The Mixed Nature of Incentives for Community Health Workers: Lessons from a Qualitative Study in Two Districts in India

Incentives play an important role in motivating community health workers (CHWs). In India, accredited social health activists (ASHAs) are female CHWs who provide a range of services, including those specific to reproductive, maternal, neonatal, child, and adolescent health. 

Qualitative interviews were conducted with 49 ASHAs and one of their family members (husband, mother-in-law, sister-in-law, or son) from Gurdaspur and Mewat districts to explore the role of family, community, and health system in supporting ASHAs in their work. Thematic analysis revealed that incentives were both empowering and a source of distress for ASHAs and their families. Earning income and contributing to the household’s financial wellbeing inspired a sense of financial independence and self-confidence for ASHAs, especially with respect to relations with their husbands and parents-in-law. 

In spite of the empowering effects of the incentives, they were a cause of distress. Low incentive rates relative to the level of effort required to complete ASHA responsibilities, compounded by irregular and incomplete payment, put pressure on families. ASHAs dedicated much of their time and own resources to perform their duties, drawing them away from their household responsibilities. Communication around incentives from supervisors may have led ASHAs to prioritize and promote those services that yielded higher incentives, as opposed to focusing on the most appropriate services for the client. ASHAs and their families maintained hope that their positions would eventually bring in a regular salary, which contributed to retention of ASHAs. 

Incentives, therefore, are both motivating and inspiring as well as a cause dissatisfaction among ASHAs and their families. Recommendations include revising the incentive scheme to be responsive to the time and effort required to complete tasks and the out-of-pocket costs incurred while working as an ASHA; improve communication to ASHAs on incentives and responsibilities; and ensure timely and complete payment of incentives to ASHAs. 

The findings from this study contribute to the existing literature on incentivized CHW programs and help throw added light on the role incentives play in family dynamics which affects performance of CHW.

Full article at:   http://goo.gl/wyuobV

By:  Enisha Sarin,^1,* Sarah Smith Lunsford,² Ankur Sooden,¹ Sanjay Rai,¹ and Nigel Livesley¹

¹University Research Co., LLC, New Delhi, India

²EnCompass LLC, Bethesda, MD, USA

Edited by: Chikaikeo Ogbonna, University of Jos, Nigeria

Reviewed by: Luret Albert Lar, University of Jos, Nigeria; Emmanuel Nwabueze Aguwa, University of Nigeria Nsukka, Nigeria; Afolaranmi Olumide Tolulope, University of Jos, Nigeria

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Asian-Pacific Clinical Practice Guidelines on the Management of Hepatitis B: A 2015 Update

Worldwide, some 240 million people have chronic hepatitis B virus (HBV), with the highest rates of infection in Africa and Asia. Our understanding of the natural history of HBV infection and the potential for therapy of the resultant disease is continuously improving. New data have become available since the previous APASL guidelines for management of HBV infection were published in 2012. 

The objective of this manuscript is to update the recommendations for the optimal management of chronic HBV infection. The 2015 guidelines were developed by a panel of Asian experts chosen by the APASL. The clinical practice guidelines are based on evidence from existing publications or, if evidence was unavailable, on the experts’ personal experience and opinion after deliberations. Manuscripts and abstracts of important meetings published through January 2015 have been evaluated. 

This guideline covers the full spectrum of care of patients infected with hepatitis B, including new terminology, natural history, screening, vaccination, counseling, diagnosis, assessment of the stage of liver disease, the indications, timing, choice and duration of single or combination of antiviral drugs, screening for HCC, management in special situations like childhood, pregnancy, coinfections, renal impairment and pre- and post-liver transplant, and policy guidelines. 

However, areas of uncertainty still exist, and clinicians, patients, and public health authorities must therefore continue to make choices on the basis of the evolving evidence. The final clinical practice guidelines and recommendations are presented here, along with the relevant background information.

