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Are there any textile bible book where I can learn more about fabrics?
I am married to US citizen. I want to start process for green card application. Can you recommend me any good para legal in NYC area? And do you know how much it would cost? Thanks
I am married to US citizen. Now I want to start process for green card application. Can you recommend me any good para legal in NYC area? And do you know how much it costs beside administration fees ($1700)?
I saw this app for creating moving images.
I want to create same effect with AE or other tool.
Appreciate any help.
I was making cinemagraphs before.
Here Im interested how to create this trippy effect. Not sure what tool to use.
Interested to know this too. Sometimes I think to present myself as agency. I am year old on UpWork and I find difficult to get new jobs. What type of freelance job you do? Is it possible to join the group?
Anyone knows cheap or free place to sleep in Rome?
If you're willing to march thirty miles southeast of the city walls, you'll find yourself deep in a trackless swamp. You will hear strange noises, such as no man has heard before. Ready your shield. Plant your pilum- your spear will do you no good in this tangled, gloomy place. Draw your sword and advance, patiently and confidently.
In this reeking realm of sickness and decay, as the strange thrumming and clanging and rumbling noises grow louder, even the fell beasts of the Pontine Marshes will slink away in fear. You will walk in silence, excepting the blood pulsing and roaring in your ears.
You will, as darkness falls, see a glow on the horizon, blazing spears of light filtered through the trees, clouds of insects thronging to the false moons as the stars are blotted out in the sky. You will see this harsh glow set the swamp in sharp relief- this is no flickering flame, not the wholesome flush of the sun. This is not the pale caress of moonlight. This is new, a truly new thing in the world. You see what looks like a rim of boulders ahead, a perfect stone circle which has sagged and collapsed along its perimeter. Shards of the stone surface jut and ramble, amid collapsed trees and squelching mud.
Here, you stand on the threshold of a new world. You must consecrate yourself and appeal to the gods and your ancestors. Is your faith pure? Is your life a palimpsest of excuses and rationalizations, or have you writ your story in bold, true strokes? Are you a Roman?
Are you a Roman?
Then tighten your grip upon your sword. Breathe, now, and will your body to move the air in and out. Will your feet forward through the mud. Forward, Roman, forward!
Here, now, as you grasp the warm rough stone, the spear of light will fall upon you. This is where you scream, your sword raised to strike. Arms are upon you from behind, almost gentle until they brush down your forearm to your wrist and you have lost the sword even before the pain travels to your head.
You are on your knees in the muck, disarmed, dishonored. There are harsh voices, gabbling, inhuman- and then they are almost playful. You will never cease to be amazed by these voices, throughout your long stay- the childlike cheer, the games and winks and good humor that thread through every conversation. This is a happy place, or at least a place which requires you to seem happy.
You will, in time, learn to use your smile to give and take what you need. You will, in time, learn that there is strength and resilience, not just ignorant childishness, in the cheer of this tribe of god-savages. You will, in time, perhaps count yourself one of them.
For now, though: Sleep.
Mate this sub is for a story based on the American military being sent back in time to the Roman empire. These are not the droids you're looking for.
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I am looking for a long-term playable ad creator with experience. Portfolio is a must.
I need to find an online vendor or print shop in nyc that can produce 1000+ black card stock paper (8.5 x 11) with our logo printed in white, as shown in photo. Card stock is 80lb or 13pt. If there is no print shop that can do this, then where can i buy the black card stock only? example
I use a company based on LI but they can ship to NYC. I'll PM you the contact info, if you're interested.
I live in Eastern Europe in a country that is not supported by Spotify. I am using Web Player in Chrome with Hola VPN but Im missing Desktop app for easier playlists sorting. How can I make it work?
I registered Spotify in US but I moved to a Eastern Europe where Spotify is not supported. I still can use it for 30 days. Is there a way to continue to use it after? I remember there was some guy that developed app for this but I can not find it now. Thanks!
I moved to Europe and I tried to use different SIM in my phone but without luck. I receive message Sim Not Valid. When I connect it to iTunes: The SIM card inserted in this iPhone does not appear to be supported. I called AT&T and they told me I need to have original sim in order to activate. Unfortunately I dont have it. What are the options to activate my phone so I can use it on any carrier? Thanks
I know how it works. OP didn't say anything one way or the other about the phone being paid off or not and so to suggest that they pay shady unlockers without first trying to unlock online is ridiculous.
