Henry Makungwa - Academia.edu (original) (raw)

Papers by Henry Makungwa

Research paper thumbnail of Assessing and improving data quality from community health workers: a successful intervention in Neno, Malawi

Public Health Action, 2013

CHWs generate household reports; Health Surveillance Assistants (HSAs) then aggregate across all ... more CHWs generate household reports; Health Surveillance Assistants (HSAs) then aggregate across all household reports to generate reports for each CHW in their area. These CHW reports are then entered into an electronic database from which monthly reports are generated for PIH and Ministry of Health (MoH) management. As with other health programs, CHW data could play a critical role in supporting implementation by assisting in identifying and addressing programmatic gaps. 2-4 However, there were numerous concerns over the quality of the data due to the large volume and complex aggregation pathways. An informal inspection revealed several instances in which chart data were aggregated incorrectly, leading to signifi cant inaccuracies in the fi nal reports presented to MoH/PIH. In this article, we describe our system for the formal assessment of the quality of CHW reports; we provide detail on the development and implementation of interventions to address poor data quality; and we conclude with a discussion on the impact of improved data quality on the ability to successfully manage the program and suggestions of extending lessons learned to other programs.

Research paper thumbnail of A household-based community health worker programme for non-communicable disease, malnutrition, tuberculosis, HIV and maternal health: a stepped-wedge cluster randomised controlled trial in Neno District, Malawi

BMJ Global Health, 2021

BackgroundCommunity health worker (CHW) programmes are a valuable component of primary care in re... more BackgroundCommunity health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expanding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC).MethodsWe conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20–40 households for monthly (or more frequent) visits.FindingsThe interven...

Research paper thumbnail of Using Community Health (CHWs) to increase access to maternal health services–preliminary findings from Neno, Malawi

Annals of Global Health, 2016

Research paper thumbnail of Increasing utilisation of perinatal services: estimating the impact of community health worker program in Neno, Malawi

BMC Pregnancy and Childbirth, Jan 6, 2020

BackgroundBy 2015, Malawi had not achieved Millennium Development Goal 4, reducing maternal morta... more BackgroundBy 2015, Malawi had not achieved Millennium Development Goal 4, reducing maternal mortality by about 35% from 675 to 439 deaths per 100,000 livebirths. Hypothesised reasons included low uptake of antenatal care (ANC), intrapartum care, and postnatal care. Involving community health workers (CHWs) in identification of pregnant women and linking them to perinatal services is a key strategy to reinforce uptake of perinatal care in Neno, Malawi. We evaluated changes in uptake after deployment of CHWs between March 2014 and June 2016.MethodsA CHW intervention was implemented in Neno District, Malawi in a designated catchment area of about 3100 women of childbearing age. The pre-intervention period was March 2014 to February 2015, and the post-intervention period was March 2015 to June 2016. A 5-day maternal health training package was delivered to 211 paid and supervised CHWs. CHWs were deployed to identify pregnant women and escort them to perinatal care visits. A synthetic control method, in which a “counterfactual site” was created from six available control facilities in Neno District, was used to evaluate the intervention. Outcomes of interest included uptake of first-time ANC, ANC within the first trimester, four or more ANC visits, intrapartum care, and postnatal care follow-up.ResultsWomen enrolled in ANC increased by 18% (95% Credible Interval (CrI): 8, 29%) from an average of 83 to 98 per month, the proportion of pregnant women starting ANC in the first trimester increased by 200% (95% CrI: 162, 234%) from 10 to 29% per month, the proportion of women completing four or more ANC visits increased by 37% (95% CrI: 31, 43%) from 28 to 39%, and monthly utilisation of intrapartum care increased by 20% (95% CrI: 13, 28%) from 85 to 102 women per month. There was little evidence that the CHW intervention changed utilisation of postnatal care (− 37, 95% CrI: − 224, 170%).ConclusionsIn a rural district in Malawi, uptake of ANC and intrapartum care increased considerably following an intervention using CHWs to identify pregnant women and link them to care.

