This Expert Panel is Archived.

While this Expert Panel is no longer active, we invite you to review and recommend past replies and resources. Membership for this Expert Panel is closed, but we hope you'll join us in one of the many communities on GHDonline.

Panelists of Strengthening and Scaling the Community Health Workforce and GHDonline staff

Cross section of the Thematic Discussion on Community Health Extension Workers on HIFA from Jan 16 – Feb 24 2017

Posted: 16 Jun, 2017     Replies: 3

"The umbrella term ‘Community Health Worker’ embraces a variety of community health aides selected, trained and working in the communities from which they come" (WHO 2007). CHWs may be men or women, young or old, literate or illiterate, salaried or volunteer, full-time or part-time.

The discussion highlights below builds on the learning from the recent Health Systems Research Symposium in Vancouver (November 2016) and current initiatives including the new WHO guideline on CHWs (in development). And it led to the Symposium on Community Health workers and their contribution towards the Sustainable Development Goals, held in Kampala, Uganda from 21-23 February 2017. Key points of the discussion were presented at the Symposium.

The discussion organised by the Health Information For All (HIFA) Project on Community Health Workers, one of eight HIFA Projects led by HIFA volunteers, addressed the following questions:

1. When listening to CHWs needs and priorities, what do they say is needed to enable them to do their work more effectively?
2. How are these needs being addressed? Where are the gaps?
3. Are there enough and appropriate avenues for the voices of CHWs to be heard (by the relevant stakeholders/authorities?)
4. What are the mental health and psychosocial needs of CHWs? How can these needs be better addressed?
5. Are we expecting too much of CHWs? Is there a risk of exploitation and/or burn-out? How can their workloads be better rationalised?
6. How can we meet the information and learning needs of CHWs working in challenging conditions?

Other issues raised (not directly related to the 6 questions) are also here

Lastly, the final version of the Kampala Statement (shared with permission from the conference organisers) is attached and can be found here. The final, formatted version is in preparation.

The responses to question 1 came largely from CHWs themselves, thanks to HIFA members Kavita Bhatia, Sunanda Reddy and Carol Namata, who facilitated inputs from WhatsApp groups in local languages. They are presented under six subheadings:

1. Recognition, respect, identity and inclusion

2. Logistics and supplies

3. Finance

4. Gender, hierarchy and transport

5. Occupational health and preferential health care

6. Systemic issues: responsiveness, corruption.

Q2

1. Recognition, respect, identity and inclusion

2. Logistics and supplies

3. Finance

4. Transport

5. Occupational health

6. Health systems issues: Referral systems

7. Other comments

Q3. Are there enough and appropriate avenues for the voices of CHWs to be heard (by the relevant stakeholders/authorities?)

Q4. What are the mental health and psychosocial needs of CHWs? How can these needs be better addressed?

These two questions elicited very few responses from any of the stakeholders, whether CHWs, trainers or programme managers. This is perhaps an important area for further enquiry?

Q5. Are we expecting too much of CHWs? Is there a risk of exploitation and/or burn-out? How can their workloads be better rationalised? Four themes emerged:

1. Excessive workload

2. Data collection and administration

3. Job aids

4. Financial compensation

Q6. How can we meet the information and learning needs of CHWs working in challenging conditions? Four themes emerged:

1. Mobile phones

2. Information resources

3. Training and knowledge sharing

4. Career development.

Other issues raised (not directly related to the 6 questions)

1. CHW role in advocacy and social determinants of health

2. CHWs and their relations to the community and health system

3. CHWs and slums

4. CHW scale-up

The full discussion from week 1 – 5 are also attached for your perusal.

Acknowledgement: HIFA is grateful for sponsorship from The Lancet, Reachout Project/Liverpool School of Tropical Medicine, World Vision International and USAID Assist Project.