OP should try the unlock portal first and see what happens. As long as their bill is paid in full they will unlock it.
The op called AT&T and they did not offer to unlock so the assumption is that it's contract was not completed. Otherwise att would have directed the op to the unlock request page. I guess if the op got an inexperienced tech...that redirect to unlocking page may not have happened
When we called at&t in the same manner they told us the same about using an att SIM unless fully unlocked. We were transferred to the department that handles unlocking to check if it could be done. That's where we were told the phone's contract was not completed and it would be useless to fill out a request.
However, if the contract is paid out, you are correct....op needs to contact att for an unlock request FIRST. A lot of those unlockers in Europe are definitely shady.
I will contact again AT&T for unlock request on my phone. I did 5 times unlock process over their website successfully. But still I receive message SIM NOT VALID.
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Are there any sub or other source with experiments people were sharing? Im looking to start with processing. Only source right now is YT.
I am using CEC mode to turn on projector over Google Mini with voice command and Chromecast plugged in HDMI. But when I command to turn it off it just shuts down without cooling. Anyone has tried to us this projector in HDMI CEC mode? Thanks
Found this by googling the same issue...looks like BenQ are aware but either can't sort it or just won't. Wonder if it's an issue on the W1070+, flash the firmware? :P
If anyone else finds this on google and sorts it, don't forget us.
I would love to see solution. Right now I can only turn on projector over CEC.
Tools and apps such as Trello works well with me.
If on a tight budget, use an Excel Spreadsheet or Google Spreadsheet that you can collaborate with teammates and clients.
Im moving to live in Europe some time. Thinking to get new US number to have for registrations and business. People recommend Skype, Google Voice and VOIP. What service id the best? And Why? Thanks!
Google Voice is definitely the cheapest but you're not actually getting a new number, you're creating a number that people can call and that call will be forwarded to your existing phone number. So you have to have an existing phone contract with someone to be able to get those calls, does that make sense?
Skype is fine but you have to be connected to the internet to send/receive calls.
VOIP is the same way.
If you're wanting to keep communication lines open between the US and you, I recommend doing something easy like Textplus or WhatsApp that lets you send texts, make long distance and local calls, and has voicemail and call forwarding options. Both are apps in the Apple and Google App stores.
I went through the same search when I moved to China. Text plus is what I use. I can choose my own phone number with my home area code. I also pay $20/year for unlimited calls to the US so I can call my family whenever, wherever I have WiFi or Data service and don't have to worry about roaming charges etc. I have a Chinese SIM card and phone so I don't always have to rely on WiFi. I like it better because it gives you the option to have your local phone service and your "US" service separate, unlike google voice. You also don't need to always be connected to the internet via WiFi like VOIP.
Skype is very similar but functions much less like a separate phone plan and more like a communication app. You send messages instead of texts and to communicate, the other person needs to have Skype as well.
I know I'm biased towards textplus but it's a great little app that saves me tons of money and is just really easy to use.
I activated Google Voice and it seems I don't need my T Mobile sim Anymore. I can call with Google number even when I pull sim out.
Text plus seems like a good solution. Can I choose to get NY area number so I can use for registration. I also need it to get calls and sms. Can I activate it in Europe and choose area number I want? Thanks a lot on detailed answer. I appreciate your help!


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Apply for Professional Cookery, VRQ Level 2 Diploma ...
You will gain a high standard of cookery and patisserie skills on this professional chef's course. You will leave the College well prepared to start a career in one of the world's fastest growing industries after having enjoyed a substantial taste of it. This course is Pass, Merit and Distinction which rewards the hard work and effort that you are putting in. This course is suitable for students who are quite academic as it is 30% assignment based and 70% practical which requires a lot of self-motivated study time to gain high grades. You will gain professional practical skills and valuable experience in our excellent training facilities. There has never ben a better time to enter the hospitality and catering industry. The industry is growing year on year and this is particularly true for our region with the expansion of quality restaurants and hotels in the city centre and across Merseyside. The theory behind the diploma is the belief that a chef needs to have a sound foundation of high quality skills and to be able to apply these skills across a range of processes and techniques. The qualification gives you the skills and knowledge required to meet the modern needs of the industry.
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Professional cookery craft assessment
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Now included in PubMed Central (PMC).
About the Author(s)
Received: 24 May 2017; Accepted: 21 Dec. 2017; Published: 26 Mar. 2018
Copyright: © 2018. The Author(s). Licensee: AOSIS.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution,
and reproduction in any medium, provided the original work is properly cited.