Below:  Treatment indications for chronic HBV-infected patients with cirrhosis or reactivation of chronic HBV infection

Below:  Treatment indications for noncirrhotic HBeAg-positive chronic HBV-infected patients

Below:  Treatment indications for noncirrhotic HBeAg-negative chronic HBV-infected patients

Below:  Reverse transcriptase mutations associated with drug resistance

Below:  Cumulative incidence of antiviral resistance in long-term studies of NA therapy

Below:  Treatment of CHB infection in HIV infected individuals

Below:  Treatment of HBV–HCV coinfected patients

Recommendations for infected persons regarding prevention of transmission of HBV to others

Have sexual contacts vaccinated

Use barrier protection during sexual intercourse if partner not vaccinated or naturally immune

Do not share toothbrushes or razors

Cover open cuts and scratches

Clean blood spills with detergent or bleach

Do not donate blood, organs or sperm

Can participate in all activities including contact sports

Children should not be excluded from daycare or school participation and should not be isolated from other children

Can share food, utensils, or kiss others

Full article at:  http://goo.gl/1208wm

By:  S. K. Sarin, M. Kumar, G. K. Lau, Z. Abbas, H. L. Y. Chan, C. J. Chen, D. S. Chen, H. L. Chen, P. J. Chen, R. N. Chien, A. K. Dokmeci, Ed Gane, J. L. Hou, W. Jafri, J. Jia, J. H. Kim, C. L. Lai, H. C. Lee, S. G. Lim, C. J. Liu, S. Locarnini, M. Al Mahtab, R. Mohamed, M. Omata, J. Park, T. Piratvisuth, B. C. Sharma, J. Sollano, F. S. Wang, L. Wei, M. F. Yuen, S. S. Zheng, and J. H. Kao

Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India

Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong SAR, China

Department of Hepatogastroenterlogy, Sindh Institute of Urology and Transplantation, Karachi, Pakistan

Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China

Genomics Research Center, Academia Sinica, National Taiwan University, Taipei, Taiwan

Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Liver Research Unit, Chang Gung Memorial Hospital and University, Chilung, Taiwan

Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey

New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand

Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Guangzhou, China

Department of Medicine, Aga Khan University, Karachi, Pakistan

Beijing Friendship Hospital, Capital Medical University, Beijing, China

Seoul, Korea

Department of Medicine, University of Hong Kong, Hong Kong, China

Internal Medicine Asan Medical Center, Seoul, Korea

Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore

Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

Yamanashi Hospitals (Central and Kita) Organization, 1-1-1 Fujimi, Kofu-shi, Yamanashi 400-8506 Japan

Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

NKC Institute of Gastroenterology and Hepatology, Prince of Songkla University, Songkhla, Thailand

Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India

Department of Medicine, University of Santo Tomas, Manila, Philippines

The Institute of Translational Hepatology, Beijing, China

Treatment and Research Center for Infectious Diseases, Beijing 302 Hospital, Beijing, China

Peking University Hepatology Institute, Beijing, China

Division of Gastroenterology and Hepatology, Department of Medicine, University of Hong Kong, Pofulam, Hong Kong

Department of Hepatobiliary and Pancreatic Surgery, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 Zhejiang Province China

Graduate Institute of Clinical Medicine and Hepatitis Research Center, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei, Taiwan

S. K. Sarin, Email: moc.liamg@nirasvihs.

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Committed Activists & The Reshaping of Status-Quo Social Consensus

The role of committed minorities in shaping public opinion has been recently addressed with the help of multiagent models. However, previous studies focused on homogeneous populations where zealots stand out only for their stubbornness. 

Here we consider the more general case in which individuals are characterized by different propensities to communicate. In particular, we correlate commitment with a higher tendency to push an opinion, acknowledging the fact that individuals with unwavering dedication to a cause are also more active in their attempts to promote their message. 

We show that these activists are not only more efficient in spreading their message but that their efforts require an order of magnitude fewer individuals than a randomly selected committed minority to bring the population over to a new consensus. 

Finally, we address the role of communities, showing that partisan divisions in the society can make it harder for committed individuals to flip the status-quo social consensus.

Purchase full article at:  http://goo.gl/6WrVFj

By:  Mistry D1, Zhang Q1, Perra N1,2, Baronchelli A3.

• 1Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, Massachusetts 02115, USA.
• 2Centre for Business Network Analysis, University of Greenwich, Park Row, London SE10 9LS, United Kingdom.
• 3Department of Mathematics, City University London, London EC1V 0HB, United Kingdom 

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México Is More Dangerous Than Ever for Women's Rights Activists

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