Effectiveness of community health workers in Brazil: a systematic review

The objective of this study is to assess the effectiveness of community health workers (CHWs) in Brazil. This systematic review included all studies that sought to assess interventions involving CHWs. Despite the low quality of evidence for most outcomes, analysis of the 23 publications included often found benefit for CHW intervention, best documented for frequency of child weighing, prevalence of breast-feeding, and delayed introduction of bottle-feeding. These findings and the current major role CHWs play in Brazil suggest that clarifying the benefit of CHW actions across a broad range of health care interventions should be a major research priority.     

Fitness for work in health care workers: biological risk

The aim of this contribution is to propose good medical practice in formulating and managing fitness for work (FFW) for health care workers exposed to biological agents. A literature review was conducted, together with a critical analysis of available scientific evidence and presentation of practical examples taken from the Italian multicentric study in which the authors have been participating since 2008. Within the health care sector and with special reference to biological risk, making and subsequently managing a FFW for a specific job is in fact a particularly arduous task for the occupational physician and for the entire hospital management system. The process that leads to issuing a FFW needs to follow the appropriate guidelines and good technical and scientific practice and also take into careful consideration current legislation (national, regional, etc); it is the result of a well grounded balance between professional ethics, rights and duties of the worker and patient, but also of the employer and of all those involved. All these aspects need to be adapted to the single work situations, applying the principle of precaution and careful flexibility in management, with accurate evaluation of each individual clinical case with its peculiarities and referral, where necessary, to expert opinion. It is also indispensable to have in place a clear and jointly agreed hospital management policy where co-responsibility is taken by each single actor, always with due respect for specific roles, so that the Occupational Physician and employers are not left to manage the issue alone.     

The relative influence of the community and the health system on work performance: a case study of community health workers in Colombia

A central component of the primary health care approach in developing countries has been the development and utilization of community-based health workers (CHWs) within the national health system. While the use of these front line workers has the potential to positively influence health behavior and health status in rural communities, there continues to be challenges to effective implementation of CHW programs. Reports of high turnover rates, absenteeism, poor quality of work, and low morale among CHWs have often been associated with weak organizational and managerial capacity of government health systems. However, no systematic research has examined the contribution of work-related factors to CHW job performance. The research reported in this paper examines the relative influence of reward and feedback factors associated with the community compared to those associated with the health system on the performance of CHWs. The data are drawn from a broader study of health promoters (CHWs) conducted in two departments (provinces) in Colombia in 1986. The research was based on a theoretical model of worker performance that focuses on job related sources of rewards and feedback. A survey research design was employed to obtain information from a random sample of rural health promoters (N = 179) and their auxiliary nurse supervisors about CHW performance and contributing factors. The findings indicate that feedback and rewards from the community have a greater influence on work performance (defined as degree of perceived goal attainment on job tasks) than do those stemming from the health system.(ABSTRACT TRUNCATED AT 250 WORDS)     

Assessment of fitness for work in health care workers: biomechanical risk factors

In current practice the assessment of fitness for work in health care workers exposed to biomechanical risk factors is often based on conventional approaches rather than on evidence-based guidelines. However, an accurate evaluation of worker's psychophysical resources compared to job demand and potential occupational risk factors is essential in order to properly assess fitness for work. The latest published guidelines on the management of patients suffering from back pain reported that the evidence-based approach can minimize the period of inactivity by encouraging return to work (and to other non-dangerous physical activities) in a relatively short period of time. As for carpal tunnel syndrome, there is no scientific evidence supporting a restriction of physical activities requiring forceful movements of the hand/wrist.     

福州社区卫技人员工作满意度与稳定性调查

采用问卷调查和半结构式访谈相结合的方法,对福州市社区卫生服务中心卫技人员进行工作满意度和稳定性调查。结果显示目前福州社区卫技人员的工作总体满意度不高,最不满意的是工资、福利;高学历年轻医生流失严重。对此,提出提高薪酬水平、满足自我实现需要、关注高学历年轻医生的发展等建议。     

城市社区卫生服务规范内容和支持条件的研究

鉴于中国广阔的地域和其社区卫生服务发展不均衡及服务内容不规范等问题,该文对我国目前社区卫生服务的规范内容和社区卫生服务在社会功能、经济补偿机制、全科医生培养等支持条件方面进行了探讨。     

Of Brazil and Quebec, food for thought: Brazilian community health workers bridge the gap between families and health professionals

The Brazilian unified health system consists of 27,000 family health teams with a network of approximately 300,000 community health agents whose mandate is to link the families they visit every month with health professionals at the family health unit. Since 2003, Quebec has been implementing its health and social services reforms by emphasizing the integration of care and services (public, associative and private) in local networks which have a formal population health responsibility. This commentary aims to underline some similarities and differences between the program of the Brazilian 'units of family health' and that of integrated network clinics (CRI) or Groups of family medicine (GMF) in Quebec. In both cases, a major concern is to organize primary care services in as close proximity as possible to the population of a given territory, and to improve accessibility and adequacy of services. In addition, through these community health agents, Brazil enables the creation of a social security network that assures an effective follow-up of all members of the population with regard to health services.     