Background: The current roles and capacity of community health workers (CHWs) in the management and control of non-communicable diseases (NCDs) remain poorly understood.
Objectives: To assess CHWs' current roles, training and knowledge about diabetes and hypertension in Khayelitsha, Cape Town.
Methods: A cross-sectional study of 150 CHWs from two non-governmental organisations contracted to provide NCD care as part of a comprehensive package of services was conducted. An interviewer-administered closed-ended questionnaire was used to determine the roles, training, in-service support, knowledge and presence of NCDs. Descriptive analyses of these domains and multivariate analyses of the factors associated with CHWs' knowledge of hypertension and diabetes were conducted.
Results: The vast majority (96%) of CHWs were female, with a mean age of 35 years; 88% had some secondary schooling and 53% had been employed as CHWs for 4 years or more. Nearly half (47%) reported having an NCD. CHWs' roles in NCDs included the delivery of medication, providing advice and physical assessment. Only 52% of CHWs reported some formal NCD-related training, while less than half of the trained CHWs (n = 35; 44%) had received follow-up refresher training. CHWs' knowledge of diabetes and hypertension was poor. In the multivariate analyses, higher knowledge scores were associated with having an NCD and frequency of supervisory contact (≥1 per month).
Conclusions: The roles performed by CHWs are broad, varied and essential for diabetes and hypertension management. However, basic knowledge about diabetes and hypertension remains poor while training is unstandardised and haphazard. These need to be improved if community-based NCD management is to be successful. The potential of peer education as a complementary mechanism to formal training needs as well as support and supervision in the workplace requires further exploration.
Non-communicable diseases (NCDs) such as diabetes and hypertension are public health problems that place a heavy burden on health facilities. To address this burden and to provide continuity of care for NCDs, it is increasingly recommended that services be offered outside of health facilities in communities (Ndou et al. 2013). In South Africa, community health workers (CHWs) provide community-based care, but for years, their efforts have been focused on home-based care for people with HIV and TB, with little done in the area of NCDs. There is a scarcity of information describing the processes required to integrate NCD care into the work of generalist CHWs, including training, supervision and orientation into roles. Where it has been assessed, studies have suggested that CHWs lack essential knowledge of chronic diseases (Bradley & Puoane 2007; Sengwana & Puoane 2004).
This study sought to fill this gap and shed light on the roles of CHWs in diabetes and hypertension management in an urban area of the Western Cape. Based on current practices, it suggested possible avenues for capacity building of CHWs for NCD care in South Africa, especially in resource-constrained settings.
This study assessed the roles, training, in-service support and knowledge related to NCDs (i.e. diabetes and hypertension). In addition, the study also examined factors associated with knowledge among CHWs providing NCD care in an urban township. It was done with the purpose of informing the development of appropriate and context-sensitive CHW training programmes. The questionnaire in this study assessed the following:
Community health workers are lay workers who have no professional training but have some training in the context of the intervention and are responsible for delivering services related to health care (Lewin et al. 2005).
Non-communicable diseases such as diabetes and hypertension have contributed significantly to the burden of disease globally, including in South Africa (Mayosi et al. 2009). According to the International Diabetes Federation (IDF), 2.28 million South Africans had diabetes in 2015 (IDF 2015), while the prevalence of hypertension is on the increase (Gomez-Olive et al. 2013; Lloyd-Sherlock et al. 2014; Thorogood et al. 2007). According to the World Health Organization in 2015, three quarters of all NCD-related deaths now occur in low- and middle-income countries (LMIC) (WHO 2016), where diabetes prevalence quadrupled between 1980 and 2014 (NCD Risk Factor Collaboration 2016). This rise in NCDs has implications for health systems and populations, affecting the most economically active age groups (Islam & Biswas 2014; Peck et al. 2014). In many regions of the world, health systems are ill-prepared to deal with the problem, and the prevention and management of NCDs remain a significant challenge. One of the constraints to managing NCDs is the poor availability of adequately trained human resources (Islam & Biswas 2014; Peck et al. 2014).
Community health workers have been proposed as a strategy to mitigate the shortage of health care professionals (Lehmann & Sanders 2007; Liu et al. 2011; O'Brien et al. 2009) such as nurses and doctors. CHWs' relationship with the community, as well as their understanding of the context, culture and language, puts them in an ideal position to assist communities with health-related issues (Lehmann & Sanders 2007; Lehmann et al. 2009). Furthermore, CHW programmes provide a link with the formal health care system, thereby ensuring a continuum of care (Liu et al. 2011), vital for longevity and the prevention of complications of NCDs.
