Strengthening Community Health Systems through CHWs and mHealth

I was interested to see this new publication from the CORE Group, which ‘improves and expands community health practices for underserved populations, especially women and children, through collaborative action and learning’, with support from USAID. Below are some extracts of particular relevance to HIFA, for further discussion:

Strengthening Community Health Systems through CHWs and mHealth

http://www.coregroup.org/storage/documents/Fall_Conference_2014/Strengthening_Community_Health_Systems_through_CHWs_and_mHealth.pdf

‘Community health workers (CHWs) have been called the “world’s most promising health workforce resource” in terms of enabling health systems in resource-constrained settings.’

‘What seems like a straightforward health promotion and service delivery strategy, of recruiting, training and supporting local people to supplement health professionals at the community level, is in fact quite complex.’

‘Increasingly, there is a trend towards using mobile technology to train and support CHWs.’

‘Amref Health Africa looked at whether they could reduce face-to-face training time and still retain the quality of the CHW’s training using mLearning in Kenya. Before getting started, Amref tackled key questions such as, what type of phone to use, basic or smart; whether to develop a platform independently or build

partnerships; what curriculum to use; and what the guiding principles of their mLearning initiative should be. At the start of the initiative, 97% of CHWs in Kenya had mobile phones, with about 70% of CHWs having a basic phone. Thus, Amref decided to leverage current technology (basic phones) in the hands of CHWs for scalability and sustainability reasons. Additionally, Amref established partnerships with Accenture, Safaricom/Vodafone, Mezzanine, and the Kenyan Ministry of Health (MOH). With Amref taking the lead, they developed the Health Enablement and Learning Platform (HELP).’

Child grants until age 23

Talks are under way in government to possibly extend child grants for needy children from 18 years of age to 23. The proposal has been met with mixed reaction, with some roleplayers welcoming it and others questioning the timing of the move and saying that such a step will make people that much more dependent on government. “And it is taxpayers who will have to pay,” said Francois Stofberg, economist at the Efficient Group. ….more and more

Seven Gauteng schools kiss the chalkboard goodbye

Seven schools in Tembisa in Ekurhuleni are stepping bravely into the digital future tomorrow morning. Briefing the media at Boitumelong Secondary School this afternoon Gauteng Education MEC Panyaza Lesufi said: “I’m signing the death warrant of the chalk, duster and chalkboard in Gauteng. We are moving on with the times and we are moving to better things.” ….more

Medical Aid Films – new films in 2015

We at Medical Aid Films have new productions coming up in the next few months and would like to inform you of what is in production and will be available for your use in 2015. For those of you who do not know of our work you can access our freely available training and education films which we hope can complement your existing training materials here: http://medicalaidfilms.org/our-films/

For those of you already using our films please take the time to complete our short online survey (https://www.surveymonkey.com/s/JTLC6FQ) as this helps us to improve the films (10 minutes of your time), for those of you who have already done so and continue to provide feedback – thank you our expertise and understanding grows with every new piece of information and our films evolve for better use in your programs.

New films in 2015:

1. Kangaroo Mother Care – we are aware of some great existing materials by a few organisations and will be producing a film that is complementary to these.

2. Respectful Maternity Care Animation about respecting women’s basic human rights in childbirth. White Ribbon Alliance will use the film to train health workers and communities in Nigeria and Malawi, with the film available worldwide in the spring.

3. We are commencing a suite of Fistula Care training films for nurses. We will start with a pilot film, training nurses on pre and post-operative care for fistula surgery patients with Fistula Foundation. Once tested we hope to develop further films in this suite to complement further training.

4. Managing Obstructed Labour for nurse/midwife training will be developed thanks to Vitol Foundation later this year and will serve to complement the Fistula Care suite.

5. As part of 5 films identified for Reproductive Health we will be releasing the first pilot film for testing in February. Thanks so much to Pathfinder International who let us film with them in Nairobi and to so many other partners who gave us so much time and expertise to draft these films. We aim to have the five developed later in 2015 once we have tested the first film.

6. Ebola films for mobile devices – to complement the many training resources on Ebola we are planning two short animations on stigma and rebuilding trust in health systems.

Thank you to so many of you who have helped and supported our work, we make these films in the hope that they can support your training. Some amazing people have shared their stories, contributing to films that really put community members and health workers at the heart. We are hugely grateful to all our partners for their incredible work with us.

Finally, one last ask of HIFA members is that we are improving the look and accessibility of our website as a priority this year, so please let us know your thoughts on what you think works and doesn’t work and how you would like to access our materials by emailing josie@medicalaidfilms.org.  

