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Are there health conditions that CHWs are more effective addressing than others? Why?

Posted: 11 Jun, 2017     Replies: 14

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.

Replies

 

David NZEYIMANA Replied at 5:01 AM, 12 Jun 2017

Thank you Manzi for these well reasoned thoughts
The role of CHWs in low-resources settings is unquestionable, several studies have shown the impact on the health care system and citizen well-beings. Some other interventions in Rwanda are trying to introduce community detection of pregnancy to increase the uptake of Antenatal care services. If CHWs are trained to conduct urine pregnancy test can increase the use of standard antenatal care services, and the ultimate goal being to reduce the number of premature infants.

Youssouf Keita and Ari Johnson Panelist Replied at 5:34 AM, 12 Jun 2017

David,

Thank you for raising this point! And thank you Manzi for your articulate introduction. Our team and several academic partners are currently in the midst of conducting a large cluster-randomized controlled trial designed to answer exactly this question: to assess the impact of proactive case detection of pregnancy by CHWs on timely access to prenatal care as well as other outcomes. We would love to learn more about your efforts and are happy to share more detail on this trial if helpful.

Best Wishes,
Ari

SENI JAMES BARKA Replied at 5:43 AM, 12 Jun 2017

As long as the community health workers remain at the grass root of primary
health care services, their training should have to be improved on clinical
management of some cases for prompt diagnosis, easy and fast referral since
they are the first contact with patients in the rural and surb urban areas.
I suggest there should be more training in degrees and higher degrees to
improve their capacity

Egide KARANGWA Replied at 6:00 AM, 12 Jun 2017

I hope so,
But we need to increase knowledge of community health workers

Emily Lloyd Replied at 6:06 AM, 12 Jun 2017

Great to read everyone's contributions so far on this topic. Following up on David and Ari's discussion of CHWs administering pregnancy tests, I'm wondering if either of you could reach out to me separately (as this panel may not be the best space) for resource support on logistics of CHVs/CHWs administering pregnancy tests to women in a First 1000 Days study we're running in Kenya and Burundi. If you have a couple minutes to share resources/guidance I'm at . Thanks!
-Emily

Ireen Silweya Replied at 6:47 AM, 12 Jun 2017

I really agree to all, we also need to increase their capacity of record
keeping such as for who has been referred etc, we need to empower them with
skills on dealing with the community members and stakeholders/partners,
above all the issue of motivation need to be addressed, this may not
necessarily be just in monetary form.
These guys are yes first line contacts and need our support for
effectiveness in their work.

Ari Johnson Panelist Replied at 7:00 AM, 12 Jun 2017

Sure, I'd be happy to help. You can reach me by email at

Youssouf Keita Panelist Replied at 8:35 AM, 12 Jun 2017

Bonjour a tous,
SENI, je suis d’accord avec vous pour l’amélioration de la formation des Agents de Santé Communautaire et la complétude de leur paquet de prise en charge.
Mais une chose qu’il ne faut pas perdre de vue est la consolidation des acquits (formations initiales) à travers des sessions de formation de recyclage et une formation continue à travers une très bonne supervision formative pour éviter les agents à ne pas tomber dans la routine.
L’autre problème que vous soulignez qui est la complétude du paquet des agents n’est pas comme je l’ai dit mal en soit mais soulève d’autres questions surtout dans les pays en voie de développement qui est la question de motivation des agents qui restent toujours problématique mais également la lourdeur administrative liée à la validation du complément.
En résumé je dirai que oui il faut améliorer la formation des agents dans d’autres domaines mais il ne faut pas oublier les acquits, prévoir un plan de formation continu à travers les formations de recyclage et les formations continues et ne pas perdre de vu les questions que soulèvent la complétude du paquet des agents à savoir la motivation et la validation du complément par les autorités.
Nous restons disponible pour discuter de cette question plus en profondeur.

Merci
Youssouf

Egide KARANGWA Replied at 9:00 AM, 12 Jun 2017

Thank You,
Not only training but after training we Can keep doing mentorship
where You Can invite 5 to 8 CHWs in the same village and share
knowledge.this make success.

Nighat Khan Replied at 9:34 AM, 12 Jun 2017

CHWs in low income settings play such a vital role. To be more specific their role in RMNCH and immunization campaigns has provided us with robust evidence.
The World Health Organization just reported how close we are to eliminating polio globally. The first three months of 2017 saw only 5 cases of polio, lowest number in history.
Role of the frontline workers in Polio vaccination in Pakistan is quite heroic in difficult and conflict areas on low wages and life-threatening situations. These local workers know their communities well and families were extremely comfortable in communicating with them. These workers ventured where formally trained medics and nurses were reluctant.

BOLATITO AIYENIGBA Replied at 10:31 AM, 12 Jun 2017

In a Northern community in Nigeria, uptake of injectable contraceptives was improved by trained CHWs. Confidentiality of service delivered seemed to be the driving force. However, to what extent this can be widely implemented and how it can raise the household survey contraceptive prevalence remain a challenge

Abimbola Olaniran Replied at 1:25 PM, 12 Jun 2017

Irrespective of health area (RMNCH, communicable diseases...), CHWs are culturally and geographically well-positioned to provide health education to the community they serve. Particularly, as they understand the local language, values, norms and beliefs better than most health professionals and can present these health messages to suit the context. Consequently, they seem effective in improving coverage of many health interventions.
However, their effectiveness in performing procedures or providing curative care for different health conditions would depend on their level of education; and duration and depth of pre-service training. We conducted a systematic review in which we categorised CHWs as lay health workers and paraprofessional CHWs (http://www.tandfonline.com/doi/full/10.1080/16549716.2017.1272223). It may be helpful to disaggregate CHWs to these categories before identifying which category is effective in improving coverage, providing curative care and performing procedures in the different health areas.

Blessings Banda Replied at 6:02 AM, 14 Jun 2017

I worked with CHW in Malawi Partners IN Health/APZU between 2011 and 2015. One strength that i saw in them was that they were holding community meetings to share the knowledge that they were being trained on. For instance drug adherence, safe water storage and use, TB and malnutrition. The community meetings were being conducted after a refresher training on a particular topic and were being supervised by CHW site supervisors who were their leaders.

Anatole Manzi Panelist Replied at 11:47 PM, 14 Jun 2017

Thanks very much all for sharing your experience and views. It is impressive to read through the list of health conditions that CHWs address in different geographic areas. I agree with everyone who suggested the need for a streamlined CHW training, mentorship and credentials. These are core factors of CHW motivation and important determinants of an effective CHW program.
I still think there is more to learn regarding conditions that CHW address. The top causes of death worldwide including heart diseases, stroke, respiratory infections, diabetes,
diarrhoeal disease, and injuries made me reflect on the role of CHW. What about malaria and malnutrition? Are they involved with mental health?
This is a great topic. Thanks again for sharing thoughts and resources. Look forward to hearing from others soon.

This Expert Panel is Archived.

This Expert Panel is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.