In support of community healthcare in developing countries
How do peer-led interventions differ from those implemented by NGOs?
The issue
Following last week’s article on decolonizing global health, this week I’d like to highlight innovative community health strategies that have had unexpected outcomes in the developing world. According to the IMF, community-based primary healthcare provides an efficient, low-cost method of reaching a great number of people. This can be achieved through improving access to preventive healthcare services, engaging citizens in care decisions, and seeking lower medical costs.
Promoting preventative healthcare
A recent study in Mozambique investigated the effects of a community-led HIV/AIDS program aimed at improving knowledge and promoting testing via home visits. However, due to an inadvertent increase in misinformation, the program initially decreased HIV testing rates. Despite this, researchers were able to counteract this effect by providing correct information across households. This highlights the importance of improving knowledge and alleviating stigma concerns in community-based interventions.
Similarly, a study in India explored the effects of incentivized peer referrals for tuberculosis screening. Relative to unincentivized encouragement, financial incentives more than doubled the number of patients screened. This strategy was also twice as effective as using health workers to identify tuberculosis cases. Peers can achieve this as they have better information on individuals in their social networks, and are also more effective at inducing them to get tested than health workers.
Increasing engagement in care decisions
In Bangladesh, researchers studied the impact of a multifaceted peer-led psychosocial intervention1 among refugee Rohingya mothers and children. This is especially relevant as refugee women are at higher risk of abandonment and violence, and have a higher depression burden than men. As a result of this intervention, trauma and depression severity decreased significantly for both mothers and children. Additionally, stunting decreased by 10 percent among children.
Moreover, a study in rural Kenya evaluated the impact of an intensive NGO-led substance abuse program that included community workshops and counseling. Not only did this intervention decrease heavy drinking among men by 21 percentage points, but it also increased annual harvest values by 35 percent. The authors believe that this was achieved through greater information and labor sharing among peers in the treatment group.
Closing thoughts
All in all, the evidence presented weighs the merits of both health peer- and NGO-led initiatives in furthering the objectives of community health. While NGOs have the expertise and funding to tackle large-scale problems, peers are essential to engaging communities with cultural sensitivity in mind.
This psychosocial intervention informed mothers in mental hardship about possible reasons for their distress and provided simple ways of addressing it. These interventions also facilitated the discussion and sharing of feelings with others to help women identify their challenges and personal coping abilities.