Anyone particularly interested in any upcoming productions and would like to be involved or give advice please also get in touch with me directly: josie@medicalaidfilms.org

Best wishes from everyone at Medical Aid Films

HIFA profile: Josie Gallo is Content Co-ordinator for Medical Aid Films in the United Kingdom. Professional interests: Media for development.       josie AT medicalaidfilms.org

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To send a message to the HIFA forum, simply send an email to: HIFA2015@dgroups.org

Design features of an online CoP as a continuing education strategy

Neil [see note below] notified us a little while ago of this article: Evans, C, Yeung, E, Markoulakis, R and Guilcher, S (2014) An Online Community of Practice to Support Evidence-Based Physiotherapy Practice in Manual Therapy, Journal of Continuing Education in the Health Professions, Volume 34, Issue 4, pages 215?223.

I read it and thought I’d share some ideas. The premise of the example is quite simple: to describe the design features of an online CoP as a continuing education strategy and to explore how the community promoted the creation and sharing of new knowledge in evidence-based manual therapy using Wenger’s constructs of mutual engagement, joint enterprise, and shared repertoire as a theoretical framework.

Mutual engagement, joint enterprise and shared repertoire are fundamental but also quite simple:

Mutual engagement refers to membership in a community in which participants, with their unique identities and diverse specializations, draw on each other and are engaged in doing things together.

Joint enterprise is the practices of the community, defined as the result of a collective process of negotiation.

Shared repertoire includes tools, routine, stories, jargon, shortcuts, or any resource that may be used over time in a shared pursuit to negotiate meaning.

They created a ten week course on using research evidence in practice and recruited Canadian physiotherapists all of whom had at least ten years experience. There were weekly activities and debates, and three assignments – carrying out an online search, critical appraisal, and writing a review for publication. The course appears to have been very successful; participants were active and gave good reports afterwards.

The authors argue that the course was in fact a community of practice, and provide evidence to show that it meets all the standard criteria as a learning CoP. It was also clear that this worked in an online format (using the Blackboard learning management system). The activity and the results of the course are convincingly analysed, using a very solid theoretical framework.

But I think the article is perhaps less value than it might sound. The authors conclude:

“Lessons for Practice

– Continuing education courses founded on community of practice principles can provide opportunities for collaborative, interactive learning.

– Participants in an online community of practice can share and create knowledge related to their practice through mutual engagement in shared endeavours.

– Design features such as guiding questions, instructor facilitation, and collaborative assignments help to create active, sustained participation in a fully online course.”

But they had ideal circumstances for the course to succeed: the best kind of participants, experienced professionals, used to consultative practices. And they note themselves that they have no idea if the connections created in this temporary CoP were continued after the course ended. (That goes under the heading of further research needed.)

I think we knew that such courses can succeed, but I am looking for a lot more than that. A CoP has to be ongoing. It might well start with a course that captures the imagination of a bunch of professionals or technicians, but there needs to be a platform for the connections made to continue afterwards. (The authors do not say whether the Blackboard platform remained available for the participants after the course finished. Knowing what universities are like these days, that seems unlikely.) The CoP structure and technology also need to be dynamic to encompass the dynamic requirements of the membership – it is a community, an organic thing – and it will ebb and flow in unpredictable ways. We need to be looking at experiments which deal with much less defined boundaries than a ten week course to find out how best to share knowledge on a continuous basis. [*see note below]

HIFA profile: Rob Parsons is a Healthcare Technology Management Consultant at Health Partners International, UK. Professional interests: Healthcare technology management, open source software, knowledge management, social media, open educational resources. robsub AT ariadne.org.uk

[*Note from HIFA moderator (Neil PW): HIFA itself is a Community of Practice on the Dgroups platform, which has more than 700 active CoPs supported by international development organisations. HIFA was evaluated in 2011 and the report identifies markers of success and recommendations for improvement (which we have only partially been able too implement, due to lack of resources). As Coordinator of HIFA and current Chair of the Dgroups Foundation, I would welcome expressions of interest from researchers who would like to undertake further research on HIFA and/or Dgroups.]

Neuroplasticity

Yesterday, the Chiawelo community practice team attended a fascinating discussion on Neuroplasticity, reading Catherine Malabou’s book called What should we do with our brain.

In the chapter : the central power in crisis, we explored the question: What is the main transition point between the neuronal and the political?

If the biological and the social mirror in each other, how do we think around health promotion, behavior change, and a change in social networking that enables the health revolution at CCP?

