Research & Scholarly Publications
At One to One Africa, we codify our programmes in partnership with leading Academic institutions. Learn more about our work through these peer publications:
GLOBAL HEALTH ACTION · VOLUME 15 · 2022
LESSONS FROM AN EIGHT-COUNTRY COMMUNITY HEALTH DATA HARMONIZATION COLLABORATIVE.
Background: Community health workers (CHWs) are individuals who are trained and equipped to provide essential health services to their neighbors and have increased access to healthcare in communities worldwide for more than a century. However, the World Health Organization (WHO) Guideline on Health Policy and System Support to Optimize Community Health Worker Programmes reveals important gaps in the evidentiary certainty about which health system design practices lead to quality care. Routine data collection across countries represents an important, yet often untapped, opportunity for exploratory data analysis and comparative implementation science. However, epidemiological indicators must be harmonized and data pooled to better leverage and learn from routine data collection.
Methods: This article describes a data harmonization and pooling Collaborative led by the organizations of the Community Health Impact Coalition, a network of health practitioners delivering community-based healthcare in dozens of countries across four WHO regions.
Objectives: The goals of the Collaborative project are to; (i) enable new opportunities for cross-site learning; (ii) use positive and negative outlier analysis to identify, test, and (if helpful) propagate design practices that lead to quality care; and (iii) create a multi-country ‘brain trust’ to reinforce data and health information systems across sites.
Results: This article outlines the rationale and methods used to establish a data harmonization and pooling Collaborative, early findings, lessons learned, and directions for future research.
Madeleine Ballard, Helen Elizabeth Olsen, Caroline Whidden, Daniele Ressler, Lynn Metze, Anoushka Millear, Daniel Palazuelos, Nandini Choudhuryg, Fabien Munyanezah, Rene Dianei, Kelly Luej, P. Émile Bobozik, Anant Raut, Andriamanolohaja Ramarsonl, Mamy Andrianomenjanaharyl, Karen Finneganm, Carey Westgaten, Wycliffe Omwandad, Leping Wango, David Citrinp, Ash Rogersq, Moses Banda Aronh, Molly Christiansenr, Agnes Watsembas, Rehan Adamjeet and Amanda Yembrick.
INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH · JANUARY 2021
INSTRUCTIVE ROLES AND SUPPORTIVE RELATIONSHIPS: CLIENT PERSPECTIVES OF THEIR ENGAGEMENT WITH COMMUNITY HEALTH WORKERS IN A RURAL SOUTH AFRICAN HOME VISITING PROGRAM.
Background: Community health worker (CHW) programs have been positioned as a way to meet the needs of those who experience marginalization and inequitable access to health care, and current global health narratives also emphasize their adaptable nature to meet growing health burdens in low-income settings. However, as CHW programs adopt more technical roles, the value of CHWs in building relationships with clients tends to be overlooked. More importantly, these programs are often reframed and redeployed without attending to the interests and needs of program clients themselves. We set out to gather perspectives of program and CHW engagement from clients of a maternal and child health program in rural South Africa.
Methods: We conducted 26 interviews with pregnant or recently-delivered clients of the Enable Mentor Mother program between February–March 2018. After obtaining informed consent, a trained research assistant conducted all interviews in the clients’ home language, isiXhosa. Interviews, translated and transcribed into English, were organized and coded using ATLAS.ti software and thematically analyzed.
Results: We found that clients’ home-based interactions with Mentor Mothers were generally positive, and that these engagements were characterized by two core themes, instructive roles and supportive relationships.. Instructive roles facilitated the transfer of knowledge and uptake of new information for behavior change. Relationships were developed within the home visit setting, but also extended beyond routine visits, especially when clients required further instrumental support. Clients further discussed a sense of agency gained through these interactions, even in cases where they chose not to, or were unable to, heed their Mentor Mother’s advice.
