Systematic review: Which interventions influence performance of community health workers?

Below are the citation and key messages of a new paper in journal Health Policy and Planning. The full text is freely available here:

The study concludes: ‘Additional intervention research to develop a better evidence base for the most effective training and supervision mechanisms and qualitative research to inform policymakers in development of CHW interventions are needed.’

Curiously, the authors also note: ‘Studies mentioning the use of mobile phones in supervision (Arem et al. 2011; Cornman et al. 2011; Jack et al. 2012) did not report a clear influence on CHW performance’. However, the review was conducted in 2013 and excludes any studies later than July 2013.

CITATION: Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review

Maryse C Kok et al. Health Policy Plan. (2014) doi: 10.1093/heapol/czu126

First published online: December 11, 2014


– A systematic review of 140 quantitative and qualitative studies identified factors related to the nature of tasks and time spent on delivery, human resource management, quality assurance, links with the community, links with the health system and resources and logistics having an influence on CHW performance.

– Good performance was associated with intervention designs involving a mix of incentives, frequent supervision, continuous training, community involvement and strong co-ordination and communication between CHWs and health professionals, leading to increased credibility of CHWs.

– When designing CHW programmes, policymakers should take into account factors that increased CHW performance in comparable settings, to maximize programme outcomes.

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ITU launches “Ebola-Info-Sharing” mobile application

The press release below is forwarded from the ITU {International Telecommuications Union, a UN agency)

You can read it online here:

ITU launches “Ebola-Info-Sharing” mobile application

Mobile apps are critical emergency telecommunications component responding to epidemics

Geneva, 19 December 2014 – ITU has launched a free mobile Application to be used in the campaign against the Ebola disease outbreak.

The “Ebola-Info-Sharing” mobile App facilitates coordination among organizations responding to the Ebola crisis and offers the general public access to the latest Ebola news from official sources, including an interactive map on Ebola.

“Information and communication technologies are now critical components of emergency telecommunications not only when natural disasters strike, but also during epidemics such as the Ebola disease outbreak,” said ITU Secretary-General Hamadoun I. Touré. “The “Ebola-Info-Sharing” App not only enhances prevention, diagnosis, treatment and monitoring of diseases but also strengthens healthcare systems through improvements in emergency response, healthcare practitioner support, healthcare surveillance and administration.”

“With such unprecedented computing power in the palm of our hands it is imperative that we harness mobile technology to serve humanity and especially in combating epidemics,” said Mr Brahima Sanou, Director of ITU’s Telecommunication Development Bureau. “Partnerships are key to the success of a collective global response to fight epidemics like Ebola.”

The App is currently available for Android mobile devices and will soon be available for iOS devices. It, has two main components:

News and maps:

This section, accessible by all users, offers access to the latest official Ebola news. In addition, an interactive map of the Ebola-affected region shows the location of healthcare centres in urban and remote areas and allows users to mark the location of infected people. The map is continuously updated.

Contacts and interactive forum:

This password-protected feature is designed for use by organizations involved in the Ebola response. It allows them to store and share useful contacts and participate in an interactive forum to discuss and exchange information. Organizations wishing to use the Application should either complete the sign-up form available on the App or send an e-mail to

The “Ebola-Info-Sharing” application has been custom-developed to operate using ultra low bandwidth requirements and has a fully functioning offline mode. It is available in English and French.

“We are working with other United Nations Agencies to incorporate mobile technologies in the Ebola response plan,” said Mr Cosmas L. Zavazava, Chief of the ITU Projects and Knowledge Management Department and ITU Focal Point on Ebola. “At the same time we provide emergency telecommunications equipment to meet the connectivity needs of rural areas that have no or limited connectivity access.”

A new ITU resolution “Using information and communication technologies to break the chain of health-related emergencies such as Ebola virus transmission” was approved unanimously during the ITU Plenipotentiary Conference held in Busan, Republic of Korea, from 20 October to 7 November 2014. The resolution called for the use of ICTs to facilitate timely exchange of information on health-related emergencies.

