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Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?

Recent years have seen increasing momentum towards task shifting of basic health services, including using community health workers (CHW) to diagnose and treat common childhood illnesses. Yet few studies have examined the role of traditional healers in meeting families’ and communities’ health needs...

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Autores principales: Dalglish, Sarah L, Straubinger, Sarah, Kavle, Justine A, Gibson, Lacey, Mbombeshayi, Evariste, Anzolo, Jimmy, Scott, Kerry, Pacqué, Michel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6615876/
https://www.ncbi.nlm.nih.gov/pubmed/31354973
http://dx.doi.org/10.1136/bmjgh-2019-001529
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author Dalglish, Sarah L
Straubinger, Sarah
Kavle, Justine A
Gibson, Lacey
Mbombeshayi, Evariste
Anzolo, Jimmy
Scott, Kerry
Pacqué, Michel
author_facet Dalglish, Sarah L
Straubinger, Sarah
Kavle, Justine A
Gibson, Lacey
Mbombeshayi, Evariste
Anzolo, Jimmy
Scott, Kerry
Pacqué, Michel
author_sort Dalglish, Sarah L
collection PubMed
description Recent years have seen increasing momentum towards task shifting of basic health services, including using community health workers (CHW) to diagnose and treat common childhood illnesses. Yet few studies have examined the role of traditional healers in meeting families’ and communities’ health needs and liaising with the formal health system. We examine these issues in Tshopo Province in the Democratic Republic of the Congo, a country with high rates of child mortality (104 deaths per 1000 live births). We conducted 127 in-depth interviews and eight focus group discussions with a range of community members (mothers, fathers and grandmothers of children under 5 years of age) and health providers (CHWs, traditional healers, doctors and nurses) on topics related to care seeking and case management for childhood illness and malnutrition, and analysed them iteratively using thematic content analysis. We find significant divergence between biomedical descriptions of child illness and concepts held by community members, who distinguished between local illnesses and so-called ‘white man’s diseases.’ Traditional healers were far less costly and more geographically accessible to families than were biomedical health providers, and usually served as families’ first recourse after home care. Services provided by traditional healers were also more comprehensive than services provided by CHWs, as the traditional medicine sphere recognised and encompassed care for ‘modern’ diseases (but not vice versa). Meanwhile, CHWs did not receive adequate training, supervision or supplies to provide child health services. Considering their accessibility, acceptability, affordability and ability to recognise all domains of illness (biomedical and spiritual), traditional healers can be seen as the de facto CHWs in Tshopo Province. National and international health policymakers should account for and involve this cadre of health workers when planning child health services and seeking to implement policies and programmes that genuinely engage with community health systems.
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spelling pubmed-66158762019-07-28 Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo? Dalglish, Sarah L Straubinger, Sarah Kavle, Justine A Gibson, Lacey Mbombeshayi, Evariste Anzolo, Jimmy Scott, Kerry Pacqué, Michel BMJ Glob Health Research Recent years have seen increasing momentum towards task shifting of basic health services, including using community health workers (CHW) to diagnose and treat common childhood illnesses. Yet few studies have examined the role of traditional healers in meeting families’ and communities’ health needs and liaising with the formal health system. We examine these issues in Tshopo Province in the Democratic Republic of the Congo, a country with high rates of child mortality (104 deaths per 1000 live births). We conducted 127 in-depth interviews and eight focus group discussions with a range of community members (mothers, fathers and grandmothers of children under 5 years of age) and health providers (CHWs, traditional healers, doctors and nurses) on topics related to care seeking and case management for childhood illness and malnutrition, and analysed them iteratively using thematic content analysis. We find significant divergence between biomedical descriptions of child illness and concepts held by community members, who distinguished between local illnesses and so-called ‘white man’s diseases.’ Traditional healers were far less costly and more geographically accessible to families than were biomedical health providers, and usually served as families’ first recourse after home care. Services provided by traditional healers were also more comprehensive than services provided by CHWs, as the traditional medicine sphere recognised and encompassed care for ‘modern’ diseases (but not vice versa). Meanwhile, CHWs did not receive adequate training, supervision or supplies to provide child health services. Considering their accessibility, acceptability, affordability and ability to recognise all domains of illness (biomedical and spiritual), traditional healers can be seen as the de facto CHWs in Tshopo Province. National and international health policymakers should account for and involve this cadre of health workers when planning child health services and seeking to implement policies and programmes that genuinely engage with community health systems. BMJ Publishing Group 2019-07-03 /pmc/articles/PMC6615876/ /pubmed/31354973 http://dx.doi.org/10.1136/bmjgh-2019-001529 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Research
Dalglish, Sarah L
Straubinger, Sarah
Kavle, Justine A
Gibson, Lacey
Mbombeshayi, Evariste
Anzolo, Jimmy
Scott, Kerry
Pacqué, Michel
Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?
title Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?
title_full Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?
title_fullStr Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?
title_full_unstemmed Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?
title_short Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?
title_sort who are the real community health workers in tshopo province, democratic republic of the congo?
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6615876/
https://www.ncbi.nlm.nih.gov/pubmed/31354973
http://dx.doi.org/10.1136/bmjgh-2019-001529
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