Community Health Workers

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]

This document discusses China’s long struggle with rural coverage for health care through the barefoot doctors program, which was introduced as a national policy focused on quickly training paramedics to meet rural needs. [adapted 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.

Increased interest in parasite-based malaria diagnosis has led to increased use of rapid diagnostic tests (RDTs), particularly in rural settings. The scarcity of health facilities and trained personnel in many sub-Saharan African countries means that limiting RDT use to such facilities would exclude a significant proportion of febrile cases. Use of RDTs by volunteer community health workers (CHWs) is one alternative, but most sub-Saharan African countries prohibit CHWs from handling blood, and little is known about CHW ability to use RDTs safely and effectively. [adapted from introduction]

All long-term care agencies struggle to find and keep sufficient, reliable, and skilled staff capable of meeting client needs and providing great quality care. This workbook offers 12 concrete steps to guide agencies in developing excellent recruitment, selection and retention practices

The purpose of these guidelines is to assist practitioners and implementing partners to run Community-Based Worker (CBW) systems more effectively, maximising impacts for clients of the service, empowering communities, empowering the CBWs themselves, and assisting governments to ensure that services are provided at scale to enhance livelihoods. The guidelines focus on how to run the CBW system rather than technicalities around HIV/AIDS or natural resources issues. [from introduction]

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]

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]

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]