Community Health Workers

Improving neonatal health and survival requires cost-effective interventions at the community level, as well as linkages between the community and the health-care system within the continuum of care for the treatment of severe illness. The primary purpose of this study was to evaluate the performance of CHWs in recognizing signs and symptoms of neonatal illness during routine household surveillance in rural Bangladesh. [from introduction]

In 2008, Malawi piloted the distribution of depo-medroxy progesterone acetate (DMPA), an injectable contraceptive, to the community by Health Surveillance Assistants. This report presents lessons learned during the initial implementation, from gaining stakeholder buy-in to curriculum development, and the initial three months after the training and implementation roll-out. [from abstract]

In this study, we aimed to determine the cost and cost-effectiveness of involving health extension workers in tuberculosis treatment in Southern Ethiopia. This paper presents an ancillary cost-effectiveness analysis of data from a randomized control trial. [adapted from introduction]

The objective of this document was to conduct a systematic review of the evidence on characteristics of community health workers (CHWs) and CHW interventions, outcomes of such interventions, costs and cost-effectiveness of CHW interventions, and characteristics of CHW training. [from abstract]

In rural settings, the promotion of household and community health practices through community health workers (CHWs) is among the key strategies to improve child health. The objective of this study was to assess the performance of CHWs in the promotion of basic child health services in rural Mali. [from abstract]

This report presents research findings on the potential for making contraceptives, and in particular injectable contraceptives, widely available through using a community-based distribution approach which would expand the cadre of providers authorized to provide contraceptives to include health surveillance assistants and community-based distribution agents. [adapted from summary]

This paper reviews the costs and cost-effectiveness of vaccination programme interventions involving lay or community health workers. [from abstract]

The policy framework is intended to provide an effective and efficient occupational workforce to support a comprehensive multidisciplinary health care service; strengthen partnerships between government, civil society and communities to consolidate, manage and focus the services offered by Community Care Workers; and delineate strategies that address systemic change within the complex systems both within the public sector and its partners. [from introduction]

This paper provides a participant-observer perspective of the evolution of community health workers from vertical and isolated activities for TB, HIV and other specific diseases to an integrated community health team approach for tackling the main disease burden in a rural district of Mozambique. [from introduction]

The goal of this paper is twofold. It uses the recent experience of Brazil’s Family Health Program to assess the effectiveness of community based health interventions as instruments for improvements in health conditions in less developed areas. It also evaluates whether the health improvements associated with the program also brought about the changes in household behavior predicted by economic theory and noticed in other contexts. [adapted from author]

Because of increased demand for injectable contraception coupled with an overburdened clinical health system, countries, particularly in sub-Saharan Africa, have recently expanded the use of non-clinic based approaches in providing this method. In this first review of the available evidence of these efforts, this consultation concluded that there is sufficient evidence to support expansion of community-based health workers providing progestin-only injectable contraceptives, especially DMPA. [from author]

This study sought to gain understanding of the motivations of community service (CS) officers to continue working at the same district hospital for a subsequent year after their obligatory year was over. The objectives were to determine the number of CS officers who actually remained at the same district hospital after completing their CS in 2002, the major factors that influenced them to remain and factors that would encourage the 2003 cohort of CS officers to remain at the same district hospital for an additional year. [from abstract]

This article reports on the obstacles to care and the outcome of treatment for patients presenting with tuberculosis to four hospitals in the rural South African region of Sekhukhuneland. [adapted from article]

We conducted this study to document the perceptions of community health workers in Pakistan on their knowledge and communication needs, image building through mass media and mechanisms for continued education. [adapted from abstract]

This article offers an analysis of the role community health worker programs and activities in South Africa. [adapted from introduction]

This report provides an overview of paid healthcare workers in Tanzania.

