Community Health Workers

This article discusses the potential contribution of community health workers to child survival rates. Several trials show substantial reductions in child mortality, particularly through case management of ill children by these types of community interventions. However, community health workers require focussed tasks, adequate remuneration, training, supervision, and the active involvement of the communities in which they work. This article discusses the need for evaluation of programmes for community health workers. [from summary]

This research sheds light on the nature, design and provision of institutional services for providing training to the premier community health service providers in the public sector in Bangladesh. Virtually no major study exists on the training of the FWVs in the country. The methodology of the research mainly consists of a personal interview and questionnaire survey, covering the concerned trainers and officials of the major public health administration and training institutions of the country, including the National Institute of Population Research and Training, the Family Planning Directorate and the Family Welfare Visitors' Training Institute.

This manual provides step-by-step guidelines as a “how-to” for implementing the CAPA approach, and was developed for use by State Ministries of Health, program managers, technical staff, and donor agencies involved in community-oriented approaches for child survival activities. Basic Support for Institutionalizing Child Survival/Nigeria (BASICS II/N), in collaboration with Nigeria’s federal and state governments, conceptualized and designed a community-based approach (CBA) called Catchment Area Planning and Action (CAPA) to empower community members to take an active role in improving the health of their children in areas of immunization, nutrition, and malaria.

The paper describes the primary health care achievements of the country with respect to the current status of the community health care workers, factors which contributed to their achievements and how their roles and responsibilities can be modified to face the future challenges. [from abstract]

This manual is a collection of adaptable tools and guidelines designed to help clinic supervisors and clinic managers achieve objective improvements in the quality of health care. The manual is especially useful for managers supervising integrated health services, who, on any given day, may be called on to support the provision of a full range of primary health services. The manual is designed to complement more detailed standard operating procedures that may be in use for specific services, for example, antiretroviral therapy. It is based on the belief that regular, systematic supervision is essential to upgrading clinic services and maintaining improvements.

In 1996, the REWARD Project identified a need for effective interventions to increase women’s communication about reproductive health among themselves and with their husbands. Project staff formed women’s groups, called Communication Action Groups (CAGs), in three rural districts. The project provides group leaders with training on communication, leadership, group dynamics, condom use, condom negotiating skills, and HIV/AIDS and sexually transmitted infections (STIs). This study was designed to evaluate the effectiveness of the CAG program so that achievements and problems could be identified and program activities strengthened.

The community approach to improving public health has been produced for community nurses who want an insight into community development practice used in nursing. The publication provides a framework and resources for nurses to use as a tool to begin to develop their own local initiatives. [from introduction]

This paper examines the experience with using various incentives to motivate and retain community health workers (CHWs) serving primarily as volunteers in child health and nutrition programs in developing countries.

In 1986 the authors conducted a survey examining the performance of health promoters in Pucallpa, Peru, three years after an initial Danish project for training and supervising those promoters ended. The survey found that some two-fifths of the promoters were still active, that increased stress had been placed on curative tasks, and that the promoters appeared to have had their greatest impact in the areas of vaccination coverage and increased use of the available public health care service. No significant changes were found in the affected population’s treatment of diarrhea or improvement of drinking water quality.

In this paper we attempt to provide an overview of the concepts and practice of community health workers (CHWs) from across a range of (developing and developed) countries, and draw some insights into policy challenges that remain in designing effective CHW schemes, particularly in the Indian context. In the subsequent sections, we provide a review of the various ways in which community health workers have been deployed in different settings. [from introduction]

The author focuses on a community health worker (CHW) intervention in India, where state-wide CHW programmes are under way as part of the National Rural Health Mission. The Mitanin programme of Chhattisgarh state in India highlights the many dilemmas and possibilities in the scaling-up of such programmes. [adapted from author]

This review paper revisits questions regarding the feasibility and effectiveness of community health worker programmes. This review aims to assess the presently existing evidence. It constitutes a desktop review, which draws together and assesses the evidence as it can be found in the published and selected grey literature since the late 1970s. [from executive summary]

This pre-tested and peer-reviewed curriculum focuses on the knowledge and skills necessary for providing holistic CHBC for people living with HIV/AIDS, transferring knowledge and skills to caregivers and CHBC clients, and mobilizing communities around HIV/AIDS prevention, care, treatment, and support. The trainer's guide includes comprehensive units that cover topics from HIV basics, communication skills, nursing care, nutrition, positive living, family planning, HIV prevention, ART, to community mobilization.
The illustrated handbook provides community health workers with a practical user-friendly tool that can be used as reference material and for skills transfer to clients and caregivers. [publisher's description]

In a rural village in India, newborn deaths have been halved not by neonatologists or high-tech interventions but by local villagers trained in simple life-saving practices. Some experts, however, are sceptical about whether this strategy can work everywhere. [from author]

In parts of rural Africa, where conflict and neglect have destroyed any remnants of a functioning health system, there is one long-running public-health programme that is not only surviving but thriving—by capitalising on communities' desires to help themselves. [author's description]

This issue of the HST Update covers topics such as: care from within the community; the Khayelihle example; and the role of organizations outside the government in community-based care.

Donor funds may be inadequate to support the growing demand for services provided by community-based distribution (CBD) programs. One solution may be to reduce the remuneration of CBD agents, but this approach may lower their productivity. Programs also need to consider reducing other costs, including those for supervision and training. The cost per agent visit—including costs associated with payments to agents and to supervisors and the costs of training—was calculated for three CBD programs in Tanzania. The output measure was visits in which contraceptives were provided or referrals made for family planning services.

