This is a critical question. While the 20th century was marked by several discussions on the need and feasibility of lay health worker programs to supplement modern medicine, the importance of community health workers has become unquestionable since early 21st century. Community health workers filled the human resource gaps especially in developing countries with high burden of diseases.
I’ve had the privilege to work closely with community health workers in rural Rwanda since 2005. They were selected by patients and/or community members. We trained them in HIV/TB accompaniment, a model that Partners In Health had developed and implemented in Haiti and other countries. It didn’t take long to realize community health workers as a cornerstone of what we were doing. Over 92% of our patients were retained in care, one of the highest HIV patient retention rates. Community health workers improved early detection of side effects, referral systems and family and patient’s psychosocial wellbeing. This is just a snapshot. The impact of community health workers is way beyond clinical outcomes.
As the importance of community health workers became obvious, countries found room for decentralization of what was traditionally known as clinical work, including diagnosis and case management. For example, in many sub-Saharan African countries, community health workers administer contraceptive injections, diagnose and treat children using the World Health Organization (WHO)’s Integrated Management of Childhood Illness (IMCI), attend prenatal consultations, and perform many more procedures.
Although community health workers have been effective in many areas, assigning them tasks that require an advanced clinical reasoning constitutes a risk to patients, with potential negative implications on their career. In my experience, community health workers are more effective with health promotion, case finding, and community-based case management only when they have streamlined guidelines. In all cases, it is essential to provide them with training, communication and user-friendly tools.
I don’t intend to have an exhaustive list of what community health workers should do. Rather, sharing experience on what health conditions where they are more effective than others as well as potential reasons.
Look forward to hearing from others.