The influence of perceived stress and musculoskeletal pain on work performance and work ability in Swedish health care workers

Objectives

To evaluate the influence of perceived stress and musculoskeletal ache/pain, separately and in combination, at baseline, on self-rated work ability and work performance at two-year follow-up.

Methods

Survey data were collected with a 2-year interval. Health care workers participating at both waves were included. Inclusion criteria were good self-reported work ability and unchanged self-rated work performance at baseline, resulting in 770 participants; 617 women and 153 men. Musculoskeletal pain was assessed using the question “How often do you experience pain in joints and muscles, including the neck and low back?”, perceived stress with a modified version of a single item from the QPS-Nordic questionnaire, work performance by the question “Have your work performance changed during the preceding 12 months?” and work ability by a single item from the work ability index. Associations between baseline data and the two outcomes at follow-up were analysed by means of the log binomial model and expressed as risk ratios (RR) with 95 % confidence intervals (CI).

Results

A combination of frequent musculoskeletal pain and perceived stress constituted the highest risk for reporting decreased work performance (RR 1.7; CI 1.28–2.32) and reduced work ability (RR 1.7; CI 1.27–2.30) at follow-up. Separately, frequent pain, but not stress, was clearly associated with both outcomes.

Conclusion

The results imply that proactive workplace interventions in order to maintain high work performance and good work ability should include measures to promote musculoskeletal well-being for the employees and measures, both individual and organizational, to minimize the risk of persistent stress reactions.     

Predictors of ethical stress, moral action and job satisfaction in health care social workers

Value conflicts can be a source of ethical stress for social workers in health care settings. That stress, unless mediated by the availability of ethical resource services, can lead to social workers' dissatisfaction with their positions and careers, and possibly result in needed professionals leaving the field. This study explored social workers' experiences in dealing with ethical issues in health care settings. Findings showed the inter-relationship between selected individual and organizational factors and overall ethical stress, the ability to take moral actions, the impact of ethical stress on job satisfaction, and the intent to leave position.     

Female health workers: lifestyle, work, and psychiatric disorders

The relationships were studied between daily life, work, and mental disorders in female health workers from the Mexican Health Insurance Institute. The study sample (n = 170) included female physicians, nurses, laboratory workers, and medical assistants. Primary data were obtained through an interview which had been previously validated in a population of workers in Mexico. Relationships were found between mental disorders and all facets of women's lives. In relation to the domestic environment, women with higher rates of mental disorders were those who were mothers, had more children, did not have household help, and had husbands or partners. Prevalence of mental disorders in relation to paid work was associated with the length of the workday, absenteeism, and lack of job content. Skills development, job satisfaction, and creativity had a "protective" or preventive effect against mental disorders and fatigue. The main risks and conditions that functioned as stressors were heat, noise, physical effort, awkward positions, and intense, repetitive work.     

Executive leadership, community action, and the habits of health care politics.

Health care executives must lead the way to the comeback of "voluntarism" in their field. This will require having four key political habits: (1) acting out of a sense of civic responsibility, (2) avoiding the dangers of faction and "magic bullets", (3) building alliances by a process of conferring with other relevant leaders and groups, and (4) participating in community activism, i.e., acting on, not reacting to, local problems and pressures.     

Fostering an Internet-based work group in community health through action research

In this article, we describe an action research study to foster an Internet-based work group as part of a two-year community health research training program in Alberta, Canada. The objectives of our study were to incorporate Internet-based technology into the program, establish a distributed work group over time, and reflect on the lessons learned. The participants represented seventeen health regions. There were thirty-five instructors and expert resource persons (varied over time), two training coordinators, four support staff, a program coordinator, two action researchers, and two independent consultants. The data collected included program documents, phone interviews, online surveys, meeting notes, online discussions, computer usage log, site visits, keystroke entry logs, help desk logs, and program evaluation reports. Content analysis was conducted with NUD*IST to identify concepts and themes from the data. Our findings suggest that role clarification, facilitative support, network linkages, and workplace learning are important aspects of fostering Internet-based work groups in a health setting, where members strive to establish themselves, seek meaning in their work, support each other, and add value to their organizations.     

