scholarly journals Availability of Essential Commodities and Related Bottlenecks for Community Health System: Systematic Literature Review

2020 ◽  
Author(s):  
Ami Pradhan ◽  
Erin Bogue ◽  
Benjamin Schreiber ◽  
Hannah Sarah Dini ◽  
Hitesh Hurkchand ◽  
...  
Keyword(s):  
Literature Review ◽  
Community Health ◽  
Community Health Workers ◽  
Systematic Literature Review ◽  
Health Workers ◽  
Hypothesis Test ◽  
Grey Literature ◽  
National Level ◽  
Health Facilities ◽  
Significant Difference

Abstract Background: This paper explores the extent of community-level stock-out of essential and program commodities for Maternal, Newborn and Child Health (MNCH) among Community Health Workers (CHWs) in Low- and Middle-Income Countries (LMICs), and identifies the underlying bottlenecks leading to such stock-outs.Methods: A systematic literature review was conducted of published and grey literature. 48 studies containing information on the number or percentage of CHWs or health facilities (HFs) stocked-out, or reasons for stock-outs at these levels, were included. In addition, interviews were conducted with domain experts from different organizations working on community health to identify primary reasons for stock-outs. The qualitative data regarding reasons for stock-outs were categorized under different themes, using a content analysis method. Results: 48.09% [CI 95%: 39.28 - 56.90] of the Community Health Workers and 54.76 % [CI 95%: 43.54 - 65.98] of the health facilities in SSA countries included in this study experienced stock-outs of essential commodities. A hypothesis test showed no significant difference in stock-out rates between CHWs and HFs. The most frequently cited reason for CHW stock-outs was a lack of financial resources, leading to inadequate national level stocks, affecting supply available at the last mile. Moreover, issues at HF and CHW levels in the following areas contributed to stock-outs: transportation, data and estimation of needs, human resources, and stock management and storage. These significant bottlenecks hinder the ability of CHWs to save lives.Conclusion: Stock-outs of health commodities impact almost half of CHWs, preventing effective service delivery. Many factors contribute to stock-outs, which occur at all levels of the health supply chain. A system strengthening approach is necessary to reduce CHW stock-outs. Sparse data, differing definitions of stock-outs, and inconsistent reporting metrics posed significant challenges to analyzing results from reviewed studies. Therefore, a set of standard metrics to measure the rate, period, and frequency of stock-outs in future studies is recommended.

scholarly journals Availability of Essential Commodities and Related Bottlenecks for Community Health System: Systematic Literature Review

2020 ◽  
Author(s):  
Ami Pradhan ◽  
Erin Bogue ◽  
Benjamin Schreiber ◽  
Hannah Sarah Dini ◽  
Hitesh Hurkchand ◽  
...  
Keyword(s):  
Literature Review ◽  
Community Health ◽  
Community Health Workers ◽  
Systematic Literature Review ◽  
Health Workers ◽  
Hypothesis Test ◽  
Grey Literature ◽  
National Level ◽  
Health Facilities ◽  
Significant Difference

Abstract Background: This paper explores the extent of community-level stock-out of essential and program commodities for Maternal, Newborn and Child Health (MNCH) among Community Health Workers (CHWs) in Low- and Middle-Income Countries (LMICs), and identifies the underlying bottlenecks leading to such stock-outs. Methods: A systematic literature review was conducted of published and grey literature. 48 studies containing information on the number or percentage of CHWs or health facilities (HFs) stocked-out, or reasons for stock-outs at these levels, were included. In addition, interviews were conducted with domain experts from different organizations working on community health to identify primary reasons for stock-outs. The qualitative data regarding reasons for stock-outs were categorized under different themes, using a content analysis method. Results: 48.09% [CI 95%: 39.28 - 56.90] of the Community Health Workers and 54.76 % [CI 95%: 43.54 - 65.98] of the health facilities in SSA countries included in this study experienced stock-outs of essential commodities. A hypothesis test showed no significant difference in stock-out rates between CHWs and HFs. The most frequently cited reason for CHW stock-outs was a lack of financial resources, leading to inadequate national level stocks, affecting supply available at the last mile. Moreover, issues at HF and CHW levels in the following areas contributed to stock-outs: transportation, data and estimation of needs, human resources, and stock management and storage. These significant bottlenecks hinder the ability of CHWs to save lives. Conclusion: Stock-outs of health commodities impact almost half of CHWs, preventing effective service delivery. Many factors contribute to stock-outs, which occur at all levels of the health supply chain. A system strengthening approach is necessary to reduce CHW stock-outs. Sparse data, differing definitions of stock-outs, and inconsistent reporting metrics posed significant challenges to analyzing results from reviewed studies. Therefore, a set of standard metrics to measure the rate, period, and frequency of stock-outs in future studies is recommended.