ICT knowledge, utilization and perception among healthcare providers at National Hospital Abuja, Nigeria

Below is the citation and abstract of a new paper in the American Journal of Health Research. The full text is available here:

http://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.s.2015030101.17.pdf

CITATION: ICT knowledge, utilization and perception among healthcare providers at National Hospital Abuja, Nigeria

Ibrahim Taiwo Adeleke1, Adejoke Abiola Salami, Moses Achinbee, Tony Chucks Anamah

American Journal of Health Research 2015; 3(1-1): 47-53

doi: 10.11648/j.ajhr.s.2015030101.17

ABSTRACT

Background: Healthcare system in Nigeria is moving towards digitalization especially in the management of patients’ health information, with a view to harmonizing medical care practice for improved healthcare quality. Information and communication technology (ICT) has transformed the way people collaborate, identify potential collaborators or friends, communicate with each other, and identify information that is relevant to their practice.

Rationale: Thus, ICT has been identified as one measure to ensure these emerging trends in the Nation’s healthcare systems.

Design/objectives: This study deployed a cross-sectional structured questionnaire to determine ICT knowledge and utilization among healthcare providers at National Hospital Abuja (n=271). Methods: We devised stratified random sampling in the recruitment of participants.

Result: It was found that profession, possession of a laptop computer, age and sex were associated with knowledge, utilization and perception of ICT. Most participants were advanced in the use of electronic mail (51.8%) and the Internet (47.1%) mostly acquired through self-efforts (46.5%). However, a greater portion of the participants exhibited poor knowledge of database management (47.8%) and statistical analysis package (46.3%). The vast majority have used computer (95.0%) and the Internet (93.6%) for more than 3 years and many (86.2 percent) expressed a desire for further ICT training. Virtually, all participants in this study opined that ICT will improve medical care quality but some anticipated concerns over medical confidentiality as ICT becomes widely adopted in the country’s healthcare systems. Aside their poor skill in database design and statistical analysis software, healthcare providers at National Hospital, Abuja possessed good knowledge and disposition towards ICT especially for the enhancement of their professional practice and for public health quality improvement. They indicated interest in further ICT training in order to enhance their information sources for an improved practice. It would be worthwhile to enrich their sources of information in order to improve public health.

Best wishes, Neil PW

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

HIFA profile: Neil Pakenham-Walsh is the coordinator of the HIFA campaign (Healthcare Information For All) and co-director of the Global Healthcare Information Network. He is also currently chair of the Dgroups Foundation (www.dgroups.info), a partnership of 18 international development organisations promoting dialogue for international health and development. He started his career as a hospital doctor in the UK, and has clinical experience as an isolated health worker in rural Ecuador and Peru.  For the last 20 years he has been committed to the global challenge of improving the availability and use of relevant, reliable healthcare information for health workers and citizens in low- and middle-income countries. He is also interested in the wider potential of inclusive, interdisciplinary communication platforms to help address global health and international development challenges. He has worked with the World Health Organization, the Wellcome Trust, Medicine Digest and INASP (International Network for the Availability of Scientific Publications). He is based near Oxford, UK. www.hifa2015.org  neil.pakenham-walsh AT ghi-net.org

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To send a message to the HIFA forum, simply send an email to: HIFA2015@dgroups.org

South African Family Practice Vol 56 No 6: November/December 2014

South African Family Practice

Vol 56 No 6: November/December 2014

Table of Contents

http://www.safpj.co.za/index.php/safpj/issue/view/344

Editorials

——–

Tribute: Douw GS Greeff – 6 November 1974-11 November 2014 (3)

Gboyega A Ogunbanjo

Review Articles

——–

Evidence-based treatment of acute otitis externa (6-8)

Kim Outhoff

Acute non-specific low back pain in primary care (10-14)

Kim Outhoff

Analgesic strategies (16-18)

C Quan

How sick is your appendectomy? (19-23)

N T Hlongwane

The Burning Truth(s) (24-26)

R Moore

Tuberculosis: the implications for anaesthesia (28-31)

T A Jackson, J M Thomas

Part 2: Medico-legal documentation – Practical completion of pages 1 and 4

of the J88 form (32-37)

J Marianne Kotze, Hanneke Brits, Mofalali S Monatisa, Johan Botes

Peripheralia

——–

The whirling dervishes (44)

Chris Ellis

________________________________________________________________________

South African Family Practice journal

http://www.safpj.co.za

Articles from Human Resources for Health, published between 26-Nov-2014 and 28-Dec-2014

Research  

Current employment characteristics and career intentions of Lithuanian dentists

Janulyte V, Aleksejuniene J, Puriene A, Peciuliene V, Benzian H

Human Resources for Health 2014, 12 :74 (20 December 2014)