Studies have shown that CHWs can play a valuable role in the prevention, management and care of chronic lifelong (CLL) conditions such as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) (Callaghan, Ford & Schneider 2010; Mwai et al. 2013; Schneider, Hlophe & Van Rensburg 2008). The role of the CHWs has also been cited in the prevention and management of diabetes and hypertension in LMIC (Farzadfar et al. 2012; Jafar et al. 2010). In these contexts, CHWs have shown to be effective in providing education as well as support to people with NCDs (Bradley & Puoane 2007; Gaziano et al. 2015; Ndou et al. 2013). There is also considerable evidence on the role and effectiveness of CHWs for the prevention and management of NCDs in high-income countries, where roles similarly include health education, adherence support and counselling (Brownstein et al. 2005, 2007; Cherrington et al. 2008). However, for CHWs to perform these tasks, they require appropriate training (Abrahams-Gessel, Denman & Montano 2015b; Lopes, Cabral & De Sousa 2014), supportive supervision (Källander et al. 2015), materials and equipment. Despite the potential role of CHWs in NCDs, studies indicate that CHWs often have poor knowledge about NCDs and their risk factors (Abrahams-Gessel, Denman & Montano 2015a; Puoane, Bradley & Hughes 2006).
Community health workers in many parts of South Africa are employed by non-governmental organisations (NGOs) intermediaries, which are often contracted by the government to render services to communities (Van Pletzen et al. 2014). These NGOs are responsible for the capacity development of the CHWs, including their training needs, orientation into roles and supervision. Overall, community-based approaches to NCDs are underdeveloped, inadequately defined and fragmented. However, in South Africa, a diverse community-based care and support infrastructure based on lay health workers is being reorganised into a more comprehensive system of outreach. Under a set of initiatives referred to as PHC Re-engineering (Naledi, Barron & Schneider 2011), a formalised CHW cadre has been piloted with expanded roles. These roles extend beyond HIV and tuberculosis (TB) to include maternal child health interventions and integrated approaches to chronic lifelong conditions (involving both communicable and NCDs).
This cadre of workers will be organised into ward-based outreach teams (WBOTs) supervised by a nurse and supported by health facilities. In the first phase of primary health care (PHC) re-engineering, the focus has been on developing the capacity for maternal child health (Whyte 2015).
A cross-sectional study of CHWs employed by two NGOs providing NCD care in Khayelitsha, Cape Town, was conducted.
Khayelitsha is a large informal settlement in Cape Town. In 2011, this township had an estimated population of 391 749 people (Statistics South Africa 2012). At the time of the study (2013), community-based services were provided by a network of 5000 CHWs employed by 45 NGOs, which were predominantly funded by government departments such as health and social development (Van Pletzen et al. 2014). However, only three NGOs were supported and funded by the Ministry of Health to provide NCD care in the community. All three NGOs were purposively selected and approached for the study, two of which consented to participate. All 160 CHWs employed in the two NGOs were then approached for an interview.
Trained research assistants using mobile phones administered a questionnaire in isiXhosa (local language). Data were collected in 2013 for 2 months.
The development of the questionnaire involved an initial phase where CHWs were observed conducting their daily activities. The observations of practice provided insights about CHWs scope of practice and work organisation among other things. This formative, exploratory phase, which is reported elsewhere (Tsolekile et al. 2014), provided the basis for designing the questionnaire for this study. Findings from this formative phase resulted in the development of four critical areas (constructs) within the CHWs' sphere of activity related to diabetes and hypertension: roles, training and induction, supervision and support, and knowledge. In an iterative process, the co-authors developed a questionnaire to assess these activities quantitatively.
Regarding their roles, CHWs were asked the following question (without further probing): 'What are the services that you provide to clients with hypertension and diabetes?' The responses were entered into a pre-coded list by fieldworkers. Knowledge was similarly assessed through a series of closed-ended questions covering risk factors, complications and prevention of hypertension and diabetes. There were 26 and 27 possible knowledge responses about diabetes and hypertension, respectively. These were basic and appropriate to the scope of CHWs.
