Adherence & Retention
Creative Solutions for Rural CHWs
Here in Zambia, the Centre for Infectious Disease Research in Zambia (CIDRZ) has a small group of CHWs involved in a pilot of DOT-HAART in the rural village of Chipembe. These CHWs have had a successful implementation of the project, but we’re still trying to work out a few challenges and would appreciate any suggestions from the GHDonline community.
Patients have welcomed the involvement of CHWs but some are beginning to see CHWs more as general caretakers, asking them for food and money for transport to the ART clinic (a distance of 25km). The CHWs have not shied away from this social responsibility, but the demands are more than many of them can afford. In the case of several paediatric clients, their parents will even send them to the CHW’s home for the evening meal. In a setting where there is no food aid or resources for a clinical transport allowance, we are trying to determine how a CHW can best support their clients' needs without overburdening their own family.
It is arguable that it is the responsibility of each CHW to draw their own boundaries, but we would be very interested to know if other organizations have had any success in helping to strike a balance within the community. Thank you in advance for your input!
Michael Rich, MD
I work in a Partners In Health Project in Rwanda. We have been using a DOTS-HAART model which we call “a daily accompaniment model” for the past three years. Three thousand patients are presently enrolled. Our CHWs also often go beyond their duties by helping in difficult social-economic hardships. However, we are very up front with the patient and the CHW that the CHWs role is not to be the patients own personal worker. We are also fortunate that we have a system in place to reimburse patient for travel to the clinic. Every month the CHWs get together and discuss problems like this. Likewise, we have patients come together every month. Both these monthly meetings are good places to go over the balance between serving the patient with good accompaniment within the community vs any patients who may cross limits with excessive demands. A good reference for you may be our Accompagnateur (CHW) curriculum on our PIH web site. www.pih.org Glad to hear you are trying out daily accompaniment! Keep the community updated on how it is going.
2:25 PM, 25 Jul 2008 | Permalink