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Innovation in health service delivery: integrating community health assistants into the health system at district level in Zambia

Overview of attention for article published in BMC Health Services Research, January 2015
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About this Attention Score

  • Above-average Attention Score compared to outputs of the same age (62nd percentile)
  • Average Attention Score compared to outputs of the same age and source

Mentioned by

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2 tweeters
facebook
1 Facebook page

Citations

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10 Dimensions

Readers on

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99 Mendeley
Title
Innovation in health service delivery: integrating community health assistants into the health system at district level in Zambia
Published in
BMC Health Services Research, January 2015
DOI 10.1186/s12913-015-0696-4
Pubmed ID
Authors

Joseph Mumba Zulu, Anna-Karin Hurtig, John Kinsman, Charles Michelo

Abstract

BackgroundTo address the huge human resources for health gap in Zambia, the Ministry of Health launched the National Community Health Assistant Strategy in 2010. The strategy aims to integrate community-based health workers into the health system by creating a new group of workers, called community health assistants (CHAs). However, literature suggests that the integration process of national community-based health worker programmes into health systems has not been optimal. Conceptually informed by the diffusion of innovations theory, this paper qualitatively aimed to explore the factors that shaped the acceptability and adoption of CHAs into the health system at district level in Zambia during the pilot phase.MethodsData gathered through review of documents, 6 focus group discussions with community leaders, and 12 key informant interviews with CHA trainers, supervisors and members of the District Health Management Team were analysed using thematic analysis.ResultsThe perceived relative advantage of CHAs over existing community-based health workers in terms of their quality of training and scope of responsibilities, and the perceived compatibility of CHAs with existing groups of health workers and community healthcare expectations positively facilitated the integration process. However, limited integration of CHAs in the district health governance system hindered effective programme trialability, simplicity and observability at district level. Specific challenges at this level included a limited information flow and sense of programme ownership, and insufficient documentation of outcomes. The district also had difficulties in responding to emergent challenges such as delayed or non-payment of CHA incentives, as well as inadequate supervision and involvement of CHAs in the health posts where they are supposed to be working. Furthermore, failure of the health system to secure regular drug supplies affected health service delivery and acceptability of CHA services at community level.ConclusionThe study has demonstrated that implementation of policy guidelines for integrating community-based health workers in the health system may not automatically guarantee successful integration at the local or district level, at least at the start of the process. The study reiterates the need for fully integrating such innovations into the district health governance system if they are to be effective.

Twitter Demographics

The data shown below were collected from the profiles of 2 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 99 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 2 2%
Kenya 2 2%
Germany 1 1%
Uganda 1 1%
South Africa 1 1%
Belgium 1 1%
Unknown 91 92%

Demographic breakdown

Readers by professional status Count As %
Student > Master 29 29%
Researcher 18 18%
Student > Ph. D. Student 13 13%
Student > Bachelor 8 8%
Unspecified 8 8%
Other 23 23%
Readers by discipline Count As %
Medicine and Dentistry 35 35%
Social Sciences 14 14%
Nursing and Health Professions 14 14%
Unspecified 9 9%
Economics, Econometrics and Finance 5 5%
Other 22 22%

Attention Score in Context

This research output has an Altmetric Attention Score of 3. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 28 March 2015.
All research outputs
#2,012,755
of 4,929,656 outputs
Outputs from BMC Health Services Research
#1,024
of 2,218 outputs
Outputs of similar age
#64,145
of 175,540 outputs
Outputs of similar age from BMC Health Services Research
#31
of 62 outputs
Altmetric has tracked 4,929,656 research outputs across all sources so far. This one has received more attention than most of these and is in the 58th percentile.
So far Altmetric has tracked 2,218 research outputs from this source. They receive a mean Attention Score of 4.5. This one has gotten more attention than average, scoring higher than 52% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 175,540 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 62% of its contemporaries.
We're also able to compare this research output to 62 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 50% of its contemporaries.