Cargando…
Task-shifting impact of introducing a pilot community health worker cadre into Zambia’s public sector health workforce
BACKGROUND: The Zambia Ministry of Health (MOH) recruited and trained a new cadre of Community Health Assistants (CHAs) as part of its National Community Health Strategy. The inaugural class of 307 CHAs completed one year of training in July 2012 and deployed to their communities. METHODS: The impac...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540482/ https://www.ncbi.nlm.nih.gov/pubmed/28767719 http://dx.doi.org/10.1371/journal.pone.0181740 |
_version_ | 1783254640899391488 |
---|---|
author | Keller, Brett McCarthy, Elizabeth Bradford Vosburg, Kathryn Musonda, Mutinta Mwila, Jere van den Broek, Jan Willem Walsh, Fiona J. |
author_facet | Keller, Brett McCarthy, Elizabeth Bradford Vosburg, Kathryn Musonda, Mutinta Mwila, Jere van den Broek, Jan Willem Walsh, Fiona J. |
author_sort | Keller, Brett |
collection | PubMed |
description | BACKGROUND: The Zambia Ministry of Health (MOH) recruited and trained a new cadre of Community Health Assistants (CHAs) as part of its National Community Health Strategy. The inaugural class of 307 CHAs completed one year of training in July 2012 and deployed to their communities. METHODS: The impact of the CHA program on the volume and type of health services provided at health posts and their respective referral health centers was measured with a non-randomized difference-in-differences design. Monthly health service provision data was collected for 12 months before and after CHA deployment at 8 health posts along with 8 referral health centers. The analysis controlled for seasonality, changes in non-CHA staffing, and periodic regional child health campaigns, and used facility-level fixed effects. RESULTS: Deploying two CHAs to a health post did not lead to a statistically-discernible increase in services at the intervention facilities. Health services provided at referral health centers increased by 697.9 services per month (95% CI: 131.4 to 1,264.3, p = .016), and combined services (at health posts and referral health centers) increased by 848.6 services per month (95% CI: 178.2 to 1,519.1, p = .013). CONCLUSION: In this pilot, the addition of CHAs in rural areas increased health service provision at referral health facilities and at facilities overall, shifting the burden of basic health services away from more highly trained health workers. Shifting tasks to lesser-trained, less-expensive cadres like the CHAs, policymakers can rapidly improve access to care with constrained budgets. Evaluations measuring the direct impact of lower level cadres without accounting for task-shifting may underestimate their contribution to the health workforce. |
format | Online Article Text |
id | pubmed-5540482 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-55404822017-08-12 Task-shifting impact of introducing a pilot community health worker cadre into Zambia’s public sector health workforce Keller, Brett McCarthy, Elizabeth Bradford Vosburg, Kathryn Musonda, Mutinta Mwila, Jere van den Broek, Jan Willem Walsh, Fiona J. PLoS One Research Article BACKGROUND: The Zambia Ministry of Health (MOH) recruited and trained a new cadre of Community Health Assistants (CHAs) as part of its National Community Health Strategy. The inaugural class of 307 CHAs completed one year of training in July 2012 and deployed to their communities. METHODS: The impact of the CHA program on the volume and type of health services provided at health posts and their respective referral health centers was measured with a non-randomized difference-in-differences design. Monthly health service provision data was collected for 12 months before and after CHA deployment at 8 health posts along with 8 referral health centers. The analysis controlled for seasonality, changes in non-CHA staffing, and periodic regional child health campaigns, and used facility-level fixed effects. RESULTS: Deploying two CHAs to a health post did not lead to a statistically-discernible increase in services at the intervention facilities. Health services provided at referral health centers increased by 697.9 services per month (95% CI: 131.4 to 1,264.3, p = .016), and combined services (at health posts and referral health centers) increased by 848.6 services per month (95% CI: 178.2 to 1,519.1, p = .013). CONCLUSION: In this pilot, the addition of CHAs in rural areas increased health service provision at referral health facilities and at facilities overall, shifting the burden of basic health services away from more highly trained health workers. Shifting tasks to lesser-trained, less-expensive cadres like the CHAs, policymakers can rapidly improve access to care with constrained budgets. Evaluations measuring the direct impact of lower level cadres without accounting for task-shifting may underestimate their contribution to the health workforce. Public Library of Science 2017-08-02 /pmc/articles/PMC5540482/ /pubmed/28767719 http://dx.doi.org/10.1371/journal.pone.0181740 Text en © 2017 Keller et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Keller, Brett McCarthy, Elizabeth Bradford Vosburg, Kathryn Musonda, Mutinta Mwila, Jere van den Broek, Jan Willem Walsh, Fiona J. Task-shifting impact of introducing a pilot community health worker cadre into Zambia’s public sector health workforce |
title | Task-shifting impact of introducing a pilot community health worker cadre into Zambia’s public sector health workforce |
title_full | Task-shifting impact of introducing a pilot community health worker cadre into Zambia’s public sector health workforce |
title_fullStr | Task-shifting impact of introducing a pilot community health worker cadre into Zambia’s public sector health workforce |
title_full_unstemmed | Task-shifting impact of introducing a pilot community health worker cadre into Zambia’s public sector health workforce |
title_short | Task-shifting impact of introducing a pilot community health worker cadre into Zambia’s public sector health workforce |
title_sort | task-shifting impact of introducing a pilot community health worker cadre into zambia’s public sector health workforce |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540482/ https://www.ncbi.nlm.nih.gov/pubmed/28767719 http://dx.doi.org/10.1371/journal.pone.0181740 |
work_keys_str_mv | AT kellerbrett taskshiftingimpactofintroducingapilotcommunityhealthworkercadreintozambiaspublicsectorhealthworkforce AT mccarthyelizabeth taskshiftingimpactofintroducingapilotcommunityhealthworkercadreintozambiaspublicsectorhealthworkforce AT bradfordvosburgkathryn taskshiftingimpactofintroducingapilotcommunityhealthworkercadreintozambiaspublicsectorhealthworkforce AT musondamutinta taskshiftingimpactofintroducingapilotcommunityhealthworkercadreintozambiaspublicsectorhealthworkforce AT mwilajere taskshiftingimpactofintroducingapilotcommunityhealthworkercadreintozambiaspublicsectorhealthworkforce AT vandenbroekjanwillem taskshiftingimpactofintroducingapilotcommunityhealthworkercadreintozambiaspublicsectorhealthworkforce AT walshfionaj taskshiftingimpactofintroducingapilotcommunityhealthworkercadreintozambiaspublicsectorhealthworkforce |