Skip to main content
Top
Published in: Human Resources for Health 1/2021

Open Access 01-12-2021 | Research

Evaluating a capacity building program on women’s health for displaced community health workers in fragile settings in Lebanon

Authors: Hady Naal, Rebecca Mendelsohn, Dayana Brome, Aya Noubani, Dana Nabulsi, Dina Muhieddine, Shadi Saleh

Published in: Human Resources for Health | Issue 1/2021

Login to get access

Abstract

Background

Displaced populations in fragile settings experience health disparities that are seldom attended to. Task-shifting, which involves training non-specialized community health workers (CHW) to deliver basic education and health services is a favorable strategy to address this problem, however very little data exist on this topic in the Middle East region. We conducted a long-term evaluation of the Women’s Health Certificate delivered to Syrian refugees and host community in informal tented settlements in Lebanon under the Mobile University for Health (MUH) program. The training was delivered through a mobile classroom approach that incorporated a blended learning modality.

Methods

We collected short-term data from the 42 trained CHW (knowledge assessments and satisfaction measures) during the delivery of the intervention between March and August 2019, and long-term data (semi-structured interviews with 8 CHW and focus group discussion with 9 randomly selected community members) one year later between July and August 2020. The evaluation approach was informed by the Kirkpatrick evaluation model, and the qualitative data were analyzed using qualitative content analysis.

Results

Data from the CHWs and community members were triangulated, and they showed that the training enhanced access to education due to its mobile nature and provided opportunities for CHWs to engage and interact with learning material that enhanced their knowledge and favorable behaviors regarding women’s health. In turn, CHWs were empowered to play an active role in their communities to transfer the knowledge they gained through educating community members and providing women’s health services and referrals. Community members benefited from the CHWs and called for the implementation of more similar training programs.