The data collection tool was piloted to ensure the appropriateness and understanding of questions and to test its content validity. The questionnaire was piloted in another township 15 km away from the study site with 17 CHWs who also provided NCD care to community members.
Data analysis was performed using SPSS software, version 24 for Windows (Microsoft, USA). Univariate analysis was conducted on socioeconomic characteristics, NCD-related training, knowledge about NCD (including risk factors, complications, preventive measures) and roles of participants. Multivariate analysis was conducted to establish the relationship between the independent variables (various socioeconomic factors, training) and the dependent variables (knowledge scores for diabetes and hypertension). In all analyses, statistical significance was set at p < 0.05.
For each domain of knowledge, responses were scored. A score of zero was given to wrong or missing responses, and a score of one for correct answers. The means, medians and 95% confidence intervals for knowledge scores were calculated for each disease.
Permission (No. 11/4/4) to conduct the study was obtained from the Research and Ethics Committee at the University of the Western Cape, the Provincial Department of Health and the two NGOs that took part in the study.
Of the 160 CHWs approached for an interview, 150 consented to participate, giving a response rate of 94%.
Table 1 shows that CHWs were mostly female (n = 144) rather than male (n = 6). The mean age of CHWs was 35.4 years; 88% had some secondary schooling and 36% had completed grade 12. More than half (53%, n = 79) of the CHWs had been in employment for 4 years and more. Seventy (47%) CHWs reported to have at least one NCD, with hypertension (33%) being the most common. Nearly one quarter of the 150 CHWs (n = 34, 23%) had more than one NCD referring to a combination of diseases or conditions such as diabetes, hypertension, arthritis, heart diseases, asthma and strokes.
Community health workers offered a diversity of responses on their roles in the management and care of NCDs (Figure 1). The four most reported roles performed included the distribution of medication (84%), advising about diet (72%), measuring of blood pressure (63%) and conducting physical activity sessions (53%). Only 21% conducted pill counts as part of their routine practice.
Of the 150 CHWs interviewed, only 79 (52%) reported having received formal NCD-related training, and of those, less than half (n = 35; 44%) received refresher training after the initial training.
A wide variety of training experiences and providers were reported, the duration of which ranged from 1 to 270 days (9 months) (Figure 2). More than half of the 79 respondents (n = 46; 58%) reported training of 14 days or less, mostly 1 or 2 days (28%), while the remainder indicated more extended periods. Training providers were a mix of higher education institutions (often as part of research), the Department of Health and independent trainers.
Although 48% (n = 71) of the CHWs had no NCD-related training, they reported being orientated into their NCD-related roles by supervisors (nurses) (31%), NGO coordinators (34%) and fellow CHWs (25%).
The frequency of supervision of CHWs varied from engaging the supervisor once a month (25%) to more than three times a month (n = 93; 62%) (Table 2). Observed supervision (supervisor accompanying CHWs on the job) was commonly reported, with only 10% of CHWs not remembering when last they were observed performing their tasks. A vast majority (91%) of CHWs viewed their supervisors as being very supportive or supportive.
Knowledge of diabetes and hypertension among CHWs was poor, with mean scores being one third of the expected knowledge scores (Table 3). Scores for preventive measures were slightly better than for the risk factors and complications.
Multiple regression analyses were performed to ascertain the combined effects of any NCD training, age, years of schooling, NCD status (absence vs. presence of NCDs), duration of employment (≤ 3 years vs. > 3 years), and frequency of supervision (< 1 per month vs. ≥ 1 per month) on diabetes and hypertension knowledge scores (as a continuous variable).
Having an NCD and regular supervision (≥ 1 month) were strongly associated with both diabetes and hypertension knowledge scores (Table 4). The odds of knowing about diabetes were 5.4 and 4.9 times for those with an NCD or supervised more than once a month, respectively. Similar findings were observed for hypertension knowledge. Training in NCDs or years of basic schooling was not associated with improved scores.
The primary objective of this study was to assess NCD-related roles, training, and diabetes and hypertension knowledge of CHWs. In this study, CHWs had high levels of schooling, and the majority were women. In many CHW programmes, females are the preferred gender because of the type of tasks required (Jaskiewicz & Deussom 2013). Many were themselves diagnosed with an NCD. More than half of CHWs had been employed for 4 or more years, indicating a relatively stable cohort.
