The global policy of primary health care support was initiated with Alma Ata Declaration in 1978. Since then primary health care and community health programmes have become synonymous. Community health workers (CHWs) play a significant role in the delivery of primary healthcare in the resource-poor countries. World Health Organisation (WHO) recognises that CHWs are providing services in remote and inaccessible parts of the world. There are programmes run by various national and international agencies to build the capacity of CHWs. However, Low and Ithindi (2003) claim that such programmes have been criticised either as being inappropriate and ineffective or as having problematic relationships between partners.
The role of CHWs has become very important due to the shortage of qualified health professionals, particularly in resource-poor countries. Hence, they have become prominent players in bridging the health care gap. Their role and activities are enormously diverse across countries, programmes and scope. CHWs are making valuable contribution to primary health care services and overall community development. However, some challenges exist on the selection, nurturing and remuneration aspects of CHWs. Further, a key challenge lies in setting up vision and systems, and institutionalising and mobilising community participation (see link below).
A DFID funded research programme called ‘The Consortium for Research on Equitable Health Systems’ has carried out a research study on ‘community health workers: a review of concepts, practice and policy concerns’ (see link below). This study suggests that CHWs have evolved with community-based health care programmes. However, the concepts and practices of CHWs differ across countries, conditioned by their aspirations and economic capacity. Seven critical factors have been identified. These are gender; selection of CHWs; nature of employment, career prospects and incentives; educational status; population and service coverage; training; and feedback, monitoring mechanisms and community participation that influence the overall performance of CHWS.
Low and Ithindi (2003) identify a set of steps and roles and responsibilities of partners involved in utilization of CHWs. Those steps include:
· Strategic direction – steering committee representation
· Preparatory phase – selection of the pilot constituency, needs assessment, development of the CHW job description, selection of the CHWs, CHW training
· Operational phase – provision of the kit box, uniforms and shoes, operational work planning, visiting households and other tasks, supervision and support, reporting to the steering committee, monitoring
· Evaluation – outcomes, efficiency and effectiveness
Further, they claim that three major types of problems can prevent programmes functioning. These are: lack of commitment by the partners, poor management and the limited scope of the partnership. These problems exclude the community from involvement in decision making and result in the top-down orientation of the programme.
References & Links:
- Low, A. and Ithindi, T. (2003). Adding value and equity to primary healthcare through partnership working to establish a viable community health workers' programme in
Namibia - http://www.who.int/hrh/documents/community_health_workers.pdf
- http://www.crehs.lshtm.ac.uk/Community_health_workers_prasad.pdf
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