Abstract | Provisional PDF | PubMed

Research  

Effects of a performance and quality improvement intervention on the work environment in HIV-related care: a quasi-experimental evaluation in Zambia

Bazant E, Sarkar S, Banda J, Kanjipite W, Reinhardt S, Shasulwe H, Mulilo JM, Kim YM

Human Resources for Health 2014, 12 :73 (20 December 2014)

Abstract | Provisional PDF | PubMed

Research  

A scoping review of training and deployment policies for human resources for health for maternal, newborn, and child health in rural Africa

Murphy GT, Goma F, MacKenzie A, Bradish S, Price S, Nzala S, Rose AE, Rigby J, Muzongwe C, Chizuni N, Carey A, Hamavhwa D

Human Resources for Health 2014, 12 :72 (16 December 2014)

Abstract | Provisional PDF | PubMed

Research  

Rwanda’s evolving community health worker system: a qualitative assessment of client and provider perspectives

Condo J, Mugeni C, Naughton B, Hall K, Tuazon MA, Omwega A, Nwaigwe F, Drobac P, Hyder Z, Ngabo F, Binagwaho A

Human Resources for Health 2014, 12 :71 (13 December 2014)

Abstract | Provisional PDF | PubMed

Research  

Impact of hospital mergers on staff job satisfaction: a quantitative study

Lim K

Human Resources for Health 2014, 12 :70 (12 December 2014)

Abstract | Full Text | PDF | PubMed

Research  

Outcomes associated with nurse practitioners in collaborative practice with general practitioners in rural settings in Canada: a mixed methods study

Roots A, MacDonald M

Human Resources for Health 2014, 12 :69 (11 December 2014)

Abstract | Provisional PDF | PubMed

Research  

Community health workers programme in Luanda, Angola: an evaluation of the implementation process

Giugliani C, Duncan BB, Harzheim E, Lavor AC, Lavor MC, Machado MM, Barbosa MI, Bornstein VJ, Pontes AL, Knauth DR

Human Resources for Health 2014, 12 :68 (9 December 2014)

Abstract | Provisional PDF | PubMed

Research  

Needs-based human resources for health planning in Jamaica: using simulation modelling to inform policy options for pharmacists in the public sector

Tomblin Murphy G, MacKenzie A, Guy-Walker J, Walker C

Human Resources for Health 2014, 12 :67 (6 December 2014)

Abstract | Full Text | PDF | PubMed

Research  

Payday, ponchos, and promotions: a qualitative analysis of perspectives from non-governmental organization programme managers on community health worker motivation and incentives

B-Lajoie M, Hulme J, Johnson K

Human Resources for Health 2014, 12 :66 (5 December 2014)

Abstract | Full Text | PDF | PubMed

BMJ EvidenceUpdates for: 1/12/2015

Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care. BMJ

Rapid diagnostic tests for diagnosing uncomplicated non-falciparum or Plasmodium vivax malaria in endemic countries. Cochrane Database Syst Rev

IQ at 6 years after in utero exposure to antiepileptic drugs: A controlled cohort study. Neurology

Is there a case for mental health promotion in the primary care setting? A systematic review. Prev Med

Slick apps set to make their appearance when Apple Watch makes its debut

I HAVE seen some of the applications that will launch for the Apple Watch when it makes its debut as early as March, albeit in simulation, and some are extraordinary. Along with the details Apple has already released about how the watch will work, it has convinced me Apple Watch will be a launching pad for the next wave of billion-dollar consumer-tech start-ups…..more

APPG Global Health: Mental Health Report

“The challenge is we have in the order of a billion people on the planet who will have a mental health problem in their lifetime and not get evidence based care for it…’, says Gary Belkin, Executive Deputy Commissioner, New York City Department of Health and Mental Hygiene, in a new report from the (UK) All Party Parliamentary Group for Global Health and APPG on Mental Health.

“We have such good cost-effective interventions. Treatments for mental disorders are as cost-effective as those for other chronic diseases like diabetes”

Vikram Patel, Wellcome Trust Senior Research Fellow, London School of Hygiene & Tropical Medicine

The report makes a number of recommendations, two of which are particularly relevant to HIFA:

Recommendation 2: NGOs and others working in international development should support staff to understand the needs and capacities of people with mental health problems, encourage the inclusion of people with mental disorders in their general development programmes, set up new mental health specific programmes,and measure the impact of their programmes on mental health

Recommendation 3: Professional bodies and mental health providers, with the support of government, should establish and expand trainingand research partnerships with low and middle income countries – seekingto teach and to learn about professional skills, tackling discrimination and policy reform

You can freely download the report here:

http://www.appg-globalhealth.org.uk/

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

PLoS Medicine: A Stronger Post-Publication Culture Is Needed for Better Science

Below is the citation and an extract from an editorial in the open-access journal PLoS Medicine.