Christina A. Laurenzi, Sarah Skeen, Bronwynè J. Coetzee, Vuyolwethu Notholi, Sarah Gordon, Emma Chademana, Julia Bishop and Mark Tomlinson.
JOURNAL OF GLOBAL HEALTH · 2021
COMPENSATION MODELS FOR COMMUNITY HEALTH WORKERS: COMPARISON OF LEGAL FRAMEWORKS ACROSS FIVE COUNTRIES.
Background: Despite the life-saving work they perform, community health workers (CHWs) have long been subject to global debate about their remuneration. There is now, however, an emerging consensus that CHWs should be paid. As the discussion evolves from whether to financially remunerate CHWs to how to do so, there is an urgent need to better understand the types of CHW payment models and their implications.
Methods: This study examines the legal framework on CHW compensation in five countries: Brazil, Ghana, Nigeria, Rwanda, and South Africa. In order to map the characteristics of each approach, a review of the regulatory framework governing CHW compensation in each country was undertaken. Law firms in each of the five countries were engaged to support the identification and interpretation of relevant legal documents. To guide the search and aid in the creation of uniform country profiles, a standardized set of questions was developed, covering: (i) legal requirements for CHW compensation, (ii) CHW compensation mechanisms, and (iii) CHW legal protections and benefits.
Results: The five countries profiled represent possible archetypes for CHW compensation: Brazil (public), Ghana (volunteer-based), Nigeria (private), Rwanda (cooperatives with performance based incentives) and South Africa (hybrid public/ private). Advantages and disadvantages of each model with respect to (i) CHWs, in terms of financial protection, and (ii) the health system, in terms of ease of implementation, are outlined
Madeleine Ballard, Carey Westgate, Rebecca Alban, Nandini Choudhury, Rehan Adamjee, Ryan Schwarz4, Julia Bishop, Meg McLaughlin, David Flood15, Karen Finnegan, Ash Rogers, Helen Olsen, Ari Johnson, Daniel Palazuelos, & Jennifer Schechter.
HEALTH & SOCIAL CARE IN THE COMMUNITY · SEPTEMBER 2020
BALANCING ROLES AND BLURRING BOUNDARIES: COMMUNITY HEALTH WORKERS’ EXPERIENCES OF NAVIGATING THE CROSSROADS BETWEEN PERSONAL AND PROFESSIONAL LIFE IN RURAL SOUTH AFRICA.
As demand for health services grows, task‐shifting to lay, health workers, has become an attractive solution to address shortages in human resources. Community health workers (CHWs), particularly in low‐resource settings, play critical roles in promoting equitable healthcare among underserved populations. However, CHWs often shoulder additional burdens as members of the same communities in which they work. We examined the experiences of a group of CHWs called Mentor Mothers (MMs) working in a maternal and child health programme, navigating the crossroads between personal and professional life in the rural Eastern Cape, South Africa. Semi‐structured qualitative interviews (n = 10) were conducted by an experienced isiXhosa research assistant, asking MMs questions about their experiences working in their own communities, and documenting benefits and challenges. Interviews were transcribed and translated into English and thematically coded. Emergent themes include balancing roles (positive, affirming aspects of the role) and blurring boundaries (challenges navigating between professional and personal obligations). While many MMs described empowering clients to seek care and drawing strength from being seen as a respected health worker, others spoke about difficulties in adequately addressing clients’ needs, and additional burdens they adopted in their personal lives related to the role. We discuss the implications of these findings, on an immediate level (equipping CHWs with self‐care and boundary‐setting skills), and an intermediate level (introducing opportunities for structured debriefings and emphasising supportive supervision). We also argue that, at a conceptual level, CHW programmes should provide avenues for professionalisation and invest more up‐front in their workforce selection, training and support.
Christina A. Laurenzi MsC, Sarah Skeen PhD, Stephan Rabie PhD, Bronwynè J. Coetzee PhD, Vuyolwethu Notholi, Julia Bishop LLM, Emma Chademana PhD, and Mark Tomlinson PhD.
