Evidence map›Paper›PMID 26547550›Full record

ArticleJournal of community health2016

Implementation of the Community Health Assistant (CHA) Cadre in Zambia: A Process Evaluation to Guide Future Scale-Up Decisions.

Katharine D Shelley, Yekoyesew W Belete, Sydney Chauwa Phiri, Mutinta Musonda, Elizabeth Chizema Kawesha, Evelyn Mutinta Muleya, Caroline Phiri Chibawe, Jan Willem van den Broek, Kathryn Bradford Vosburg

Abstract read
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In one paragraph

Article in Journal of community health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 1 synthesis or guideline pooled it.

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  6. Community Health Worker programmes' integration into national health systems: Scoping review.African journal of primary health care & family medicine · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Katharine D ShelleyDepartment of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Room E8009, Baltimore, MD, 21205, USA. katharine.shelley@jhu.edu.
Yekoyesew W BeleteMDG Acceleration Initiative, UNICEF, Lusaka, Zambia.
Sydney Chauwa PhiriClinton Health Access Initiative, Lusaka, Zambia.
Mutinta MusondaHuman Resources Administration, Ministry of Foreign Affairs, Lusaka, Zambia.
Elizabeth Chizema KaweshaDisease Surveillance, Research and Control, Ministry of Health, Lusaka, Zambia.
Evelyn Mutinta MuleyaHuman Resources and Administration, Ministry of Health, Lusaka, Zambia.
Caroline Phiri ChibaweMother and Child Health, Ministry of Community Development, Mother and Child Health, Lusaka, Zambia.
Jan Willem van den BroekClinton Health Access Initiative, Lusaka, Zambia.
Kathryn Bradford VosburgClinton Health Access Initiative, Lusaka, Zambia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Universal health coverage requires an adequate health workforce, including community health workers (CHWs) to reach rural communities. To improve healthcare access in rural areas, in 2010 the Government of Zambia implemented a national CHW strategy that introduced a new cadre of healthcare workers called community health assistants (CHAs). After 1 year of training the pilot class of 307 CHAs deployed in September 2012. This paper presents findings from a process evaluation of the barriers and facilitators of implementation of the CHA pilot, along with how evidence was used to guide ongoing implementation and scale-up decisions. Qualitative inquiry was used to assess implementation during the first 6 months of the program rollout, with 43 in-depth individual and 32 small group interviews across five respondent types: CHAs, supervisors, volunteer CHWs, community members, and district leadership. Potential 'implementation moderators' were explored using deductive coding and thematic analysis of participant perspectives on community acceptance of CHAs, supervision support mechanisms, and coordination with volunteer CHWs, and health system integration of a new cadre. Community acceptance of CHAs was generally high, but coordination between CHAs and existing volunteer CHWs presented some challenges. The supervision support system was found to be inconsistent, limiting assurance of consistent quality care delivered by CHAs. Underlying health system weaknesses regarding drug supply and salary payments furthermore hindered incorporation of a new cadre within the national health system. Recommendations for implementation and future scale based on the process evaluation findings are discussed.

Indexed as

Community Health WorkersHealth PlanningHealth Services ResearchDecision MakingFemaleHealth WorkforceHumansInterviews as TopicMaleQualitative ResearchZambiaCommunity health workersHealth systems strengtheningHuman resources for healthQualitative process evaluationZambia

Identifiers

PMID26547550

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.