Emmanuel Ifechukwude Benyeogor
Public Health Epidemiologist

Regional Faculty Committee Member,
Global Health Trials, UK (TGHN)
Country Representative (Nigeria)/ Social Media Steering Committee Member
Health Information For All (HIFA)
Tel: +2347038976724 (Mobile)

Attached resource:

Replies

 

Neil Pakenham-Walsh Replied at 7:54 AM, 16 Jun 2017

Thank you Emmanuel, that's a great summary. I look forward to explore possibilities for collaboration among the various groups and forums with an interest in promoting CHWs. The HIFA Project on CHWs is here: http://www.hifa.org/projects/community-health-workers We focus primarily on information and learning needs of CHWs.

Best wishes, Neil
Coordinator, HIFA Project on Community Health Workers
http://www.hifa.org/projects/community-health-workers
Let's build a future where people are no longer dying for lack of healthcare information - Join HIFA: www.hifa.org
HIFA profile: Neil Pakenham-Walsh is the coordinator of the HIFA campaign (Healthcare Information For All - www.hifa.org ) and current chair of the Dgroups Foundation (www.dgroups.info), which supports 700 communities of practice for international development, social justice and global health. Twitter: @hifa_org FB: facebook.com/HIFAdotORG

Connie Gates Replied at 12:12 PM, 23 Jun 2017

I agree that it is difficult to have a common conversation about CHWs when there is no common ‘definition’. Often I have this experience when discussing the CRHP/Jamkhed VHWs, and addressing questions like have been posed in these GHDonline discussions.
For those of you who are not familiar with CRHP/Jamkhed, here’s a brief description, focusing on the VHWs, and points relevant to some of the discussion topics – it’s difficult to ‘tease’ out the specifics for each question.
CHWs/VHWs at CRHP/Jamkhed are chosen by their communities (usually about 1:1000 pop, which is average size of the villages), work as volunteers with community groups, sharing their knowledge and skills so everyone knows about MCH, malaria & TB, NCDs, mental health, environment – and together they solve their problems. VHWs are trained and get personal supportive visits in their villages by the Mobile Health Team on a regular basis, as well as being mentored by more experience VHWs. Priorities are set by the communities, including their involvement in surveys and other data collection, which gives more motivation to the villagers and VHW to work together to address the issue. They also understand the importance of ‘social’ determinants of health, including caste system, women’s status, harmful traditional practices.
The VHWs are not ‘overburdened’ since they are supported by their communities and they decide on their own priorities. She has other income sources, so is independent of CRHP for her livelihood, and she can also follow her own ‘professional’ interests, whether as a farmer, a grocery store owner or a government employee, and continue with her VHW role, as a leader in health, development and well-being of her community.
The Jamkhed values-based approach works with communities that want them and are cooperative (community participation is a key component), building their capacity to do things for themselves, which leads to sustainability of village development through empowerment.
CRHP leaders have been on state & national government committees, and so has some influence that way on government programs, e.g. National Rural Health Mission.
CRHP has established the Jamkhed International Institute so people from all over India and the world come to learn about and from the VHWs and villagers, as well as staff, especially Mobile Health Team.
You are always welcome!

As someone said, the CHWs should be part of our discussion. Here at Jamkhed, many of the VHWs are illiterate/semi-literate, and most don’t know how to use computers, nevermind internet! But I agree that their voices should be heard. So attached are quotes by VHWs and a few from community members from a study done about the empowerment (individual & community) process at CRHP/Jamkhed in 2015. There are lots more, but I think this is enough for now!

You can contact me if you want more information about CRHP/Jamkhed and/or the empowerment study.
Thanks for allowing me to be part of the conversation - though I'm sorry I was slow and lengthy!
Connie Gates

Attached resource:

David Giber Replied at 9:08 AM, 25 Jun 2017

Hi Connie

Do you have any information on the surveys you do with the community to
assess needs?

This Expert Panel is Archived.

While this Expert Panel is no longer active, we invite you to review and recommend past replies and resources. Membership for this Expert Panel is closed, but we hope you'll join us in one of the many communities on GHDonline.

Panelists of Strengthening and Scaling the Community Health Workforce and GHDonline staff