A holistic and coherent package of training and health workforce management practices supports health workers to deliver person-centred skin NTD services

Training, supporting and empowering health care workers (both paid and voluntary) at different levels of the health system is pivotal to the delivery of person-centred care for NTDs. Our initial research found high levels of attrition and that some health workers lacked knowledge and motivation and had stigmatising attitudes toward people affected by NTDs. In REDRESS, we developed a holistic and coherent package of training and health workforce management practices to support health workers to deliver NTD services, including; training (guided by adult based learning approaches), direction and supervision, provision of resources, and rewards for good performance. Mental health and stigma awareness were integrated within the intervention, supervision processes and all job aids. Following the intervention, health workers at all levels described providing more and better services for people with skin NTDs, e.g. community health assistants (CHAs) and community health promoters (CHPs) identified and referred more persons affected. Formal health workers described increased motivation and managed patients with greater confidence at facility level, as they had improved knowledge and skills, clearer roles, more resources and increased recognition. However, a lack of drugs and supplies to provide treatment needed by patients was felt to contribute to demotivation by health workers at both facility and community levels.