Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study
Background/objective The increasing burden of non-communicable diseases (NCDs) in Nepal underscores the importance of strengthening primary healthcare systems to deliver efficient care. In this study, we examined the barriers and facilitators to engaging community health workers (CHWs) for NCDs prev...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/12/e040350.full |
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| author | Sushil Baral Corneel Vandelanotte Tuhin Biswas Chandani Kharel Lal B Rawal Kie Kanda Abu S Abdullah Uday Narayan Yadav |
| author_facet | Sushil Baral Corneel Vandelanotte Tuhin Biswas Chandani Kharel Lal B Rawal Kie Kanda Abu S Abdullah Uday Narayan Yadav |
| author_sort | Sushil Baral |
| collection | DOAJ |
| description | Background/objective The increasing burden of non-communicable diseases (NCDs) in Nepal underscores the importance of strengthening primary healthcare systems to deliver efficient care. In this study, we examined the barriers and facilitators to engaging community health workers (CHWs) for NCDs prevention and control in Nepal.Design We used multiple approaches including (a) review of relevant literature, (b) key personnel and stakeholders’ consultation meetings and (c) qualitative data collection using semistructured interviews. A grounded theory approach was used for qualitative data collection and the data were analysed thematically.Setting Data were collected from health facilities across four districts in Nepal and two stakeholder consultative meetings were conducted at central level.Participants We conducted in-depth interviews with CHWs (Health Assistants, Auxiliary Health Workers, Auxiliary Nurse Midwife) (n=5); key informant interviews with health policymakers/managers (n=3) and focus group discussions (FGDs) with CHWs (four FGDs; total n=27). Participants in two stakeholder consultative meetings included members from the government (n=8), non-government organisations (n=7), private sector (n=3) and universities (n=6).Results The CHWs were engaged in a wide range of public health programmes and they also deliver NCDs specific programmes such as common NCDs screening, provisional diagnosis, primary care, health education and counselling, basic medication and referral and so on. These NCD prevention and control services are concentrated in those districts, where the WHO, Package for prevention and control of NCDs) program is being implemented. Some challenges and barriers were identified, including inadequate NCD training, high workload, poor system-level support, inadequate remuneration, inadequate supply of logistics and drugs. The facilitating factors included government priority, formation of NCD-related policies, community support systems, social prestige and staff motivation.Conclusion Engaging CHWs has been considered as key driver to delivering NCDs related services in Nepal. Effective integration of CHWs within the primary care system is essential for CHW’s capacity buildings, necessary supervisory arrangements, supply of logistics and medications and setting up effective recording and reporting systems for prevention and control of NCDs in Nepal. |
| format | Article |
| id | doaj-art-eb2a6dec1b6e412fa1915517cd3afa8b |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-eb2a6dec1b6e412fa1915517cd3afa8b2024-11-22T01:05:08ZengBMJ Publishing GroupBMJ Open2044-60552020-12-01101210.1136/bmjopen-2020-040350Community health workers for non-communicable disease prevention and control in Nepal: a qualitative studySushil Baral0Corneel Vandelanotte1Tuhin Biswas2Chandani Kharel3Lal B Rawal4Kie Kanda5Abu S Abdullah6Uday Narayan Yadav7HERD International, Kathmandu, NepalPhysical Activity Research Group, Central Queensland University Appleton Institute, Rockhampton, Queensland, Australia2 University of Queensland, Brisbane, Queensland, AustraliaResearch, HERDInternational, Kathmandu, NepalSchool of Health Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney, NSW, Australia5 Health Section, Japanese International Cooperation Agency (JICA), Accra, Ghana11 Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USACentre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, NSW, AustraliaBackground/objective The increasing burden of non-communicable diseases (NCDs) in Nepal underscores the importance of strengthening primary healthcare systems to deliver efficient care. In this study, we examined the barriers and facilitators to engaging community health workers (CHWs) for NCDs prevention and control in Nepal.Design We used multiple approaches including (a) review of relevant literature, (b) key personnel and stakeholders’ consultation meetings and (c) qualitative data collection using semistructured interviews. A grounded theory approach was used for qualitative data collection and the data were analysed thematically.Setting Data were collected from health facilities across four districts in Nepal and two stakeholder consultative meetings were conducted at central level.Participants We conducted in-depth interviews with CHWs (Health Assistants, Auxiliary Health Workers, Auxiliary Nurse Midwife) (n=5); key informant interviews with health policymakers/managers (n=3) and focus group discussions (FGDs) with CHWs (four FGDs; total n=27). Participants in two stakeholder consultative meetings included members from the government (n=8), non-government organisations (n=7), private sector (n=3) and universities (n=6).Results The CHWs were engaged in a wide range of public health programmes and they also deliver NCDs specific programmes such as common NCDs screening, provisional diagnosis, primary care, health education and counselling, basic medication and referral and so on. These NCD prevention and control services are concentrated in those districts, where the WHO, Package for prevention and control of NCDs) program is being implemented. Some challenges and barriers were identified, including inadequate NCD training, high workload, poor system-level support, inadequate remuneration, inadequate supply of logistics and drugs. The facilitating factors included government priority, formation of NCD-related policies, community support systems, social prestige and staff motivation.Conclusion Engaging CHWs has been considered as key driver to delivering NCDs related services in Nepal. Effective integration of CHWs within the primary care system is essential for CHW’s capacity buildings, necessary supervisory arrangements, supply of logistics and medications and setting up effective recording and reporting systems for prevention and control of NCDs in Nepal.https://bmjopen.bmj.com/content/10/12/e040350.full |
| spellingShingle | Sushil Baral Corneel Vandelanotte Tuhin Biswas Chandani Kharel Lal B Rawal Kie Kanda Abu S Abdullah Uday Narayan Yadav Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study BMJ Open |
| title | Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study |
| title_full | Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study |
| title_fullStr | Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study |
| title_full_unstemmed | Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study |
| title_short | Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study |
| title_sort | community health workers for non communicable disease prevention and control in nepal a qualitative study |
| url | https://bmjopen.bmj.com/content/10/12/e040350.full |
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