Conclusion

This is one of few studies reporting a long-term community-level evaluation of a task-shifting program on women’s health among displaced populations in Lebanon. Our findings support the need to increase funding for similar programs, and to focus on delivering programs for a variety of health challenges. It is also essential to enhance the reach and length of recruitment to wider communities, to design concise, interactive, and engaging sessions, and to provide tools to facilitate circulation of learning material, and resources for referrals to health services.
Literature
1.
go back to reference Hagopian A, Qaddour A. Global Health Challenges in Conflict and Displacement. In APHA’s 2020 VIRTUAL Annual Meeting and Expo (Oct. 24–28). American Public Health Association. 2020. Hagopian A, Qaddour A. Global Health Challenges in Conflict and Displacement. In APHA’s 2020 VIRTUAL Annual Meeting and Expo (Oct. 24–28). American Public Health Association. 2020.
2.
go back to reference UN. Syria: ‘The tragedy is deepening’ as UN figures reveal nearly 5 million children have known nothing but war. United Nations News. 2020. UN. Syria: ‘The tragedy is deepening’ as UN figures reveal nearly 5 million children have known nothing but war. United Nations News. 2020.
3.
go back to reference OPRS. Syria regional refugee response. Operational portal refugee situations. 2020. OPRS. Syria regional refugee response. Operational portal refugee situations. 2020.
4.
go back to reference El Arnaout N, Rutherford S, Zreik T, Nabulsi D, Yassin N, Saleh S. Assessment of the health needs of Syrian refugees in Lebanon and Syria’s neighboring countries. Confl Health. 2019;13(1):1–14.CrossRef El Arnaout N, Rutherford S, Zreik T, Nabulsi D, Yassin N, Saleh S. Assessment of the health needs of Syrian refugees in Lebanon and Syria’s neighboring countries. Confl Health. 2019;13(1):1–14.CrossRef
5.
go back to reference UNHCR. Global Focus UNHCR Operations Worldwide. UNHCR The UN Refugee Agency. UNHCR. Global Focus UNHCR Operations Worldwide. UNHCR The UN Refugee Agency.
6.
go back to reference Saleh S, Abdouni L, Dimassi H, Nabulsi D, Harb R, Jammoul Z, et al. Prevalence of non-communicable diseases and associated medication use among Syrian refugees in Lebanon: an analysis of country-wide data from the Sijilli Electronic Health Records Database. 2020; pp. 1–17. https://doi.org/10.21203/rs.3.rs-58159/v1 Saleh S, Abdouni L, Dimassi H, Nabulsi D, Harb R, Jammoul Z, et al. Prevalence of non-communicable diseases and associated medication use among Syrian refugees in Lebanon: an analysis of country-wide data from the Sijilli Electronic Health Records Database. 2020; pp. 1–17. https://​doi.​org/​10.​21203/​rs.​3.​rs-58159/​v1
8.
go back to reference Samari G. Syrian refugee women’s health in Lebanon, Turkey, and Jordan and recommendations for improved practice. World Med Heal Policy. 2017;9(2):255–74.CrossRef Samari G. Syrian refugee women’s health in Lebanon, Turkey, and Jordan and recommendations for improved practice. World Med Heal Policy. 2017;9(2):255–74.CrossRef
10.
go back to reference Hanna-Amodio C. Syrian refugee access to healthcare in Lebanon. Relief Web. 2020. Hanna-Amodio C. Syrian refugee access to healthcare in Lebanon. Relief Web. 2020.
11.
go back to reference Matinhure S, Chimbari MJ. Barriers and enablers to task shifting for caesarean sections in sub-Saharan Africa: a scoping review. Afr J Reprod Health. 2019;23(3):149–60.PubMed Matinhure S, Chimbari MJ. Barriers and enablers to task shifting for caesarean sections in sub-Saharan Africa: a scoping review. Afr J Reprod Health. 2019;23(3):149–60.PubMed
13.
go back to reference Ehiri JE, Gunn JKL, Center KE, Li Y, Rouhani M, Ezeanolue EE. Training and deployment of lay refugee/internally displaced persons to provide basic health services in camps: a systematic review. Glob Health Action. 2014;7(1):23902.PubMedCrossRef Ehiri JE, Gunn JKL, Center KE, Li Y, Rouhani M, Ezeanolue EE. Training and deployment of lay refugee/internally displaced persons to provide basic health services in camps: a systematic review. Glob Health Action. 2014;7(1):23902.PubMedCrossRef
14.
go back to reference Ferrinho P, Sidat M, Goma F, Dussault G. Task-shifting: experiences and opinions of health workers in Mozambique and Zambia. Hum Resour Health. 2012;10:1–8.CrossRef Ferrinho P, Sidat M, Goma F, Dussault G. Task-shifting: experiences and opinions of health workers in Mozambique and Zambia. Hum Resour Health. 2012;10:1–8.CrossRef
15.
go back to reference Naal H, El Koussa M, El Hamouch M, Hneiny L, Saleh S. A systematic review of global health capacity building initiatives in low-to middle-income countries in the Middle East and North Africa region. Global Health. 2020;16(1):52.CrossRef Naal H, El Koussa M, El Hamouch M, Hneiny L, Saleh S. A systematic review of global health capacity building initiatives in low-to middle-income countries in the Middle East and North Africa region. Global Health. 2020;16(1):52.CrossRef
16.
go back to reference Hoke TH, Wheeler SB, Lynd K, Green MS, Razafindravony BH, Rasamihajamanana E, et al. Community-based provision of injectable contraceptives in Madagascar: “Task shifting” to expand access to injectable contraceptives. Health Policy Plan. 2012;27(1):52–9.PubMedCrossRef Hoke TH, Wheeler SB, Lynd K, Green MS, Razafindravony BH, Rasamihajamanana E, et al. Community-based provision of injectable contraceptives in Madagascar: “Task shifting” to expand access to injectable contraceptives. Health Policy Plan. 2012;27(1):52–9.PubMedCrossRef
17.
go back to reference Schneeberger C, Mathai M. Emergency obstetric care: Making the impossible possible through task shifting. Int J Gynecol Obstet. 2015;131:S6-9.CrossRef Schneeberger C, Mathai M. Emergency obstetric care: Making the impossible possible through task shifting. Int J Gynecol Obstet. 2015;131:S6-9.CrossRef
19.