Research paper thumbnail of Determining whether Community Health Workers are ‘Deployment Ready’ Using Standard Setting

Annals of Global Health, Nov 5, 2018

Determining whether community health workers are "deployment ready" using standard setting. Annal... more Determining whether community health workers are "deployment ready" using standard setting. Annals of Global Health.

Research paper thumbnail of Mapping for action: Variation in HIV program coverage in rural Malawi

ABSTRACT Background: Geographic Information Systems (GIS) is an important tool for monitoring, ev... more ABSTRACT Background: Geographic Information Systems (GIS) is an important tool for monitoring, evaluation and targeted improvement of healthcare services. Abwenzi Pa Za Umoyo (APZU), the sister organization of Partners In Health (PIH) in Malawi, began using GIS in Neno District in 2010 to better understand geographic distribution of patients, facilitate program planning and conduct routine disease surveillance. In this analysis, GIS was used to explore geographic variation in HIV program coverage across the district. Methods: GPS coordinates for village centroids were captured by locating the chief’s house in 194 villages across the district. Patients’ home villages were extracted from APZU’s HIV EMR, aggregated and mapped at the census enumeration area (EA) level. Expected adult (age 15-49) HIV cases were also mapped by applying rural adult HIV prevalence (8.9%) to projected EA-level adult population data derived from the 2008 Malawi Census. Results: 4,279 patients were mapped to 157 census enumeration areas within Neno District, where 4,923 adult HIV cases were expected (87.4% coverage). Coverage varied substantially at the EA level (mean = 105.7%, IQR= 0.0%, 114.8%). Discussion: In rural areas where patients have difficulty accessing HIV services, GIS is an effective tool to rapidly identify geographic gaps in coverage. Mobile clinics can be deployed to locations with lower coverage to offer HIV testing and counseling services and increase program enrollment. GIS can also be used to identify locations where coverage gaps make new static health facilities most needed, as part of a broader strategy to reduce barriers to HIV care and treatment.

Research paper thumbnail of Assessing and improving data quality from community health workers: a successful intervention in Neno, Malawi

Public Health Action, 2013

CHWs generate household reports; Health Surveillance Assistants (HSAs) then aggregate across all ... more CHWs generate household reports; Health Surveillance Assistants (HSAs) then aggregate across all household reports to generate reports for each CHW in their area. These CHW reports are then entered into an electronic database from which monthly reports are generated for PIH and Ministry of Health (MoH) management. As with other health programs, CHW data could play a critical role in supporting implementation by assisting in identifying and addressing programmatic gaps. 2-4 However, there were numerous concerns over the quality of the data due to the large volume and complex aggregation pathways. An informal inspection revealed several instances in which chart data were aggregated incorrectly, leading to signifi cant inaccuracies in the fi nal reports presented to MoH/PIH. In this article, we describe our system for the formal assessment of the quality of CHW reports; we provide detail on the development and implementation of interventions to address poor data quality; and we conclude with a discussion on the impact of improved data quality on the ability to successfully manage the program and suggestions of extending lessons learned to other programs.

Research paper thumbnail of A household-based community health worker programme for non-communicable disease, malnutrition, tuberculosis, HIV and maternal health: a stepped-wedge cluster randomised controlled trial in Neno District, Malawi

BMJ Global Health, 2021

BackgroundCommunity health worker (CHW) programmes are a valuable component of primary care in re... more BackgroundCommunity health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expanding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC).MethodsWe conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20–40 households for monthly (or more frequent) visits.FindingsThe interven...

