions and countries, and trends over time. Findings Between 2007 and 2017, total development assistance targeting CHW projects was around United States dollars (US$) 5 298.02 million, accounting for 2.5% of the US$ 209 277.99 million total development assistance for health. The top three donors (Global Fund to Fight AIDS, Tuberculosis and Malaria, the government of Canada and the government of the United States of America) provided a total of US$ 4 350.08 million (82.1%) of development assistance for these projects. Sub- Saharan Africa received a total US$ 3 717.93 million, the largest per capita assistance over 11 years (US$ 0.39; total population: 9 426.25 million). Development assistance to projects that focused on infectious diseases and child and maternal health received most funds during the study period. Conclusion The share of development assistance invested in the CHW projects was small, unstable and decreasing in recent years. More research is needed on tracking government investments in CHW-related projects and assessing the impact of investments on programme effectiveness. Objectif Estimer le montant et revolution de l'aide au developpement portant sur des projets relatifs aux agents de sante communautaires dans les pays a revenu faible et intermediate, entre 2007 et 2017. Methodes Nous avons extrait des donnees du Systeme de notification des pays creanciers de l'Organisation de cooperation et de developpement economiques concernant le financement de l'aide apportee a des projets axes sur les agents de sante communautaires dans 114 pays, de 2007 a 2017. Nous avons obtenu des estimations pour les projets specifiquement decrits par certains mots cles et pour les projets dont certaines parties pouvaient concerner les agents de sante communautaires. Nous avons analyse les tendances de l'aide au developpement par objectif, donateurs, regions et pays destinataires, ainsi que son evolution dans le temps. Resultats Entre 2007 et 2017, le total de l'aide au developpement versee a des projets portant sur les agents de sante communautaires s'est eleve a environ 5298,02 millions de dollars des Etats-Unis ($ US), soit 2,5% des 209 277,99 millions de $ US d'aide au developpement totale allouee a la sante. Les trois principaux donateurs (Fonds mondial de lutte contre le sida, la tuberculose et le paludisme, gouvernement du Canada et gouvernement des Etats-Unis d'Amerique) ont verse un total de 4350,08 millions de $ US (82,1%) d'aide au developpement pour ces projets. LAfrique subsaharienne a requ un total de 3717,93 millions de $ US, soit l'aide par habitant la plus importante sur les 11 annees (0,39 $ US; population totale: 9426,25 millions). Durant la periode examinee, la majorite des fonds alloues a l'aide au developpement etaient destines a des projets portant sur les maladies infectieuses et la sante maternelle et infantile. Conclusion La part de l'aide au developpement investie dans des projets axes sur les agents de sante communautaires etait faible, irreguliere et en baisse ces dernieres annees. De plus amples recherches sont necessaires pour suivre les investissements du gouvernement dans des projets concernant les agents de sante communautaires et evaluer l'impact de ces investissements sur l'efficacite des programmes. Objetivo Estimar el nivel y la tendencia de la asistencia para el desarrollo destinada a proyectos relacionados con los trabajadores de salud de la comunidad en paises de bajos y medianos ingresos entre 2007 y 2017. Metodos Se extrajeron datos del sistema de informacion de acreedores de la Organizacion para la Cooperacion y el Desarrollo Economicos sobre la financiacion de la ayuda para proyectos de apoyo a los trabajadores de salud de la comunidad (community health workers, CHW) en 114 paises entre 2007 y 2017. Se elaboraron estimaciones para los proyectos descritos especificamente mediante palabras clave pertinentes y para los proyectos que podrian incluir componentes sobre los CHW. Se analizo la pauta de la asistencia para el desarrollo por finalidad, donantes, regiones y paises receptores, y las tendencias a lo largo del tiempo. Resultados Entre 2007 y 2017, el total de la asistencia para el desarrollo destinada a proyectos de CHW fue de unos 5 298,02 millones de dolares estadounidenses (USD), lo que representa el 2,5% del total de la asistencia para el desarrollo destinada a la salud, que ascendio a 209 277,99 millones de USD. Los tres principales donantes (el Fondo Mundial de Lucha contra el SIDA, la Tuberculosis y la Malaria, el Gobierno de Canada y el Gobierno de los Estados Unidos de America) aportaron un total de 4 350,08 millones de USD (82,1%) de la asistencia para el desarrollo destinada a estos proyectos. El Africa subsahariana recibio un total de 3 717,93 millones de USD, la mayor asistencia per capita en 11 anos (0,39 USD; poblacion total: 9 426,25 millones). La asistencia para el desarrollo de proyectos centrados en las enfermedades infecciosas y la salud materno infantil recibio la mayor parte de los fondos durante el periodo de estudio. Conclusion La contribucion de la asistencia para el desarrollo invertida en los proyectos de los CHW fue pequena, inestable y decreciente en los ultimos anos. Se necesita mas investigacion sobre el seguimiento de las inversiones gubernamentales en proyectos relacionados con los CHW y la evaluacion del impacto de las inversiones en la eficacia de los programas., Introduction To attain universal health coverage for the most vulnerable populations and to prepare against future epidemics, such as Ebola, there have been calls for scaling-up community health worker (CHW) [...]

Background: The number of global health (GH) physician training programs in the United States has increased in the past decade. Few studies have explored the demographics of individuals in these programs, the impact of global health training on career development, and specific factors associated with whether graduates achieve a career in global health. Objectives: We aimed to describe characteristics of program graduates and quantify which previously identified factors were associated with achieving a self-defined career in GH among a cohort of graduates from one GH post-graduate training program in a highly resourced academic medical center in the United States between 2003 and 2018. Methods: We conducted a cross-sectional survey and analyzed differences between participants who self-identified as having a career in GH compared to those who did not. Findings: Among 59 individuals invited to participate, 53 (89.9%) responded to the survey. Having a GH mentor was associated with having a career in GH (OR 10.3; p = 0.004). Those who had a GH career were more likely to have a clearly-defined career path (p = 0.03), have institutional support in their current job (p = 0.00006), be able to manage the split between their GH and non-GH work (p = 0.0001), find funding to achieve their objectives in GH (p = 0.01), invest in their personal and family life (p = 0.05), and split work abroad and domestically with few challenges (p = 0.01). Conclusions: We present sociodemographic and career characteristics for graduates from a GH training program in a highly resourced academic medical center in the United States. Mentorship, institutional support, funding, ability to balance GH with non-GH work, and time spent domestically or abroad are key factors associated with successful careers in GH. If institutional funding is allocated to strengthen these aspects of GH training, we anticipate more sustained GH career development. [ABSTRACT FROM AUTHOR]

The 2013-2016 Ebola virus disease outbreak in West Africa exposed an urgent need to strengthen health surveillance and health systems in low-income countries, not only to improve the health of [...]