Abstract:
Background: Displaced populations in fragile settings experience health disparities that are seldom attended to.
Task-shifting, which involves training non-specialized community health workers (CHW) to deliver basic education
and health services is a favorable strategy to address this problem, however very little data exist on this topic in the
Middle East region. We conducted a long-term evaluation of the Women’s Health Certifcate delivered to Syrian refugees and host community in informal tented settlements in Lebanon under the Mobile University for Health (MUH)
program. The training was delivered through a mobile classroom approach that incorporated a blended learning
modality.
Methods: We collected short-term data from the 42 trained CHW (knowledge assessments and satisfaction measures) during the delivery of the intervention between March and August 2019, and long-term data (semi-structured
interviews with 8 CHW and focus group discussion with 9 randomly selected community members) one year later
between July and August 2020. The evaluation approach was informed by the Kirkpatrick evaluation model, and the
qualitative data were analyzed using qualitative content analysis.
Results: Data from the CHWs and community members were triangulated, and they showed that the training
enhanced access to education due to its mobile nature and provided opportunities for CHWs to engage and interact
with learning material that enhanced their knowledge and favorable behaviors regarding women’s health. In turn,
CHWs were empowered to play an active role in their communities to transfer the knowledge they gained through
educating community members and providing women’s health services and referrals. Community members benefted from the CHWs and called for the implementation of more similar training programs.
Conclusion: This is one of few studies reporting a long-term community-level evaluation of a task-shifting program
on women’s health among displaced populations in Lebanon. Our fndings support the need to increase funding for
similar programs, and to focus on delivering programs for a variety of health challenges. It is also essential to enhance
the reach and length of recruitment to wider communities, to design concise, interactive, and engaging sessions, and
to provide tools to facilitate circulation of learning material, and resources for referrals to health services.