Browse by Subject

Thousands of community workers are helping Ethiopia to deliver primary health-care services to people living in rural areas. However, critics say that the training these workers receive is not adequate for them to attend many of the health problems they encounter. [from introduction]

The researchers conclude that given the HRH crisis, ART delivery models requiring much less doctor time need to be developed. Overall, there is a need to shift tasks from medical doctors to nurses and from nurses to community health workers. In particular, the patients themselves need to play an important role in the delivery of ART. The outcomes of the various scenarios are predicted. [from author]

Evaluations of Community Health Worker programs consistently document improvements in health, yet few articles clearly describe the roles of Community Health Workers (CHWs) from the CHWs’ perspective. This article presents the CHWs’ points of view regarding the various roles they played in a community-based participatory research (CBPR) project, Poder es Salud/Power for Health in Portland, Oregon, including their roles as community organizers and co-researchers. [introduction]

Neonatal mortality accounts for a high proportion of deaths in children under the age of 5 years in Bangladesh. This article describes a project for advancing the health of newborns and mothers implementing a community-based intervention package through government and non-government organisation infrastructures to reduce neonatal mortality. [from abstract]

This report details the findings of the Forum on Engaging the Private Sector in Child Health held in Uganda in 2005. It discusses the potential of private providers and the private sector as a resource for improving community health outcomes. [from executive summary]

This paper describes Nepal’s efforts, starting from the mid-1980s, to develop and implement community-based management of pneumonia. [from abstract]

Produced in collaboration with Save the Children USA, this step-by-step guide explains how to introduce injectable contraceptives

The mapping exercise illustrated in this report was conducted to inform and support the efforts of the Ugandan Ministry of Health to increase the contraceptive prevalence through enhanced community-based distribution (CBD) of family planning. The specific objectives of the exercise were to determine the historical and current coverage of CBD of family planning services in Uganda, by both governmental and nongovernmental programs, and to identify potential districts for scaling up these services. [adapted from summary]

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.

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]

Despite ample evidence that HIV has entered the general population, most HIV awareness programs in India continue to neglect rural areas. Low HIV awareness and high stigma, fueled by low literacy, seasonal migration, gender inequity, spatial dispersion, and cultural taboos pose extra challenges to implement much-needed HIV education programs in rural areas. This paper describes a peer education model developed to educate and empower low-literacy communities in the rural district of Perambalur in India. [from abstract]

In the rural areas of sub-Saharan Africa, the majority of young children affected by malaria have no access to formal health services. Home treatment through mothers of febrile children supported by mother groups and local health workers has the potential to reduce malaria morbidity and mortality. [from author]

This report details the impact of Pathfinder Interational’s community-based approach to reproductive health and family planning in Ethiopia.

The success of primary health care programmes in Thailand over the past three decades can be attributed not only to medical advances but to the role of community health volunteers. Buddhist monks and their temples have been strongly involved in health promotion and education, particularly in remote, rural communities. [from introduction]

The objectives of the study were to assess the extent to which CHW deployment has been addressing important health priorities; document success stories and lessons, identify champions; understand the range of ways that CHW programmes have evolved in South Africa and compile recommendations and lessons learned to improve practice. [from executive summary]

In both Asia and Latin America, community-based health workers have been trained in safe injection techniques and routinely provide injectable contraception. However, the African continent still resists this service delivery mechanism with the rationale that it is unsafe for clients to receive injections from paramedical personnel. This argument is weakening, however, as non-reusable syringes become the norm and with the recent development of a checklist, based on the latest WHO Medical Eligibility Criteria, for safe provision of DMPA by community-based agents.

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]

Home-based management of malaria (HMM) is promoted as a major strategy to improve prompt delivery of effective malaria treatment in Africa. The published literature was searched for studies that evaluated the health impact of community- and home-based treatment for malaria in Africa. [from abstract]

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]

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.

Under the ENABLE Safe Motherhood Core Initiative, CEDPA/India collaborated with the Community Aid and Sponsorship Program on the Safe Motherhood Initiative to reduce maternal death by showing women, their families and their communities how to prepare for a safe delivery, to identify pregnancy-related complications at their onset, and to seek medical help immediately. [publisher’s description]

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]

The Health Service Extension Programme (HSEP) is an innovative approach to addressing the shortfall in health human resources in Ethiopia. It has developed a new cadre of Health Extension Workers (HEWs), who are charged with providing the health and hygiene promotion and some treatment services, which together constitute the bedrock of Ethiopia’s community health system. This study seeks to explore the experience of the HSEP from the perspective of the community who received the service. [from abstract]

The health worker crisis is particularly acute in rural and hard to reach areas, where 80% of the population in Africa live. The resultant low capacity at the peripheral level of the health system is a crucial barrier to good health. AMREF believes that developing capable, motivated and supported health workers at all levels of the health system is essential in ensuring the delivery of accessible and effective health care across Africa… This briefing draws on AMREF’s experience to look at three key issues: the importance of appropriate training, task-shifting to lower cadres of worker, and training and supporting community health workers (CHW) in order to bring health care closer to communities.

In Yumbe District of north-western Uganda, Village Health Teams (VHT) have been established in line with the national strategy for community involvement in health. The Yumbe VHT programme has won an award for innovative support to strengthening decentralisation. This paper reviews aspects of the programme outlining its successes and challenges.

The results [of this study] combined with the small size of El Salvador suggest that alternative strategies to community health workers may be a more cost effective approach. While prevention is desirable, community health workers do not have the skills or services that the communities value, which makes them less effective in promoting prevention. Alternative modes of reaching the community could reduce costs and raise the effectiveness of public health spending. [from abstract]

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]

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]

Given the very limited health infrastructure and resources and the need to provide a palliative care service to about one percent of the population each year, community and home-based care is viewed as the key to responding to these needs. Some countries have already developed strong home-based care networks in coordination with the PHC system to respond to the HIV/AIDS epidemic. Palliative care, as part of the continuum of care of HIV/AIDS, cancer and other chronic conditions can be integrated into this existing network. [author’s description]

This guideline is for human resources planners and managers in the health sector and sets out the steps required to extend the health workforce by incorporating lay workers (field officers), especially in the delivery of antiretroviral therapy (ART) to home-based clients.