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Community Health Workers Work practice and Intervention

Community Health Workers Work practice and Intervention. June 2011 Abyot, University of Oslo/HISP. Background - India. The routines Recording Tracking Reporting Health Service Family planning Pregnancy care Immunization Nutrition Sanitation … …. Background – Ethiopia (April 2009).

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Community Health Workers Work practice and Intervention

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  1. Community Health Workers Work practice and Intervention June 2011 Abyot, University of Oslo/HISP

  2. Background - India • The routines • Recording • Tracking • Reporting • Health Service • Family planning • Pregnancy care • Immunization • Nutrition • Sanitation • … • …

  3. Background – Ethiopia (April 2009) • Similar practice

  4. The major routines - Recording • CHW maintaining on average 20 registers • ANC register • Immunization register • TB Register • Birth • Death Register • …

  5. Example (ANC Register) • no of live/still birth perivous • no of children • Expected date of delivery • …. • …. Program Stage Instance ANC Registration ANC 1 Visit Case register • IFA tablets • TT Booster • Anemic • TT 1 date • TT2 date • ANC Complications ANC 2 Visit Mother Care ANC 3 Visit Program Instance • Delivery Date • Place of Delivery • Abortion • Still Birth (patient) • Blood Pressure after delivery • Pulse after delivery • Temperature after delivery • Any abnormality in Plancenta • Breast feeding initiated at time of birth Delivery PNC

  6. Major routine - Recording • Issues for standardization/policy • Number of stages • 5 stage practice as suggested by WHO**? • What if we have high risk mothers? • for example the poor states of India follow a 7 stage practice • Dataelements • What are we going to record under each stage? • For example talking about weight while there is no weighing machine • Interoperability • With issues of migration • Storage • Where, how **http://whqlibdoc.who.int/hq/2001/WHO_RHR_01.30.pdf

  7. Major routine - Tracking • Issues for standardization/policy • Individual identification number • National level? • Capacity/scale… • Facility level? • Migration… • House numbering • Culture of settlement in the rural community • Naming – ??“Wife Of”, “Son/Daughter Of”?? • Visit plan • Strict follow up of the protocol? • Holidays?

  8. Major routine - Reporting • Issues for standardization/policy • Dataelements (minimum dataset) • Information for local action • Who reports what • Especially during migration and uncompleted services • Aggregation scheme to feed national reporting systems • For example age group • HL7??

  9. Interventions • Assessment of major HIS artifacts (developing countries) Two domains: Aggregate Hospital/Clinic

  10. Limitations – aggregate systems • Data quality • “Why is it that despite high [Routine Immunization] coverage, we are failing to eradicate diseases like polio? We have to start double checking immunization numbers being [reported] to us by states ... once vaccination data becomes name based rather than number based, we will be able to account for the exact number of children actually vaccinated” The Times of India, 15 September 2009. “Azad doubts data on child vaccination. http://timesofindia.indiatimes.com/india/Azad-doubts-data-on-child-vaccination/articleshow/5011257.cms • Routine reporting systems suffer from problems of data quality Mate K.S., Bennett B., Mphatswe W., Barker P., Rollins N.(2009). Challenges for Routine Health System Data Management in a Large Public Programme to Prevent Mother-to-Child HIV Transmission in South Africa. PLoS ONE 4(5): e5483. doi:10.1371/journal.pone.0005483. • Workload • “More than this reporting system, I also want a system which can tell me when a due date is for my pregnant woman; it is difficult to calculate delivery dates by hand” HEW from India, Feb. 2009 • Manual tallying

  11. Limitations – Hospital/clinic systems • Fundamental conceptual difference • patients will be coming to a clinic/hospital to get the required service • hospital working practice • laboratory data (including imaging), • drug supply, billing and also human resource. very complex to computerize even for the world’s richest nations

  12. Community system • Preventive practice • Light weight application - mHealth

  13. DHIS-Community module (mHealth) • Assist CHW work practices • Registration/recording • Tracking and • Reporting

  14. 3 ANC Process 5 Old Cases Monthly activity plan for CHW generated by computer Monthly compilation report Third visit for Individual CCC Based on monthly activity plan CHW schedules her activity CHW sends monthly compilation report Second visit & TT2 for Individual BBB Activity Plan PNC visit for Individual AAA Old Cases 4 2 100 IFA for Individual XXX (name, age, phone no., address,…. other required details) 1 Pregnant women gets registered & receives some services Sub Centre (CHW) New registration MCH Register

  15. DHIS-Community module Architecture

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