In 2015, ITU will deploy a more robust platform for use by the humanitarian community that will take advantage of social media and the big data revolution.

According to the World Health Organization, a total of 17 908 cases of Ebola have been reported to date by the Ministries of Health of Guinea, Sierra Leone and Liberia. The outbreak has claimed over 6,373 lives.

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Challenges to implementing WHO guidelines for management of acute stress, PTSD, and bereavement

Below is the citation and summary points of a new paper in the open access journal PLoS Medicine, looking at the challenges of implementing WHO guidelines for management of acute stress, post-traumatic stress disorder and bereavement in low- and middle-income countries. The paper also includes a summary table of guidelines but unfortunately the format does not allow me to copy and paste the text here.

The full text of the article is freely available here:

CITATION: Tol WA, Barbui C, Bisson J, Cohen J, Hijazi Z, et al. (2014) World Health Organization Guidelines for Management of Acute Stress, PTSD, and Bereavement: Key Challenges on the Road Ahead. PLoS Med 11(12): e1001769. doi:10.1371/journal.pmed.1001769


The implementation of new WHO mental health guidelines for conditions and disorders specifically related to stress is likely to face obstacles, particularly in low- and middle-income countries.

Formulation of evidence-based guidelines is complicated by limited knowledge regarding (a) the effectiveness of commonly implemented interventions, (b) the effectiveness of established evidence-based interventions when used in situations of ongoing adversity, and (c) the effectiveness of widely used cultural practices in LMICs. The application of the guidelines requires improved knowledge on how to reduce potentially harmful practices that are widely applied.

The implementation of recommendations regarding psychotherapeutic interventions will require an approach that balances (a) strengthening the availability and capacity of specialists to train and supervise and (b) shifting to the delivery of psychotherapy by non-specialists.

The strengthening of evidence for managing these conditions will require collaborative efforts by researchers and practitioners in a manner that is mindful of local sociocultural and health system realities.

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ICN position statement: The right to connect via information and communication technology

The International Council of Nurses (a HIFA Supporting Organisation) has issued a 1-page position statement on ‘The right to connect via information and communication technology’. The full statement can be downloaded as a PDF here:

Here are extracts:

‘The International Council of Nurses (ICN) strongly believes that people should be able to connect with each other and to share information via information and communication technology (ICT) – fixed-telephone, mobile-cellular telephone and the Internet. ICN believes that ICT can improve access to good healthcare, address inequalities in its provision and help citizens take a more active role in healthcare.

‘Nurses, other healthcare workers, patients, carers and citizens increasingly rely on ICT to communicate, to manage information and to access knowledge. However, there is a significant and persistent global ‘digital divide’…

‘Unless there is more equity in access, the ongoing shift towards electronic communication such as SMS and email and towards the Internet as a source information and knowledge will serve to disenfranchise a large proportion of the world’s population and a significant number of nurses.’

In 2010 HIFA produced on behalf of ICN a more detailed fact sheet on this subject: Meeting the information needs of health professionals. This was produced as part of a major campaign by ICN and other international health organisations called the Positive Practice Environments Campaign. For reasons that are unclear, the PPE campaign did not receive renewal of funding and was unfortunately terminated. The fact sheet is freeely available here:

Positive Practice Environments: Meeting the information needs of health professionals

Best wishes,


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Palliative Care in Africa special issue

“Palliative care is important because the pain in cancer is akin to torture,” says Professor Merriman, Founder of Hospice Africa Uganda and Guest Editor of this special issue. “We have known how to control pain since 1967, yet less than 3% of people in Africa have their pain controlled.”

Contributors from Sudan, Nigeria, Rwanda and Uganda describe a hopeful continent in which older societal beliefs, family traditions, government policy and modern healthcare combine to meet the challenges of palliative care. Many African nations share a strong cultural suspicion of opioid medications, including morphine. Healthcare professionals may be wary of prescribing painkillers, due to a common misapprehension that they will encourage patients to become addicted to drugs. Taken together, the papers represent a cross-section of palliative care efforts in Africa in the past twenty years – and a powerful vision for the movement’s future.

