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Of the 62 tests that were repeated due to errors, 79% achieved concordance between the CHW and the DR. Satisfaction with the use of the DR by the CHWs was high.Use of innovative mHealth strategies for monitoring and quality control can ensure quality within a large scale implementation of community level testing by lay health workers.
It follows that in areas where aggregated data from electronic patient records are available, the diabetes risk scores may be used as a population prediction tool for example, to produce small area statistics (perhaps as pictorial maps) of diabetes risk across a population, thereby allowing targeted design and implementation of community level public health interventions.
While an association between training and the identification of DHF is not causal, it is likely that the surveillance training, the inclusion of hemorrhagic fever into a routine data collection, and the increased availability of rapid diagnostic tools contributed to the early identification and timely implementation of community level control measures during this outbreak.
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However, there is a political will on the part of the Government of Malawi to improve PHC implementation at community level and to ensure larger community participation.
3– 6 Assessments of CHW performance pose unique challenges because of their remote locations, diverse responsibilities, and variable caseloads, 7 and it remains unclear which method provides the optimal balance between data validity, reliability and feasibility of implementation at the community level.
However, the evaluators of Finnish health promotion policy have repeatedly expressed critical assessment of the leadership and implementation of community action at the local level [ 19, 20].
We will therefore limit it to comments on some important aspects of efficiency related to implementation at the community level.
This shows large scope for increasing resilience in collaboration with the community, through for example the development of community-level risk management committees, improvement and implementation of (gas) mitigation strategies and disaster preparedness approaches.
We will assess the implementation of ASTUTE program outreach activities and document the acceptability and feasibility of community-level nutrition-specific and nutrition-sensitive interventions.
2. Factors influencing effective implementation at the community level.
Experience with KMC implementation at the community level is much more restricted than hospital-level initiatives [ 115].
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