In this context, CHWs work as generalists, meaning that they provide a broad range of services in the community. The management of NCDs forms only a part of the package of services offered by CHWs among others. The NCD-related roles they performed ranged from the distribution of medication to measuring of blood pressure and advice about diets. These roles are a clear indication of CHWs' efforts in assisting clients to better self-manage their conditions. Self-management is a critical component of chronic disease management (Wagner et al. 2001). However, offering a broad range of services can inhibit their ability to be efficient. Thus, there is a need to develop a set of realistic roles that not only cater to the need of the community but also consider the realities of CHWs.
Training, together with technical and material support, is regarded as one of the crucial factors in CHW performance (Dal Poz et al. 2007; Lehmann & Sanders 2007). Despite their designated roles in NCDs, only 52% of the CHWs reported to have received formal training in this domain. In addition, there was a lack of standardisation of both trainers and training duration. Inconsistencies in the training result in discrepancies in practice, which may contribute to differences in care between and within organisations. Models of standardised and structured approaches to CHW training in NCDs have been documented elsewhere (Love et al. 2004), and could serve as a basis for developing programmes in South Africa.
To retain knowledge, follow-up or refresher training is necessary. In the study, a few CHWs received refresher training. In the absence of refresher training, knowledge and the ability to perform specific tasks can be quickly lost (Singh & Sachs 2013). In a study in Nepal, 3 days of additional training of CHWs once a year was found to improve the quality of services provided (Curtale et al. 1995).
The work of CHWs requires them to be knowledgeable about the most prevalent diseases in the community. Overall, knowledge scores were poor for both diabetes and hypertension. This lack of knowledge has implications for their roles such as the provision of information, advising on the dietary intake and facilitation of support groups. Cherrington et al. in their study found that CHWs' lack of knowledge regarding diabetes provided misguided information to patients (Cherrington et al. 2008). Misinformation has the potential to lead to serious medical consequences. However, Cherrington et al. warn that the scope of information that CHWs are responsible for should be re-examined to avoid overburdening CHWs.
The multivariate analysis showed that having an NCD and regular supervision was associated with better knowledge scores. Such findings suggest that CHWs with a condition could also act as expert patients, and because they have the condition, they may be more motivated to acquire knowledge. Supervision is well established as a positive influence on CHW performance and has been associated with improved diabetes and hypertension knowledge when coupled with training (Labhardt et al. 2010).
The results of this study suggest that there are multiple potential sources of NCD-related knowledge apart from formalised training; acknowledging these processes of knowledge acquisition is therefore essential in the debate on the capacity building of CHWs. These alternative sources of knowledge open the possibility for informal training where knowledge transfer occurs through supervisor-led induction and peer-led education. Although relatively few respondents (n = 18; 25%) indicated that they had received induction from other CHWs, in a previous study which observed daily activities of CHWs, it became apparent that peer-to-peer training or peer-led education is an essential source of learning and knowledge transfer (Tsolekile et al. 2014). This approach offers CHWs an opportunity to learn from each other outside hierarchical settings, which often is the case in formal training settings. Although peer training requires facilitation skills and the identification of suitable performers, it still shows some promise. Furthermore, peer-led approaches to training may be another way of supporting and supplementing standardised training (Josiah Willock et al. 2015).
Many have viewed effective and regular supervision as a strategy to assist with work-related challenges experienced by CHWs (Brownstein et al. 2005; Dal Poz et al. 2007). Others have reported that the quality of support and supervision provided to CHWs, together with the promotion of their safety and well-being, resulted in improved motivation and performance (Jaskiewicz & Tulenko 2012). Also, supervision can assist in identifying and correcting poor practices, thus aiding in building the capacity of CHWs. In this study, CHWs reported that they were under regular supervision and supervisors, who are professional nurses, often observed their work. It has been shown that diversity in supervision approaches and the quality of supervision yielded a more significant impact compared to the frequency of supervision (Brownstein et al. 2005).
Although this study provided noteworthy findings, the results should be interpreted with caution, especially about the generalisability of the findings. It was conducted in only two NGOs that deal with NCDs such as diabetes and hypertension as a part of a comprehensive package of care for a range of diseases, leaving out NGOs that may predominantly work with diseases such as HIV. The Western Cape, where the study was undertaken, is well resourced compared to other provinces in South Africa; this could be reflected in the quality of the supervision and the ability to access training opportunities from other institutions. Finally, the sample size was relatively small, limiting the possibility of disaggregated analyses. Nevertheless, the study provides insight into community-based NCD care, as well as training, supervision, knowledge and roles of CHWs who are responsible for providing NCD services in communities.