Read this special issue for free.

Access ecancer’s free Palliative care elearning course for healthcare professionals in Africa.

HIFA profile: Katie Foxall is Publishing Manager at eCancer, Bristol, UK. katie AT


To send a message to the HIFA forum, simply send an email to:

Mobilising Ebola survivors

To hasten #Ebola containment, mobilize survivors

Survivors of Ebola infection are valuable resources still largely overlooked in the struggle to contain the epidemic. With a case recovery rate of around 30% at the present time for the current West African epidemic,2 survivors already number thousands. There are several reasons why Ebola survivors may be critical to controlling the epidemic.

First, and most importantly, the recovered have developed immunity to the current strain of Ebola and therefore are able to care for the sick with little to no risk of re-infection…

Second, survivors can donate their blood, as their antibodies might be protective and help those infected to survive the deadly virus…

Third, unlike most foreign response staff, survivors speak local languages, understand cultural dynamics and may be viewed more favourably than outsiders…

Finally, Ebola survivors may play a role in generating an effective, community-based response…

To the above list, I would add the importance of survivors as advocates to demonstrate to their communities that Ebola is not a death sentence – survival from the disease is possible if people seek early treatment.

Best wishes,


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Vision-related apps

The Association of Vision Science Librarians maintains a list of primarily vision-related apps, with some general medical content as well; you can find it at under the ‘resources’ tab.   A quick caution:  we have been having trouble with the site erratically asking for a password login; it should not, so if this happens, close your browser and try again.

Best wishes,

Pam Sieving

HIFA profile: Pamela Sieving is an informationist at the National Institutes of Health, USA. She is particularly interested in vision-related health care delivery and education for that work. pamsieving AT


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Advancing mHealth by connecting global health professionals to people, products, and ideas

We are excited to announce that K4Health is the new home to the seminal publications of the mHealth Alliance!

The field of mHealth was galvanized in 2008 by the flagship United Nations Foundation-Vodafone Foundation publication, mHealth for Development. Since then, the mHealth Alliance and key partners have produced a collection of over 20 mHealth publications.  These materials cover topics ranging from patient privacy to the mobile gender gap to technology standards and more. The collection has served to define and shape the field of mHealth and is now available on the Knowledge for Health (K4Health) platform.

K4Health’s mHealth Knowledge portal generates, curates, and disseminates high quality resources for the field, making it the ideal new home for the mHealth Alliance collection. Incorporating the collection into the knowledge portal will ensure that these publications continue to serve as a set of critical building blocks as the mHealth sector progresses towards national digital health systems.

In the spirit of true partnership, the United Nations Foundation, which served as the host of the mHealth Alliance, would like to thank the United States Agency for International Development and the Johns Hopkins Center for Communication Programs for providing a platform for these publications. Through mHealth Knowledge, these publications will continue to inform responsible and evidence-based practices in the use of mobile health for the benefit of those most in need.

Read more from Patty Mechael ( . (

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What’s new on mHealth Knowledge?

edX Course: Entrepreneurship and Healthcare in Emerging Economies

Explore how entrepreneurship and innovation tackle complex health problems in emerging economies.

About this Course

Entrepreneurship and Healthcare in Emerging Economies aims to engage students in an inter-disciplinary approach to understanding the nature of complex health problems throughout the world, with an illustrative focus on South Asia. Students will become acquainted with prior attempts to address these problems, to identify points of opportunity for smart entrepreneurial efforts, and to propose and develop their own candidate solutions.

Throughout, the emphasis is on individual agency—what can the learner do to address a defined problem? While we use the lens of health to explore entrepreneurial opportunities, students will see that both problems and solutions are inevitably of a multi-disciplinary nature, and we will draw on a range of sectors and fields of study…..more

’10 Apps that are Reshaping Healthcare in Africa’

Venture Africa, the Pan-African business magazine, has developed a list of ’10 health apps that are saving millions of lives within Africa’. *None* of them appear to be designed to help health workers to diagnose and treat illness.

