‘Successful disease control requires deep and meaningful engagement with local communities.’ This is the conclusion of a systematic review looking at the role of nurses and community health workers in confronting neglected tropical diseases in sub-Saharan Africa.

In our recent thematic discussion on CHWs we noted the wider issue of investment in CHWs versus investment in other primary health workers (including nurses). This is perhaps beyond the remit of this systematic review, but if anyone knows any research in this area, please let us know.

The authors also note (in the full text): ‘A lack of education of community members and CHWs was a major theme of the literature, and the importance of community education done by community nurses and CHWs is difficult to overemphasize.’

PLoS Negl Trop Dis. 2016 Sep 15;10(9):e0004914. doi: 10.1371/journal.pntd.0004914. eCollection 2016.

The Role of Nurses and Community Health Workers in Confronting Neglected Tropical Diseases in Sub-Saharan Africa: A Systematic Review.

Corley AG1, Thornton CP2, Glass NE1.

https://www.ncbi.nlm.nih.gov/pubmed/27631980

Corresponding author:  acorley3@jhu.edu

ABSTRACT

INTRODUCTION:

Neglected tropical diseases produce an enormous burden on many of the poorest and most disenfranchised populations in sub-Saharan Africa. Similar to other developing areas throughout the world, this region’s dearth of skilled health providers renders Western-style primary care efforts to address such diseases unrealistic. Consequently, many countries rely on their corps of nurses and community health workers to engage with underserved and hard-to-reach populations in order provide interventions against these maladies. This article attempts to cull together recent literature on the impact that nurses and community health workers have had on neglected tropical diseases.

METHODS:

A review of the literature was conducted to assess the role nurses and community health workers play in the primary, secondary, and tertiary prevention of neglected tropical diseases in sub-Saharan Africa. Articles published between January 2005 and December 2015 were reviewed in order to capture the full scope of nurses’ and community health workers’ responsibilities for neglected tropical disease control within their respective countries’ health systems.

RESULTS:

A total of 59 articles were identified that fit all inclusion criteria.

CONCLUSIONS:

Successful disease control requires deep and meaningful engagement with local communities. Expanding the role of nurses and community health workers will be required if sub-Saharan African countries are to meet neglected tropical disease treatment goals and eliminate the possibility future disease transmission. Horizontal or multidisease control programs can create complimentary interactions between their different control activities as well as reduce costs through improved program efficiencies-benefits that vertical programs are not able to attain.

KEY MESSAGES

Workforce considerations

  • SSA countries should ensure that their nurses’ education and scope of practice are sufficient for the NTD control measures they are asked to undertake.
  • Program managers must consider the same workforce factors for CHWs as they would with formal health care personnel.

Treating urban and mobile pastoralist populations

  • Ethnic diversity and a weaker social fabric are theorized barriers to increasing intervention coverage rates in urban populations.
  • Health structures ill equipped to meet mobile pastoralist populations’ needs create a barrier to their treatment.

Intervention integration and horizontal program planning

  • Vertical disease control programs, while potentially effective, can affect the capacity of already strained health systems to care for other conditions and populations.
  • Combining multiple NTD control programs and better integrating such programs into countries’ primary care systems are strategies that could serve to create further service delivery efficiencies and improve overall capacity.

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Best wishes, Neil

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