Impacts of community lay-leader health worker training & practice (Uttarakhand, India)
Abstract
This study has investigated the impacts of the Community Lay-Leaders Health Training Certificate course on trainees and their communities, specific to the state of Uttarakhand, north India. A suite of semi-structured interviews and focus group discussions were conducted among course stakeholders and graduates respectively, and textual data was added to the data set. Thematic analysis of the results revealed four themes, including: (1) the effectiveness of course design and delivery, together with the key role of the Coordinating Facilitator; (2) the match between graduates’ practices, the providing institution’s objectives and general expectations of community health worker; (3) the strengthening of the health system through skills multiplication, collaboration with existing authorities, and advocacy for higher quality in professional practice; and (4) the need for ongoing support and training post-graduation. The findings are consistent with literature concerning community health workers’ roles and challenges, although some potentially unique outcomes were noted with respect to the pastoral support provided to trainees and the pro-active transfer of graduates’ knowledge and skills to fellow villagers.
References
Lehmann, U. and D. Sanders, Community health workers: what do we know about them, in The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. Geneva: World Health Organization. 2007. p. 1-42.
Oliver, M., et al., What do community health workers have to say about their work, and how can this inform improved programme design? A case study with CHWs within Kenya. 2015. 8.DOI 10.3402/gha.v8.27168.
Saprii, L., et al., Community health workers in rural India: analysing the opportunities and challenges Accredited Social Health Activists (ASHAs) face in realising their multiple roles. Human Resources for Health, 2015. 13(1): p. 95. DOI 10.1186/s12960-015-0094-3.
Patel, V., et al., Assuring health coverage for all in India. The Lancet, 2015. 386(10011): p. 2422-2435.
Bajpai, V., The Challenges Confronting Public Hospitals in India, Their Origins, and Possible Solutions. Advances in Public Health, 2014. 2014: p. 27.DOI 10.1155/2014/898502.
Ministry of Health and Family Welfare, Rural Health Statistics 2014-15. 2015, Government of India, Ministry of Health and Family Welfare, Statistics Division.
Bhattacharyya, K., et al., Community health worker incentives and disincentives: how they affect motivation retention and sustainability. 2001.
Butcher, N., et al., Evaluation of community health worker training course effectiveness in India. Christian Journal for Global Health, 2016. 3(2): p. 18-26.
Walker, D.G. and S. Jan, How do we determine whether community health workers are cost-effective? Some core methodological issues. Journal of community health, 2005. 30(3): p. 221-229.
Lewin, S., et al., Lay health workers in primary and community health care: A systematic review of trials. 2006, World Health Organization: Geneva.
Patel, A.R. and M.P. Nowalk, Expanding immunization coverage in rural India: a review of evidence for the role of community health workers. Vaccine, 2010. 28(3): p. 604-613.
Kahssay, H.M., M.E. Taylor, and P.A. Berman, Community health workers: the way forward. 1998: World Health Organization.
Fathima, F.N., et al., Assessment of ‘Accredited Social Health Activists’—A National Community Health Volunteer Scheme in Karnataka State, India. Journal of health, population, and nutrition, 2015. 33(1): p. 137.
Krishna D Rao, S.R., Human resources for health in India: current challenges and policy options, in India Infrastructure Report 2013-14: The Road to Universal Health Coverage. 2014, IDFC Foundation. p. 251-264.
Jaskiewicz, W. and K. Tulenko, Increasing community health worker productivity and effectiveness: a review of the influence of the work environment. Human resources for health, 2012. 10(1): p. 38.
Bhutta, Z.A., et al., Global experience of community health workers for delivery of health related millennium development goals: a systematic review, country case studies, and recommendations for integration into national health systems. 2010, Global Health Workforce Alliance. p. 249-261.
Funes, R., et al., Preparing the next generation of community health workers: the power of technology for training. 2012: Iheed Institute.
Copyright (c) 2017 Nicole Butcher, Nathan Grills

This work is licensed under a Creative Commons Attribution 4.0 International License.
Christian Journal for Global Health applies the Creative Commons Attribution License to all articles that we publish. Under this license, authors retain ownership of copyright for their articles or they can transfer copyright to their institution, but authors allow anyone without permission to copy, distribute, transmit, and/or adapt articles, even for commercial purposes so long as the original authors and Christian Journal for Global Health are appropriately cited.
This work is licensed under a Creative Commons Attribution 4.0 International License.