Background
Methods
Study design
Intervention
Model development procedures
Ethical considerations
Results
Stakeholders and value drivers
Stakeholders | Perceived positive and negative value drivers identified by Stakeholders | Representative quote on the perceived positive value of the intervention | Representative quote on the perceived negative value of the intervention | |
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TB patients (n = 11) | • CHWs increase feelings of support and care through counselling • Encouragement from CHWs increased self-efficacy and motivation to complete treatment • Prevention of family or community from TB infection • Anticipated and/or experienced isolation and stigma |
“I had to try to follow the treatment. Luckily, I had the help from my healthcare worker. She encouraged me and helped me receive my medicine. In general, I was very happy and even went to hug her and said thank you. Without her, I don’t know what I would have done.” – Male, TB Patient, Painter
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“I was afraid that people would avoid me since this is a communicative disease. Many people have knowledge about TB and are okay with it. But for people who do not know about TB, they are probably scared.”- Male, TB Patient, Silversmith
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Site coordinators & CHWs (n = 9) | • Earlier disease detection • More access to healthcare services • Increased sense of personal satisfaction due to positive patient outcomes • Creation of community and strengthened interpersonal relationships • Lack of patient trust in the health care system |
“My healthcare worker lit a flame in me, she encouraged us to place more heart in our jobs, we felt excitement in our work. We feel happy when working with patients and creating trust. I have worked for this for nearly twenty years, and I love my job.” – Female, Community Health Worker
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“The most difficult thing is trust. For example, there was a case of a drug-resistant TB patient who had a positive result, but he did not believe that he suffered from TB. He did not agree to treatment even though the TB counsellor visited his house and a healthcare worker talked with him.” – Male, Community Health Worker
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TB program (n = 3) | • Direct support for ACF activities • Strengthened collaborations between National and Provincial TB programs and local governments • CHWs supported programs and increased collaboration • Heavier workload and need for overtime support |
“The force of community health workers has worked so far and I still highly appreciate them and consider them as the important bridge between the project, people with TB, clinics and units.” – Male, Head District TB Unit Officer 1
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“It is not just that we work extra hours, but the intensity of screening will also be heavier. With the program, patients get chest x-rays and some days there may be up to 30. Therefore, there is more work to do.” – Male, Head District TB Unit Officer 2
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Provincial and District Government (n = 3) | • Direct support for ACF activities • Broader community and household reach • Ability to target high risk groups • Fear and lack of trust of the government from patients |
“Since the Proper Care program started, we are more active, we find cases actively at our unit. For example, each year, we detect about 100 TB patients, but the number of TB cases increased to 150 patients last year. – Male, District Health Center Director 1
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“Our activities make people afraid of being taken advantage of due to the approach. For some difficult places, we have to invite leaders of the residential clusters. They will come along with us for safety reasons, moreover to avoid the negative exploitation of counsellors’ and health workers’ work.” – Male, District Health Center Director 2
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Viet Nam TB Ecosystem (n = 3) | • Increase in funding for TB • Influence on domestic policy • Improvement of corporate image and reputation • Communicating project mission fit to corporations |
“It really helped us to inform national policy. Back in the day, we didn’t really know what it’s like on the ground. Now, we have someone who really understands the details to help us make an impact. – Male, Organization Country Director
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“One of our challenges was really to convince our management that the Proper Care project was worth investing in. There’s a pot of money that was available to us, and we were all competing for it” – Female, Organization Department Senior Director
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Abbreviations: ACF: Active Case Finding, CHW: Community Health Worker, TB: Tuberculosis |
Stakeholders | Perceived benefits | Perceived challenges |
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TB patients | Patients noted that CHWs were the main benefit due to their ability to provide both tangible support (TB knowledge and counseling) as well as feelings of being supported and having a caring community. Encouragement from CHWs increased feelings of self-efficacy and motivated patients to prevent spread and complete treatment. | Isolation and stigma were the main challenges, in terms of the patients themselves, and in their perception of others. However, this value driver was indicated as a difficulty of the disease, not necessarily of the program. |
Site coordinators & CHWs | The largest benefit project staff experienced for themselves was a sense of personal satisfaction when patients experienced positive health outcomes. Patients were viewed as friends or peers, creating a stronger sense of community. | A challenge faced by patients, which also translated to a challenge for project staff, was a lack of trust in the health care system. Staff encountered difficulties in contacting patients or convincing patients to obtain treatment at the district-level TB treatment facility. |
TB Program | Direct support for ACF activities was mentioned as the greatest benefit. District-level TB healthcare providers noticed strengthened collaboration between the National TB Control Program, implementing partners, and the local government. CHWs were an essential bridge between stakeholders and provided consultation and advocacy for patients. The program provided direct support though GeneXpert tests, and this program support produced an increased number of TB patients detected and linked to treatment. | District-level TB healthcare providers felt burdened with an increased workload when being required to perform setup activities and manage community activities. The number of meetings, training, and reports were increased and many providers requested additional staff to assist with the workload. |
Provincial and District Government | For government members, direct support for ACF activities was most beneficial, with an emphasis on the increase in concrete numbers such as households approached and individuals screened. They acknowledged the comprehensiveness of the program: approaching vulnerable groups, thorough data analysis, and tangible improvements. | A challenge was a fear and lack of trust of the government from TB patients, which made it difficult to reach patients and effectively communicate the aims of the program. |
Viet Nam TB Ecosystem | Sponsors saw an improvement in their image, reputation, and partnerships. The project facilitated collaboration between all relevant groups which was mutually rewarding, and strengthened the credibility of the project. | During the project’s inception, the challenge was convincing funders that the project fit with the overall goals of the corporations. Through observing activities at the grassroots level and collaborating with local organizations, sponsors were able to change their mindsets surrounding the project. |