’10 Apps that are Reshaping Healthcare in Africa’

  • Hello Doctor
  • mPedigree
  • MomConnect
  • Matibabu
  • MedAfrica
  • mRamadan
  • Smart Health app
  • Sehatuk
  • Omomi (My Child)
  • DrBridge

The first version of Samsung and Mobilium’s Smart Health app for Africa was launched in October 2013 and HIFA mem bers found it to have major limitations, eg ‘no one will read all the text (it is lengthy and not as informative as it could be) and in that sense it will be ignored’. I note they recently launched a second version here (it only works on android, which I do not have – please try it out and let us know what you think):

It is hard to imagine how these 10 apps could be saving thousands of lives in Africa, let alone millions.


Maybe the following could be of interest

Diagnosaurus 2.0 DDx PDA Tool

For Palm, Windows Mobile, Blackberry, iOS, Android, Windows Phone 7.  Diagnosaurus provides differential diagnoses (DDx) of symptoms, signs, and diseases. By using the pulldown menu, you can choose to view entries by organ system, or select to view the list of symptoms only, the list of diseases only, or all of the entries.

For example, if you wish to review the causes of a patient’s chief complaint, simply select the symptom or sign from the alphabetical listing. If you have made a diagnosis and wonder what other disorders to consider select your diagnosis from the list to see its DDx. Users can browse through approximately 1,000 diagnoses by organ, system, symptom and disease. There’s also a special etiology section for referencing possible causes of disease. Price: $1.99

Courtesy HIFA2015

BioMed Central and Springer: New Ebola Resource Center

The ongoing Ebola outbreak in West Africa is the largest and most complex in history.  It has been declared a public health emergency of international concern by the World Health Organization (WHO) and to date 17,256 suspected cases and 6,113 deaths have been reported[1]. However, the World Health Organization has said that these numbers may be vastly underestimated[2].

In response to this we have created a resource center which provides links to scientific articles related to Ebola published in BioMed Central and Springer journals.

Access the Ebola Resource Center

All articles are freely available and we hope that the scientific information provided will further the understanding of the virus.

Kind regards,

The BioMed Central Team

Best wishes, Neil

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The Next Millennium is Here – or At Least the Next Millennium Report

The Next Millennium is Here ­ or At Least the Next Millennium Report

UN Secretary General Dr Ban Ki-moon today presented his synthesis report on the post-2015 Development Agenda. Entitled “The Road to Dignity by 2030: Ending Poverty, Transforming All Lives and Protecting the Planet”, this is Ban Ki-moon’s updating of the Millennium Development report (which Kofi Annan rather more modestly called “We the Peoples – The Role of the United Nations in the 21st Century).

In case HIFA members are interested, I have reviewed this report from the health information perspective in my Ruminations blog: .


Courtesy HIFA2015


Barbara Starfield Collection

Professor Barbara Starfield (1932-2011), a physician and health services researcher, was university distinguished professor and professor of health policy and pediatrics at Johns Hopkins University.  She championed the value and need of strong primary health care systems worldwide. This collection emphasizes the case for primary care and includes a number of Barbara Starfield’s own articles as well as other key related material.  You can read more about her on the website, and can also access several of her presentations, which she left in perpetuity for others to consult and use…..more

Educational Animations on Ebola from Scientific Animations Without Borders

We would like to make you aware that Scientific Animations Without Borders (SAWBO) creates educational animations and then places them into a diversity of languages by working with volunteers from around the world.  Once created all animations are then made freely available to anyone wanting to use them for educational purposes only.

Today, we would like to let you know SAWBO has released its first animation on Ebola; the animation is currently available in English, French, as well as in Themne and Krio for Sierra Leone.  SAWBO appreciates all the support from collaborators who have helped get this done.

