Impact of mental health training on village health workers regarding clinical depression in rural India.

Village health worker (VHW) programs are known to be effective means of promoting health of communities. Comprehensive rural health project in India recently trained VHWs to identify, refer, and help people with mental health issues. This study evaluated knowledge, attitude, and behavior of VHWs regarding depression. Cluster sampling was used including all 36 VHWs trained in mental health. Among these, 24 were available and willing to participate in the study. Five FGDs were conducted among 24 VHWs, and the results were analyzed qualitatively. Four out of five groups were able to diagnose the presented case correctly as depression. VHWs were able to identify many symptoms and to suggest management options for depression. They showed supportive and empathetic attitudes towards depressed patients. VHWs are likely to be useful at identifying and assisting people with depression in the communities with lack of adequate resources provided they receive ongoing training and supervision.

Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the Expert Panel.

BACKGROUND: The contributions that community-based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health-related Millennium Development Goals by 2015. This article provides a summary of a series of articles about the effectiveness of CBPHC in improving MNCH and offers recommendations from an Expert Panel for strengthening CBPHC that were formulated in 2008 and have been updated on the basis of more recent evidence. METHODS: An Expert Panel convened to guide the review of the effectiveness of community-based primary health care (CBPHC). The Expert Panel met in 2008 in New York City with senior UNICEF staff. In 2016, following the completion of the review, the Panel considered the review's findings and made recommendations. The review consisted of an analysis of 661 unique reports, including 583 peer-reviewed journal articles, 12 books/monographs, 4 book chapters, and 72 reports from the gray literature. The analysis consisted of 700 assessments since 39 were analyzed twice (once for an assessment of improvements in neonatal and/or child health and once for an assessment in maternal health). RESULTS: The Expert Panel recommends that CBPHC should be a priority for strengthening health systems, accelerating progress in achieving universal health coverage, and ending preventable child and maternal deaths. The Panel also recommends that expenditures for CBPHC be monitored against expenditures for primary health care facilities and hospitals and reflect the importance of CBPHC for averting mortality. Governments, government health programs, and NGOs should develop health systems that respect and value communities as full partners and work collaboratively with them in building and strengthening CBPHC programs - through engagement with planning, implementation (including the full use of community-level workers), and evaluation. CBPHC programs need to reach every community and household in order to achieve universal coverage of key evidence-based interventions that can be implemented in the community outside of health facilities and assure that those most in need are reached. CONCLUSIONS: Stronger CBPHC programs that foster community engagement/empowerment with the implementation of evidence-based interventions will be essential for achieving universal coverage of health services by 2030 (as called for by the Sustainable Development Goals recently adopted by the United Nations), ending preventable child and maternal deaths by 2030 (as called for by the World Health Organization, UNICEF, and many countries around the world), and eventually achieving Health for All as envisioned at the International Conference on Primary Health Care in 1978. Stronger CBPHC programs can also create entry points and synergies for expanding the coverage of family planning services as well as for accelerating progress in the detection and treatment of HIV/AIDS, tuberculosis, malaria, hypertension, and other chronic diseases. Continued strengthening of CBPHC programs based on rigorous ongoing operations research and evaluation will be required, and this evidence will be needed to guide national and international policies and programs.

Prevalence of hypertension and prehypertension in a community-based primary health care program villages at central India.

OBJECTIVE: The objective of this study is to evaluate the effects of a community-based effort in a rural area of central India to decrease the prevalence of hypertension among the middle-aged and older population by using multiple blood pressure measurements. METHODS: With a prevalence of 16.8% (error of 3.36, and 95% confidence interval) from a recent study in a nearby district, the sample size required for this study was 495 subjects. A proportionally stratified random sample design was used. With maps of ten villages, where in a community-based health project had been in place for many years, 20 households and 20 backups were randomly selected from a list of all households. Multiple BP measurements were obtained and categorized and one-month period prevalence was calculated. Statistical analyses of frequency and percentage were performed. RESULTS: Approximately one-fifth of the population above 40 years of age in central India where a community-based approach is in place was hypertensive. This is significantly lower than the previously documented prevalence rate of one-third or even more prevalence rate in India. The attribute of caste and religion, a specific rural Indian characteristic did not have any significant bearing on the above results. The prevalence tended to increase progressively with age until 70 years, after which it declined. Multiple blood pressure measurements may yield an accurate prevalence of hypertension. CONCLUSION: With the documented evidences from India, the current reduced prevalence of hypertension could have been influenced by the community-based interventions in this population.

Village health worker training for complications of labor and delivery in rural Maharashtra, India.

BACKGROUND: By analyzing the perspectives of village health worker/trainers with the Comprehensive Rural Health Project (CRHP), this study aimed to investigate their level of knowledge of treatment, risks, and prevention of complications of labor and delivery and to evaluate current teaching methods. METHODS: Three focus groups of six village health workers/trainers were conducted and divided according to level of experience. The resulting semistructured discussion was analyzed according to grounded theory. RESULTS: Participants displayed strong content retention with respect to clinically relevant knowledge. Village health workers experienced barriers, including lack of education and casteism, which affected their ability to establish trust in the community. Clinical observation was perceived to be the most effective learning method and is recommended for teaching village health workers about the treatment and prevention of the complications of labor and delivery. CONCLUSION: When implementing this training model in comparable global communities, local culture and its impact on establishing trust is an important factor to consider.