go back to reference Witter S, Namakula J, Wurie H, Chirwa Y, So S, Vong S, et al. The gendered health workforce: mixed methods analysis from four fragile and post-conflict contexts. Health Policy Plan. 2017;32:v52-62.PubMedPubMedCentralCrossRef Witter S, Namakula J, Wurie H, Chirwa Y, So S, Vong S, et al. The gendered health workforce: mixed methods analysis from four fragile and post-conflict contexts. Health Policy Plan. 2017;32:v52-62.PubMedPubMedCentralCrossRef
20.
go back to reference Kirkpatrick D. Implementing the four levels: a practical guide for effective evaluation of training programs. California: Barrett-Koehler; 2009. Kirkpatrick D. Implementing the four levels: a practical guide for effective evaluation of training programs. California: Barrett-Koehler; 2009.
21.
go back to reference Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.CrossRef Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.CrossRef
22.
go back to reference Elo S, Kääriäinen M, Kanste O, Pölkki T, Utriainen K, Kyngäs H. Qualitative Content Analysis. SAGE Open. 2014;4(1):215824401452263.CrossRef Elo S, Kääriäinen M, Kanste O, Pölkki T, Utriainen K, Kyngäs H. Qualitative Content Analysis. SAGE Open. 2014;4(1):215824401452263.CrossRef
23.
go back to reference Seidman G, Atun R. Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries. Hum Resour Health. 2017;15(1):1–13.CrossRef Seidman G, Atun R. Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries. Hum Resour Health. 2017;15(1):1–13.CrossRef
24.
go back to reference Bolton P, Lee C, Haroz EE, Murray L, Dorsey S, Robinson C, et al. A transdiagnostic community-based mental health treatment for comorbid disorders: development and outcomes of a randomized controlled trial among Burmese refugees in Thailand. PLoS Med. 2014;11(11):e1001757.PubMedPubMedCentralCrossRef Bolton P, Lee C, Haroz EE, Murray L, Dorsey S, Robinson C, et al. A transdiagnostic community-based mental health treatment for comorbid disorders: development and outcomes of a randomized controlled trial among Burmese refugees in Thailand. PLoS Med. 2014;11(11):e1001757.PubMedPubMedCentralCrossRef
25.
go back to reference Low S, Tun KT, Mhote NPP, Htoo SN, Maung C, Kyaw SW, et al. Human resources for health: task shifting to promote basic health service delivery among internally displaced people in ethnic health program service areas in eastern Burma/Myanmar. Glob Health Action. 2015;8(1):24937.CrossRef Low S, Tun KT, Mhote NPP, Htoo SN, Maung C, Kyaw SW, et al. Human resources for health: task shifting to promote basic health service delivery among internally displaced people in ethnic health program service areas in eastern Burma/Myanmar. Glob Health Action. 2015;8(1):24937.CrossRef
26.
go back to reference Sethi S, Jonsson R, Skaff R, Tyler F. Community-based noncommunicable disease care for Syrian refugees in Lebanon. Glob Heal Sci Pract. 2017;5(3):495–506.CrossRef Sethi S, Jonsson R, Skaff R, Tyler F. Community-based noncommunicable disease care for Syrian refugees in Lebanon. Glob Heal Sci Pract. 2017;5(3):495–506.CrossRef
27.
go back to reference O’Laughlin KN, Rouhani SA, Faustin ZM, Ware NC. Testing experiences of HIV positive refugees in Nakivale Refugee Settlement in Uganda: Informing interventions to encourage priority shifting. Confl Health. 2013;7(1):1–9.CrossRef O’Laughlin KN, Rouhani SA, Faustin ZM, Ware NC. Testing experiences of HIV positive refugees in Nakivale Refugee Settlement in Uganda: Informing interventions to encourage priority shifting. Confl Health. 2013;7(1):1–9.CrossRef
28.
go back to reference West L, Isotta-Day H, Ba-Break M, Morgan R. Factors in use of family planning services by Syrian women in a refugee camp in Jordan. J Fam Plan Reprod Heal Care. 2017;43(2):96–102.CrossRef West L, Isotta-Day H, Ba-Break M, Morgan R. Factors in use of family planning services by Syrian women in a refugee camp in Jordan. J Fam Plan Reprod Heal Care. 2017;43(2):96–102.CrossRef
29.
go back to reference Roehl A, Reddy SL, Shannon GJ. The flipped classroom: an opportunity to engage millennial students through active learning strategies. J Fam Consum Sci. 2013;105(2):44–9.CrossRef Roehl A, Reddy SL, Shannon GJ. The flipped classroom: an opportunity to engage millennial students through active learning strategies. J Fam Consum Sci. 2013;105(2):44–9.CrossRef
31.
go back to reference Gobezayehu AG, Mohammed H, Dynes MM, Desta BF, Barry D, Aklilu Y, et al. Knowledge and skills retention among frontline health workers: community maternal and newborn health training in rural Ethiopia. J Midwifery Women’s Heal. 2014;59(SUPPL1):21–31.CrossRef Gobezayehu AG, Mohammed H, Dynes MM, Desta BF, Barry D, Aklilu Y, et al. Knowledge and skills retention among frontline health workers: community maternal and newborn health training in rural Ethiopia. J Midwifery Women’s Heal. 2014;59(SUPPL1):21–31.CrossRef
32.
go back to reference Noubani A, Diaconu K, Ghandour L, El Koussa M, Loffreda G, Saleh S. A community-based system dynamics approach for understanding factors affecting mental Health and Health seeking behaviors in Beirut and Beqaa regions of Lebanon. Global Health. 2020;16(1):1–13.CrossRef Noubani A, Diaconu K, Ghandour L, El Koussa M, Loffreda G, Saleh S. A community-based system dynamics approach for understanding factors affecting mental Health and Health seeking behaviors in Beirut and Beqaa regions of Lebanon. Global Health. 2020;16(1):1–13.CrossRef
Metadata
Title
Evaluating a capacity building program on women’s health for displaced community health workers in fragile settings in Lebanon
Authors
Hady Naal
Rebecca Mendelsohn
Dayana Brome
Aya Noubani
Dana Nabulsi
Dina Muhieddine
Shadi Saleh
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Human Resources for Health / Issue 1/2021
Electronic ISSN: 1478-4491
DOI
https://doi.org/10.1186/s12960-021-00585-0

Other articles of this Issue 1/2021

Human Resources for Health 1/2021 Go to the issue