scholarly journals Availability of Essential Commodities and Related Bottlenecks for Community Health System: Systematic Literature Review

2020 ◽  
Author(s):  
Ami Pradhan ◽  
Erin Bogue ◽  
Benjamin Schreiber ◽  
Hannah Sarah Dini ◽  
Hitesh Hurkchand ◽  
...  
Keyword(s):  
Literature Review ◽  
Community Health ◽  
Community Health Workers ◽  
Systematic Literature Review ◽  
Health Workers ◽  
Hypothesis Test ◽  
Grey Literature ◽  
National Level ◽  
Health Facilities ◽  
Significant Difference

Abstract Background: This paper explores the extent of community-level stock-out of essential and program commodities for Maternal, Newborn and Child Health (MNCH) among Community Health Workers (CHWs) in Low- and Middle-Income Countries (LMICs), and identifies the underlying bottlenecks leading to such stock-outs. Methods: A systematic literature review was conducted of published and grey literature. 48 studies containing information on the number or percentage of CHWs or health facilities (HFs) stocked-out, or reasons for stock-outs at these levels, were included. In addition, interviews were conducted with domain experts from different organizations working on community health to identify primary reasons for stock-outs. The qualitative data regarding reasons for stock-outs were categorized under different themes, using a content analysis method. Results: 48.09% [CI 95%: 39.28 - 56.90] of the Community Health Workers and 54.76 % [CI 95%: 43.54 - 65.98] of the health facilities in SSA countries included in this study experienced stock-outs of essential commodities. A hypothesis test showed no significant difference in stock-out rates between CHWs and HFs. The most frequently cited reason for CHW stock-outs was a lack of financial resources, leading to inadequate national level stocks, affecting supply available at the last mile. Moreover, issues at HF and CHW levels in the following areas contributed to stock-outs: transportation, data and estimation of needs, human resources, and stock management and storage. These significant bottlenecks hinder the ability of CHWs to save lives. Conclusion: Stock-outs of health commodities impact almost half of CHWs, preventing effective service delivery. Many factors contribute to stock-outs, which occur at all levels of the health supply chain. A system strengthening approach is necessary to reduce CHW stock-outs. Sparse data, differing definitions of stock-outs, and inconsistent reporting metrics posed significant challenges to analyzing results from reviewed studies. Therefore, a set of standard metrics to measure the rate, period, and frequency of stock-outs in future studies is recommended.

Stock-Outs of Essential Medicines Among Community Health Workers (CHWs) In Low- And Middle-Income Countries (LMICs): A Systematic Literature Review of The Extent, Reasons, And Consequences

2021 ◽  
Author(s):  
Abimbola Olaniran ◽  
Jane Briggs ◽  
Ami Pradhan ◽  
Erin Bogue ◽  
Benjamin Schreiber ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Grey Literature ◽  
Community Level ◽  
Health Centers ◽  
Essential Medicines ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Background: This paper explores the extent of community-level stock-out of essential medicines among Community Health Workers (CHWs) in Low- and Middle-Income Countries (LMICs) and identifies the reasons for and consequences of essential medicine stock-outs. Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Five electronic databases were searched with a prespecified strategy and the grey literature examined, January 2006 - March 2021. Papers containing information on (i) the percentage of CHWs stocked out or (ii) reasons for stock-outs along the supply chain and consequences of stock-out were included and appraised for risk of bias. Outcomes were quantitative data on the extent of stock-out, summarized using descriptive statistics, and qualitative data regarding reasons for and consequences of stock-outs, analyzed using thematic content analysis and narrative synthesis. Results: Two reviewers screened 1083 records; 78 evaluations were included. Over the last fifteen years, CHWs experienced stock-outs of essential medicines nearly one third of the time and at a significantly (p < 0.01) higher rate than the health centers to which they are affiliated (28.93% [CI 95%: 28.79 - 29.07] vs 9.17 % [CI 95%: 8.64 - 9.70], respectively). A comparison of the period 2006-2015 and 2016-2021 showed a significant (p < 0.01) increase in CHW stock-out level from 26.36% [CI 95%: 26.22 -26.50] to 48.65% [CI 95%: 48.02- 49.28] while that of health centers increased from 7.79% [95% CI: 7.16 - 8.42] to 14.28% [95% CI: 11.22- 17.34]. Distribution barriers were the most cited reasons for stock-outs. Ultimately, patients were the most affected: stock-outs resulted in out-of-pocket expenses to buy unavailable medicines, poor adherence to medicine regimes, dissatisfaction, and low service utilization. Conclusion: Community-level stock-out of essential medicines constitutes a serious threat to achieving universal health coverage and equitable improvement of health outcomes. This paper suggests stock-outs are getting worse, and that there are particular barriers at the last mile. There is an urgent need to address the health and non-health system constraints that prevent the essential medicines procured for LMICs by international and national stakeholders from reaching the people who need them the most.