In much of sub-Saharan Africa, a significant portion of the population lives in rural areas, leaving many women with limited access to clinic-based family planning services. Thus CBD of contraceptives remains an important service delivery mechanism in this region. The primary aim of this study was to assess the safety, quality, and feasibility of Depo-Provera provision by community reproductive health workers.

In 1996 an act of Parliament created the Ghana Health Service (GHS) as an extra-ministerial agency that is outside the civil service, freeing the health sector to change, innovate, and reform health care operations in Ghana. This flexibility enables the GHS to utilize research for guiding innovation with research activities. The GHS has adopted a model for community-based service delivery known as the Community-based Health Planning and Services (CHPS) Initiative. CHPS is an integral part of the current Ghana Health Service Five Year Programme of Work and represents the health sector component of the national poverty alleviation programme.

Community-based Health Planning and Services (CHPS) initiative as a strategy to deliver community level service is a key health system reform for the Health Sector in general and the Ghana Health Service in particular. If the health sector is to achieve the Health Millennium Development Goals’ in Ghana, then there is the need for a drastic shift in the paradigm of service provision. CHPS provides us with a vehicle for making this paradigm shift so as to deliver community level service by engaging communities in taking decisions concerning their own health and recognizing that the primary producers of health are the individuals within households – especially mothers.

Outline of the community-based health planning and services (CHPS) initiative developed by the Ghana Health Services, as an enhanced Close to Client (CTC) System. CHPS aims to provide accessible primary health care to all communities of Ghana, by enabling District Health Management Teams throughout Ghana to develop approaches to community health care that are consistent with local traditions, sustainable with available resources, and compatible with prevailing needs. This article discusses, step by step, the processes involved in managing, planning, coordinating, and monitoring the CHPS initiative.

The emphasis of the COPHIA program is the provision of home-based care and support services by multi-purpose community-based health workers to vulnerable households in the geographic focus areas that are coping with the burden of caring for seriously ill family members or caring for orphans and vulnerable children. The COPHIA community-based health workers, with the support of clinical and non-clinical supervisors, provide the direct physical and emotional care and support services to PLWHA and orphans and vulnerable children in the project catchment area with the support of trained primary caregivers.

Guidance for integrated postpartum care at the community/household level that reduces maternal and newborn mortality and encourages health in the immediate postpartum period is lacking. This report identifies and summarizes descriptive and research studies of existing community-based postpartum programs which provide counseling and services along with education on self-care. The literature review identified three models of community-base postpartum care: home visits by professional health care providers, home visits by community workers and home visits by community workers with referral or health facility support.

The African Heads of State meeting in Abuja, Nigeria on Roll Back Malaria adopted effective treatment of malaria nearer the home as one of the strategies for malaria control in Africa. A potentially effective strategy for bringing early, appropriate and low cost treatment of malaria closer to the home is through the use of community health workers (CHWs). There is paucity of information about people's actual preferences for CHWs and how stated preferences relates to revealed preferences for both the CHW strategy and other strategies for improving the timeliness of malaria treatment in not only Nigeria but in many malaria endemic countries.

The objective of this article was to compare the cost-effectiveness of the tuberculosis programm run by the Bangladesh Rural Advancement Committee, which uses community health workers (CHWs), with that of the government program which does not use CHWs. [adapted from author]

This research brief presents results from a cost analysis of an adolescent reproductive health intervention that found that using community health workers was less expensive than using doctors for provision of reproductive health services to young women. [from publisher]

The township health system in Myanmar is regarded as means to achieve the end of an equitable, efficient and effective health system based on the principles of primary health care approach. A township hospital caters medical care at the second referral level. Under the leadership and management of a Township Medical Officer in each township, para-professionals deployed at Rural Health Centers (RHCs) and Sub-centers under each RHC’s jurisdiction play key roles for providing primary health care services for rural population. There had been an expansion of township hospital beds, RHCs and Sub-centers during the past 15 years.

Effective TB control requires a properly functioning health service, with good management, diagnostic facilities, trained staff and reliable drug supply – especially at the periphery. Examples from many countries have shown that community-based approaches to DOTS can achieve high cure rates. And private practitioners – many of whom treat many patients and are still using pre-DOTS strategies - must be involved if TB is to be controlled. Strengthening health services, establishing partnerships between public health services, the community and private practitioners, and ensuring that everyone with TB has access to effective treatment and care, are therefore important challenges. [author's description]

This research study is a situational analysis and investigation to propose alternative models, including estimation of the quantitative demand for Mobile Emergency Medical Service Units (MEMUs) and the demand for Emergency Medical Technicians (EMTs) in Thailand during the next two decades. Three models of the MEMUs, and three categories of EMTs are proposed. In producing all kind of EMTs, their career development and continuing education should be planned. [from abstract]

This article outlines the development and content of a community-based research capacity building framework for Aboriginal and Torres Strait Islander health workers. The focus is on the major issues that enhance a proactive service delivery model using culturally appropriate research methods. The overall aim of the framework is to supplement current institutionally-based education and training resources for health workers with community-based research training modules. These modules can be tailored to provide research and evaluation skills relevant to health workers taking a more proactive role in facilitating health and wellbeing programs in their own communities.