This paper discusses the role and impact of community health workers in Nyanza Province, Kenya, in response to the growing demands the HIV epidemic has placed on the people and communities in this region. [adapted from abstract]

The Zambia Prevention, Care and Treatment Partnership began training and placing community volunteers as lay counsellors in order to complement the efforts of the health care workers in providing HIV counselling and testing services. These volunteers are trained using the standard national counselling and testing curriculum. This study was conducted to review the effectiveness of lay counsellors in addressing staff shortages and the provision of HIV counselling and testing services. [from abstract]

With the scarcity of African health professionals, volunteers are earmarked for an increased role in HIV/AIDS management, with a growing number of projects relying on grassroots community members to provide home nursing care to those with AIDS - as part of the wider task-shifting agenda. Yet little is known about how best to facilitate such involvement. This paper reports on community perceptions of a 3-year project which sought to train and support volunteer health workers in a rural community in South Africa. [from abstract]

Currently, a wide variety of community health workers are active in many antiretroviral treatment delivery sites. This article investigates whether present community health worker programmes for antiretroviral treatment are taking into account the lessons learnt from past experiences with community health worker programmes in primary health care and to what extent they are seizing the new antiretroviral treatment-specific opportunities. [from abstract]

This document provides resources on Ethiopia’s experiences with community health worker programs. [from abstract]

Ethiopia’s poor health status is due primarily to communicable diseases, poor nutrition, and lack of access to health services in general and for most of the rural, nomadic pastoralist and fringe areas in particular. In response, the government has launched a Health Extension Program for which training of Health Extension Workers has been started. This study assesses the first year’s training program in terms of its inputs, processes and output. [from abstract]

Female Community Health Volunteers (FCHVs) act as a bridge between the government and the community and serve as a frontline for local health resources. The objectives of this study of FCHV in Twenty Districts of Nepal was to see the existing condition of the FCHVs working in the communities of Nepal. The survey collected information on basic health services provided by FCHVs to the community in terms of the provision of specific commodities and the provision of information, communication, counseling, and other support to the rural community. [adapted from summary]

The shortage of health staff in developing countries has led to renewed interest in community-based health care workers. However, poor populations are increasingly accessing health services from a wide variety of providers operating as private or semi-private agents in unregulated markets. In this environment, is there a role for the community health worker? [from author]

China’s long struggle with rural coverage for health care goes back to the early part of the 20th century. In 1968, the programme of barefoot doctors was introduced by the journal Red Flag as a national policy focused on quickly training paramedics to meet rural needs. Most barefoot doctors, who graduated from secondary school education, practised after training at the county or community hospital for 3—6 months. Hence medical coverage in the countryside rapidly expanded. However, the barefoot doctors, who generated their work points with medical services just like agricultural work (ie, their income was counted by transferring time for medical service to similar time for agricultural work) were not at par with the regularly trained doctors and their incomes were 50% lower. [from author]

This report concludes that assigning nurses to community locations where they provide basic curative and preventive care substantially reduces childhood mortality and accelerates progress towards attainment of the child survival MDG. The research in Navrongo demonstrates that affordable and sustainable means of combining nurse services with volunteer action can accelerate attainment of both the International Conference on Population and Development agenda and the MDGs. [from summary]

A community health planning and service strategy was started in Ashanti region in 2001 with the intention of improving geographic access to comprehensive health care. The region used community-based surveillance as an entry point. The implementation process and health outcomes were tracked and evaluated after a year. [from summary]

The current global tuberculosis (TB) epidemic has pressured health care managers, particularly in developing countries, to seek for alternative, innovative ways of delivering effective treatment to the large number of TB patients diagnosed annually. One strategy employed is direct observation of treatment for all patients. In high-burden settings innovation with this strategy has resulted into the use of lay community members to supervise TB patients during the duration of anti-TB treatment.

This chapter is an excerpt from “Community-Based Health Care: Lessons from Bangladesh to Boston.” Using tools of statistical quality control, simple field epidemiology can both motivate and lead community health efforts to achieve higher coverage of essential services. Even basic health workers can measure their accomplishments, which motivates all involved to strive toward agreed-upon goals. The importance of repeated measurement at the local level is well illustrated in this chapter. [adapted from author]

This summary of the 2008 Asia-Pacific Action Alliance on Human Resource for Health Conference discusses findings and recommendations from this event, as well as issues covered at the conference including development and planning of rural HRH strategy; strengthening community and rural health workers and primary healthcare; and fostering regional cooperation on HRH.