Cost-effectiveness of sick leave policies for health care workers with influenza-like illness, Brazil, 2009

We describe the effect of influenza-like illness (ILI) during the outbreak of pandemic (H1N1) 2009 on health care worker (HCW) absenteeism and compare the effectiveness and cost of 2 sick leave policies for HCWs with suspected influenza. We assessed initial 2-day sick leaves plus reassessment until the HCW was asymptomatic (2-day + reassessment policy), and initial 7-day sick leaves (7-day policy). Sick leaves peaked in August 2009: 3% of the workforce received leave for ILI. Costs during May-October reached R$798,051.87 (≈US $443,362). The 7-day policy led to a higher monthly rate of sick leave days per 100 HCWs than did the 2-day + reassessment policy (8.72 vs. 3.47 days/100 HCWs; p<0.0001) and resulted in higher costs (US $609 vs. US $1,128 per HCW on leave). ILI affected HCW absenteeism. The 7-day policy was more costly and not more effective in preventing transmission to patients than the 2-day + reassessment policy.     

Effectiveness of community health workers in the care of people with hypertension

BACKGROUND: The contributions of community health workers (CHWs) in the delivery of culturally relevant programs for hypertension control have been studied since the 1970s. This systematic review examines the effectiveness of CHWs in supporting the care of people with hypertension. METHODS: Computerized searches were conducted of multiple bibliographic electronic databases from their inception until May 2006. No restrictions were applied for language or study design, and studies were restricted to those that reported at least one outcome among participants. RESULTS: Fourteen studies were identified, including eight randomized controlled trials (RCTs). Many of the studies focused on poor, urban African Americans. Significant improvements in controlling blood pressure were reported in seven of the eight RCTs. Several studies reported significant improvements in participants' self-management behaviors, including appointment keeping and adherence to antihypertensive medications. Four studies reported positive changes in healthcare utilization and in systems outcomes. Two of the RCTs showed significant improvements in other patient outcomes, such as changes in heart mass and risk of CVD. CONCLUSIONS: Community health workers may have an important impact on the self-management of hypertension. Programs involving CHWs as multidisciplinary team members hold promise, particularly for diverse racial/ethnic populations that are under-served.     

绩效管理对基层卫生人员工作绩效的影响机制研究——工作动机的中介作用

目的：分析基层医疗卫生机构绩效管理制度运行现状,探究绩效管理对基层卫生人员工作绩效的影响及其作用机制。方法：采用多阶段整群抽样,对山东省青岛、东营与枣庄三市18家社区卫生服务中心和20家乡镇卫生院的基层卫生人员进行问卷调查和个人深入访谈,共计回收有效问卷870份,访谈175人。结果：绩效管理各维度(考核规范性、考核意义感、反馈及时性、分配公平性)中,有三个维度给予正面评价的人员比例未过半数,对四个维度给予负面评价的人员比例均在10%～20%之间,其中分配公平性的得分相对最低。绩效管理对任务绩效无显著影响,对关系绩效与学习绩效有显著弱影响。卫生人员工作动机的主导类型为控制性动机,工作动机在绩效管理要素和工作绩效之间起完全中介作用,且自主性动机对关系绩效和学习绩效的影响强于控制性动机。结论：当前基层医疗卫生机构绩效管理存在指标设置不合理、考核过程形式化、考核结果反馈不及时等问题,激励作用有限,对基层卫生人员工作绩效影响较弱。为此,应通过制定合理的考核指标、加强针对考核结果的沟通与反馈、发挥绩效工资的激励作用、培育发展性的绩效管理文化等举措完善基层医疗卫生机构绩效管理,提高基层卫生人员工作动机与绩效。     

Training primary health care workers to foster community participation.

A low level of community participation was identified as one of the weaknesses of the health sector in the United Republic of Tanzania. In order to remedy this situation, a systematic process of training trainers and students was established with full involvement of village people. Twenty-five themes were put forward as starting points for discussions between students and villagers. The students were encouraged to learn from the villagers by listening to them and asking them questions. They also participated in community activities and lived with villagers so as to obtain a good understanding of rural living conditions. In this way, problems were identified and solutions were jointly formulated. A workbook was developed during a series of workshops with students, trainers, village communities, and planners. At least two teachers were trained from each health training school; all schools were supplied with workbooks. The approach has been adopted by most health training schools in Tanzania, and the Ministry of Health is now committed to it. Both students and trainers find this to be a valuable learning experience.     

The Care Span: Medicaid savings resulted when community health workers matched those with needs to home and community care

The Affordable Care Act of 2010 builds on earlier efforts to expand home and community-based alternatives to institutional long-term care. Identifying people living in the community who have unmet long-term care needs and who may be at risk for entering nursing homes may be crucial to these efforts. The Arkansas Community Connector Program used specially trained community health workers to identify such people in three disadvantaged counties and connect them to Medicaid home and community-based services. The result was a 23.8?percent average reduction in annual Medicaid spending per participant during the period 2005-08. Net three-year savings to the Arkansas Medicaid program equaled $2.619?million. Similar interventions may help other localities achieve cost-saving and equitable access to publicly funded long-term care options other than institutional care.