The findings have specific implications for the community prevention, management and control of NCD at the community level. Firstly, it is recommended that the scope of practice of CHWs should be defined, and their roles should consider the context and characteristics of CHWs. Secondly, standardised NCD training should be provided to all CHWs and NGOs, and this training should ideally be included as part of core modules in basic generalist training. Thirdly, training should be linked to structured in-service refresher programmes to ensure that knowledge from initial training is retained. Furthermore, this training needs to be of sufficient duration and should adopt appropriate methods. To enhance the roles of CHWs and to strengthen CHW programmes, work-based learning and support from supervisors as well as peers should be considered. Lastly, the study suggests the need to consider and further explore informal processes of knowledge acquisition such as supervisor and peer education, especially in contexts where formal training programmes are scarce.
This study suggests a need for an integrated approach to building the capacity of CHWs for NCD care that combines considerations of selection (as an expert patient) with structured training and supportive supervision. This work also provides insight into the need for the standardisation of training material as well as follow-up training that is structured and linked to basic training. Furthermore, the study highlights informal training systems that exist within NGOs, and these need to be considered when designing training systems.
We would like to acknowledge the Chronic Diseases Initiative for Africa for the funding support. We would like to acknowledge Prof. Dinky Levitt and Prof. Krisela Steyn for their role in the development of data collection tools. We would also like to thank the community health workers and the concerned NGOs for their time and valuable contributions to the study.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
L.P.T. initiated the study and was responsible for the data collection, data analysis and writing of the manuscript, as part of her PhD studies. H.S. assisted in the conceptualisation of the study design, preparation of the manuscript, data analysis and critical revision of the article. T.P. contributed to the preparation of the manuscript and critical revision of the article. Funding for this study was provided by the Chronic Diseases Initiative for Africa.
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Know before you go
Entry feeNo
Parking informationPark just off Porter Lane, DE4 4FT or at The National Stone Centre
Grazing animalsYes, sometimes
Walking trails
Paths open at all times. Please note that the reserve has some dangerous mine shafts which are normally capped but may be liable to soil movement. Please be careful.
There is limited parking for disabled visitors, by agreement with the neighbouring land owner, adjacent to the recreation ground and adjoining the reserve on the western boundary. All paths are uneven but several should be accessible to wheelchairs (accompanied) and people of limited mobility in dry weather.
When to visit
Opening timesOpen at all times
Best time to visitEarly summer for the wild flowers - follow the wild flower trail
About the reserve
This reserve is part of an ancient lead mining area.
The name Gang Mine comes from the word 'gangue', meaning waste, for the waste minerals which were dumped around the shafts. The lead spoil heaps are of little agricultural use, and only a small number of plants are able to tolerate the high concentration of minerals.
Among the species that thrive here are the nationally rare spring sandwort, and alpine pennycress. Both are locally known as leadwort. The lead spoil grades into other open areas. In some, lichens dominate the ground cover, while in others colonising species such as kidney vetch and thyme dominate. These open areas provide ideal conditions for ground-hunting invertebrates such as wolf spiders and ground beetles.
Away from the lead spoil heaps the habitat is mostly unimproved neutral grassland with a variety of flowers such as yarrow, mouse-ear hawkweed and bush vetch and occasional pyramidal orchid. The dew pond, a traditional drinking place for livestock, has been restored and adds an interesting feature to the reserve, providing permanent water, a valuable habitat for amphibians including the rare great crested newt.
Metal-rich grasslands such as Gang Mine are uncommon across Europe and because of this the area has been designated not only as a Site of Special Scientific Interest but also under European Law as a Special Area of Conservation.
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Environmental designation
Take a look at the latest sightings
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Cetti's warblers are present
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A Little Egret was a nice surprise on the Duck Marsh pond
Wyver Lane sightings report by Les Easom
Spotted at Wyver Lane
Carr Vale sighting reported by Mark Beevers
What better way to start the round up than with today's exceptional find, a male Garganey.
Belper Sightings report by Jill Greenwood
Otter sighting in Belper!
Nearby nature reserves
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Check out the reserve map
Play Wild rating
Play Wild all year round but beware of mine shafts.


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420 mm 520 mm
Signature-Elephants Foot Print
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Malasha, 2010
Subject: Animals and Nature
Style: Other
Medium: Other. Parchment
Ref. Code: aga30082010
Not For Sale