scholarly journals Toward a geography of community health workers in Niger: a geospatial analysis

2021 ◽  
Author(s):  
Nicholas P Oliphant ◽  
Nicolas Ray ◽  
Khaled Bensaid ◽  
Adama Ouedraogo ◽  
Asma Yaroh Gali ◽  
...  
Keyword(s):  
High Resolution ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Health Facilities ◽  
Health Coverage ◽  
Community Case Management ◽  
Front Line ◽  
Integrated Community Case Management ◽  
Geographical Accessibility

Background Little is known about the geography of community health workers (CHWs), their contribution to geographical accessibility of primary health care (PHC) services, and strategies for optimizing efficiency of CHW deployment in the context of universal health coverage (UHC). Methods Using a complete georeferenced census of front-line health facilities and CHWs in Niger and other high resolution spatial datasets, we modelled travel times to front-line health facilities and CHWs between 2000-2013, accounting for training, essential commodities, and maximum population capacity. We estimated additional CHWs needed to maximize geographical accessibility of the population beyond the reach of existing front-line health facilities and CHWs. We assessed the efficiency of geographical targeting of the existing CHW network compared to modelled CHW networks designed to optimize geographical targeting of the estimated population, under-five deaths, and plasmodium falciparum malaria cases. Results The percent of the population within 60 minutes walking to the nearest CHW increased from 0·0% to 17·5% between 2000-2013, with 15·5% within 60 minutes walking to the nearest CHW trained on integrated community case management (iCCM) — making PHC services and iCCM, specifically, geographically accessible for an estimated 2·3 million and 2·0 million additional people, respectively. An estimated 10·4 million people (59·0%) remained beyond a 60-minute catchment of front-line health facilities and CHWs. Optimal deployment of 8064 additional CHWs could increase geographic coverage of the estimated total population from 41·5% to 73·6%. Geographical targeting of the existing CHW network was inefficient but optimized CHW networks could improve efficiency by 55·0%-81·9%, depending on targeting metric. Interpretations We provide the first high-resolution maps and estimates of geographical accessibility to CHWs at national scale, highlighting improvements between 2000-2013 in Niger, geographies where gaps remained, approaches for improving targeting, and the importance of putting CHWs on the map to inform planning in the context of UHC.

scholarly journals Community Health Workers for Non-Communicable Diseases Prevention and Control in Bangladesh: A Qualitative Study

2020 ◽  
Author(s):  
Lal Rawal ◽  
Shamim Jubayer ◽  
Shohel R Choudhury ◽  
Sheikh Mohammad Shariful Islam ◽  
Abu Abdullah
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Prevention And Control ◽  
Health Workers ◽  
Community Support ◽  
Communicable Diseases ◽  
Health Facilities ◽  
Non Communicable Diseases ◽  
And Control ◽  
Central Level

Abstract Objective: To examine the barriers and facilitators to engaging Community Health Workers (CHWs) for Non-communicable Diseases (NCDs) prevention and control in Bangladesh.Design: We used multipronged approaches, including a. Situation analyses using a literature review, key personnel and stakeholders’ meetings, and exploratory studies. A grounded theory approach was used for qualitative data collection, and data were analysed thematically.Setting: Data were collected from health facilities across three districts in Bangladesh, and two stakeholder consultative meetings were conducted at the central level.Participants: We conducted in-depth interviews with CHWs (Health Inspector; Community Health Care Provider; Health Assistant and Health Supervisor) (n=4); key informant interviews with central level health policymakers/ managers (n=15) and focus group discussions with CHWs (4 FGDs; total n=29). Participants in a stakeholder consultative meeting included members from the government (n=4), non-government organisations (n=2), private sector (n=1) and universities (n=2).Results: The CHWs in Bangladesh deliver a wide range of public health programs. They also provide several NCDs specific services, including screening, provisional diagnosis, and health education and counselling for common NCDs, dispatching of basic medications, and referral to relevant health facilities. These services are being delivered from the sub-district health facility, community clinics and urban health clinics. The participants identified key challenges and barriers, which include lack of NCD specific guidelines, inadequate training, excessive workload, inadequate systems-level support, and lack of logistics supplies and drugs. The facilitating factors to engage CHWs included government commitment and program priority, development of NCD related policies and strategies, the establishment of NCD corners, community support systems, social recognition and staff motivation.Conclusion: Engaging CHWs has been a key driver to NCDs services delivery in Bangladesh. However, there is a need for capacity building of CHWs, systems-level support and maximizing CHWs engagement to prevention and control of NCDs in Bangladesh.

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