SOCIAL SCIENCE & MEDICINE · VOLUME 258 · AUGUST 2020
HOW DO PREGNANT WOMEN AND NEW MOTHERS NAVIGATE AND RESPOND TO CHALLENGES IN ACCESSING HEALTH CARE? PERSPECTIVES FROM RURAL SOUTH AFRICA.
Women in low- and middle-income countries and in contexts characterized by inequality face various interpersonal and structural barriers when accessing formal maternal and child health (MCH) services. These barriers persist even in contexts where programs to increase access to services, such as community health worker (CHW) interventions, have been implemented. However, while barriers to accessing care have been extensively documented, less is known about the diverse ways that women respond to, and navigate, these situations. This study explores strategies pregnant women and new mothers use to navigate and respond to health care barriers in a rural district in the Eastern Cape, South Africa. Twenty-six pregnant or recently delivered clients of the Enable Mentor Mother program were interviewed about their experiences of accessing formal MCH services. Interviews were conducted between February-March 2018 by an experienced isiXhosa-speaking research assistant, translated and transcribed into English, with transcripts coded and organized by themes using ATLAS.ti software. Facing resource shortages, inconsistent communication, and long travel times to clinics, participants employed diverse, innovative strategies to navigate interpersonal and structural barriers to care. While some participants chose to respond to barriers more passively—citing endurance and acceptance as practices of health system engagement—those participants who focused more on active responses tended to leverage their education, existing relationships, and available community resources to overcome barriers. Nevertheless, most participants described feelings of frustration and dejection. While CHW interventions may alleviate some of the burdens facing fragile health care systems in these contexts, these programs still rely on an underlying infrastructure of care that primary health care clinics and hospitals should be providing. Future programming should work in tandem with formal health systems and should support staff to improve quality of care provided to pregnant women, new mothers, and their infants to prioritize their health at a time of vulnerability.
Christina A. Laurenzia, Sarah Skeena, Bronwyne J. Coetzee, Sarah Gordona, Vuyolwethu Notholia and Mark Tomlinsona.
RESEARCH IN NURSING & HEALTH · NOVEMBER 2019
THE HOME VISIT COMMUNICATION SKILLS INVENTORY: PILOTING A TOOL TO MEASURE COMMUNITY HEALTH WORKER FIDELITY TO TRAINING IN RURAL SOUTH AFRICA.
Community‐based home visiting programs using community health workers (CHWs) have become popular modes of delivering health care services, especially in settings where health workers are overburdened and resources are limited. Yet, little is known about the processes that shape effective implementation in low‐resource settings, and whether these processes adhere to home visitors’ training. This study used the newly‐developed Home Visit Communication Skills Inventory (HCSI) to explore the delivery of a CHW program in rural South Africa. Routine home visits from CHWs to their maternal care clients were audio‐recorded with consent, and later transcribed and translated into English. The HCSI, devised and piloted using existing frameworks and program‐specific training components, consisted of 21 items covering domains related to active listening, active delivery, and active connecting, and was used to score English transcripts of the home visits. The HCSI was used to generate general frequencies and aggregate scores for each CHW. Eighty‐four home visits by 14 CHWs showed a diverse application of communication skills. Active listening and active delivery were common, with fewer instances of active connecting observed. Practices disaggregated by CHW showcased varying strengths by an individual. In reviewing visit characteristics, longer average visit duration was significantly correlated with the presence of multiple types of active connecting skills. While technical skills were widely observed, fewer CHWs engaged in more complex “connecting” skills. The HCSI is a feasible, low‐cost, and practical way to describe home visit fidelity among CHWs. Audio‐based checklists can be used to describe fidelity to a model in the absence of additional supervisory resources.
Christina A. Laurenzi, Sarah Gordon, Sarah Skeen, Bronwynè J. Coetzee, Julia Bishop, Emma Chademana and Mark Tomlinson.
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