Research paper thumbnail of Using Community Health (CHWs) to increase access to maternal health services–preliminary findings from Neno, Malawi

Annals of Global Health, 2016

Research paper thumbnail of Increasing utilisation of perinatal services: estimating the impact of community health worker program in Neno, Malawi

BMC Pregnancy and Childbirth, Jan 6, 2020

BackgroundBy 2015, Malawi had not achieved Millennium Development Goal 4, reducing maternal morta... more BackgroundBy 2015, Malawi had not achieved Millennium Development Goal 4, reducing maternal mortality by about 35% from 675 to 439 deaths per 100,000 livebirths. Hypothesised reasons included low uptake of antenatal care (ANC), intrapartum care, and postnatal care. Involving community health workers (CHWs) in identification of pregnant women and linking them to perinatal services is a key strategy to reinforce uptake of perinatal care in Neno, Malawi. We evaluated changes in uptake after deployment of CHWs between March 2014 and June 2016.MethodsA CHW intervention was implemented in Neno District, Malawi in a designated catchment area of about 3100 women of childbearing age. The pre-intervention period was March 2014 to February 2015, and the post-intervention period was March 2015 to June 2016. A 5-day maternal health training package was delivered to 211 paid and supervised CHWs. CHWs were deployed to identify pregnant women and escort them to perinatal care visits. A synthetic control method, in which a “counterfactual site” was created from six available control facilities in Neno District, was used to evaluate the intervention. Outcomes of interest included uptake of first-time ANC, ANC within the first trimester, four or more ANC visits, intrapartum care, and postnatal care follow-up.ResultsWomen enrolled in ANC increased by 18% (95% Credible Interval (CrI): 8, 29%) from an average of 83 to 98 per month, the proportion of pregnant women starting ANC in the first trimester increased by 200% (95% CrI: 162, 234%) from 10 to 29% per month, the proportion of women completing four or more ANC visits increased by 37% (95% CrI: 31, 43%) from 28 to 39%, and monthly utilisation of intrapartum care increased by 20% (95% CrI: 13, 28%) from 85 to 102 women per month. There was little evidence that the CHW intervention changed utilisation of postnatal care (− 37, 95% CrI: − 224, 170%).ConclusionsIn a rural district in Malawi, uptake of ANC and intrapartum care increased considerably following an intervention using CHWs to identify pregnant women and link them to care.

Research paper thumbnail of Determining whether Community Health Workers are ‘Deployment Ready’ Using Standard Setting

Annals of Global Health, Nov 5, 2018

Determining whether community health workers are "deployment ready" using standard setting. Annal... more Determining whether community health workers are "deployment ready" using standard setting. Annals of Global Health.

Research paper thumbnail of Mapping for action: Variation in HIV program coverage in rural Malawi

ABSTRACT Background: Geographic Information Systems (GIS) is an important tool for monitoring, ev... more ABSTRACT Background: Geographic Information Systems (GIS) is an important tool for monitoring, evaluation and targeted improvement of healthcare services. Abwenzi Pa Za Umoyo (APZU), the sister organization of Partners In Health (PIH) in Malawi, began using GIS in Neno District in 2010 to better understand geographic distribution of patients, facilitate program planning and conduct routine disease surveillance. In this analysis, GIS was used to explore geographic variation in HIV program coverage across the district. Methods: GPS coordinates for village centroids were captured by locating the chief’s house in 194 villages across the district. Patients’ home villages were extracted from APZU’s HIV EMR, aggregated and mapped at the census enumeration area (EA) level. Expected adult (age 15-49) HIV cases were also mapped by applying rural adult HIV prevalence (8.9%) to projected EA-level adult population data derived from the 2008 Malawi Census. Results: 4,279 patients were mapped to 157 census enumeration areas within Neno District, where 4,923 adult HIV cases were expected (87.4% coverage). Coverage varied substantially at the EA level (mean = 105.7%, IQR= 0.0%, 114.8%). Discussion: In rural areas where patients have difficulty accessing HIV services, GIS is an effective tool to rapidly identify geographic gaps in coverage. Mobile clinics can be deployed to locations with lower coverage to offer HIV testing and counseling services and increase program enrollment. GIS can also be used to identify locations where coverage gaps make new static health facilities most needed, as part of a broader strategy to reduce barriers to HIV care and treatment.