CITATION: Bastian H (2014) A Stronger Post-Publication Culture Is Needed for Better Science. PLoS Med 11(12): e1001772. doi:10.1371/journal.pmed.1001772

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001772

‘Passive consumption of scientific papers, and the withholding of adequate information by authors, cannot advance science. Thinking and talking about our responses to research reports is still science’s vibrant and compelling intellectual core. Capturing that post-publication intellectual effort more rigorously is essential for better science.’

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

An online community of practice to support evidence-based physiotherapy practice in manual therapy

Please see below the citation, abstract, and lessons for practice from a new paper in the Journal of Continuing Education in the Health Professions (with thanks to Irina Ibraghimova and LRC Network). The full text is freely available here: http://onlinelibrary.wiley.com/doi/10.1002/chp.21253/full

I would like to mention that HIFA itself is an example of a ‘community of practice’ and we would welcome expressions of interest from researchers who may like to explore the impact of HIFA on policy and practice.

CITATION: Evans C, Yeung E, Markoulakis R, Guilcher S. An online community of practice to support evidence-based physiotherapy practice in manual therapy.

J Contin Educ Health Prof. 2014 Oct;34(4):215-23. doi: 10.1002/chp.21253.

ABSTRACT

INTRODUCTION: The purpose of this study was to explore how a community of practice promoted the creation and sharing of new knowledge in evidence-based manual therapy using Wenger’s constructs of mutual engagement, joint enterprise, and shared repertoire as a theoretical framework.

METHODS: We used a qualitative approach to analyze the discussion board contributions of the 19 physiotherapists who participated in the 10-week online continuing education course in evidence-based practice (EBP) in manual therapy. The course was founded on community of practice, constructivism, social, and situated learning principles.

RESULTS: The 1436 postings on 9 active discussion boards revealed that the community of practice was a social learning environment that supported strong participation and mutual engagement. Design features such as consistent facilitation, weekly guiding questions, and collaborative assignments promoted the creation and sharing of knowledge. Participants applied research evidence to the contexts in which they worked through reflective comparison of what they were reading to its applicability in their everyday practice. Participants’ shared goals contributed to the common ground established in developing collective knowledge about different study designs, how to answer research questions, and the difficulties of conducting sound research.

DISCUSSION: An online longitudinal community of practice utilized as a continuing education approach to deliver an online course based on constructivist and social learning principles allowed geographically dispersed physiotherapists to be mutually engaged in a joint enterprise in evidence-based manual therapy. Advantages included opportunity for reflection, modeling, and collaboration. Future studies should examine the impact of participation on clinical practice.

LESSONS FOR PRACTICE

1. Continuing education courses founded on community of practice principles can provide opportunities for collaborative, interactive learning.

2. Participants in an online community of practice can share and create knowledge related to their practice through mutual engagement in shared endeavors.

3. Design features such as guiding questions, instructor facilitation, and collaborative assignments help to create active, sustained participation in a fully online course.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

BMJ EvidenceUpdates 2014-12-29: What’s everyone reading now?

#

Article Title

1

Long-term proton pump inhibitor (PPI) use and the development of gastric pre-malignant lesions.

Cochrane Database Syst Rev

2

Interventions for enhancing medication adherence.

Cochrane Database Syst Rev

3

Six- Versus Twelve-Week Antibiotic Therapy for Nonsurgically Treated Diabetic Foot Osteomyelitis: A Multicenter Open-Label Controlled Randomized Study.

Diabetes Care

4

Heart Failure, Saxagliptin, and Diabetes Mellitus: Observations from the SAVOR-TIMI 53 Randomized Trial.

Circulation

5

The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.

Cochrane Database Syst Rev

6

Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease.

Cochrane Database Syst Rev

7

Effects of Coenzyme Q10 on Statin-Induced Myopathy: A Meta-analysis of Randomized Controlled Trials.

Mayo Clin Proc

8

Early versus on-demand nasoenteric tube feeding in acute pancreatitis.

N Engl J Med

9

Recommendations on screening for prostate cancer with the prostate-specific antigen test.

CMAJ

10

Early additional food and fluids for healthy breastfed full-term infants.

Cochrane Database Syst Rev