The English version of the video can be found on Youtube at .  The website where the videos can be downloaded can be found at and we would be glad to send people the files directly if they have any problems with the downloads.

SAWBO animations can be played and shared between cell phones (3gp version) or shared by e-mail (3gp version) or placed onto TVs, DVDs, USB cards, projection systems, etc…

We would like your help where possible.  

First, if you know of any groups that can use these animations in their educational programs, in countries currently being impacted by Ebola, please let them know about this resource and that they can use and distribute these animations in educational programs in keeping with their local, regional or national government systems.  The SAWBO team has some resources to also send some groups DVDs or USB cards with the animations on them.  SAWBO’s goal is to get the educational information to groups that can use them directly and in keeping with local, regional or national educational programs on Ebola.

Second, we are looking for more volunteers to help us translate and record our animations into more languages in the countries currently being impacted by Ebola.  Volunteers would need to be able to speak the language, have access to a voice-recording device like a cell phone or a computer, record their voice and save it as an electronic file.  Access to the Internet would be required for us to correspond with them and exchange files.  

We are currently looking for volunteers for the following languages – Mende, Susu, Mano, Kpelle, Liberian Kreyol, Bassa, Kono, Fula and Maninka.  If you, or anyone you know, might be able to help with these voice-overs please let us know.  

Individuals or groups can contact us at



Barry Pittendrigh, Julia Bello-Bravo and the rest of the SAWBO team

A new network to promote evidence-based research

Caroline Struthers

Education and Training Manager, EQUATOR Network

As Iain Chalmers and colleagues have been saying for many years, to embark on research without reviewing systematically evidence of what is already known, particularly when the research involves people or animals, is unethical, unscientific, and wasteful. On 3 December 2014, following the Evidence-Based Research meeting in Bergen, Norway, an international Evidence-Based Research (EBR) Network will be inaugurated ( to press funders, regulators, researchers, academic institutions, and journals to implement the changes that are needed to promote evidence-based research. One of the key objectives of the EBR Network is that all doctoral students, supervisors, and senior researchers should learn the methodology of systematic reviews and use these research syntheses to anchor more effectively questions for additional primary research.

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How do health extension workers in Ethiopia allocate their time?



Governments are increasingly reliant on community health workers to undertake health promotion and provide essential curative care. In 2003, the Government of Ethiopia launched the Health Extension Programme and introduced a new cadre, health extension workers (HEWs), to improve access to care in rural communities. In 2013, to inform the government’s plans for HEWs to take on an enhanced role in community-based newborn care, a time and motion study was conducted to understand the range of HEW responsibilities and how they allocate their time across health and non-health activities.


The study was administered in 69 rural kebeles in the Southern Nations Nationalities and People’s Region and Oromia Region that were intervention areas of a trial to evaluate a package of community-based interventions for newborns. Over 4 consecutive weeks, HEWs completed a diary and recorded all activities undertaken during each working day. HEWs were also surveyed to collect data on seasonal activities and details of the health post and kebele in which they work. The average proportion of productive time (excluding breaks) that HEWs spent on an activity, at a location, or with a recipient each week, was calculated.


The self-reported diary was completed by 131 HEWs. Over the course of a week, HEWs divided their time between the health post (51%) and the community (37%), with the remaining 11% of their time spent elsewhere. Curative health activities represented 16% of HEWs’ time each week and 43% of their time was spent on health promotion and prevention. The remaining time included travel, training and supervision, administration, and community meetings. HEWs spent the majority (70%) of their time with individuals, families, and community members.


HEWs have wide-ranging responsibilities for community-based health promotion and curative care. Their workload is diverse and they spend time on activities relating to family health, disease prevention and control, hygiene and sanitation, as well as other community-based activities. Reproductive, maternal, newborn, and child health activities represent a major component of the HEW’s work and, as such, they can have a critically important role in improving the health outcomes of mothers and children in Ethiopia.