How does informal community system/social system(structure) improve the performance of community health workers?
Many types of preventive and promotive health services are delivered at the community level. The Community Health Workers (midwives, nurse, enrolled nurse etc.) of the health facility are responsible for providing health service at the community level. Challenges for health care delivery service at the community level includes health disparities, access to care, quality of care and health care costs. CHWs are uniquely positioned as liaisons between health facility and communities to help mitigate these challenges. There are several studies to suggest that CHWs can impact on a variety of individual and population health outcomes and when appropriately organized and managed they can be an effective mechanism to improve health, empower communities and reduce health care costs where expensive fully trained health care workers are not available.
Due largely to overburdened workers, existing CHWs are frequently inadequate to provide community health services to all households needed them. To support CHWs most countries have selected Community Health Volunteers (CHVs) in every village to provide promotive and preventive health services. Each CHV is expected to provide health services to 100 to 200 HHs. Since they are volunteers they will not be able to provide their time and commitment as paid workers. The volunteers also have their family obligations every day which they cannot ignore. In addition, because of the geographical situation and the large coverage area it is physically difficult for a volunteer to visit every house to provide health services.
Local communities are not “empty vessels”. Health programmers need to understand and work with the existing community system. During my program implementation work in different countries I have observed that community members manage various social activities (wedding, birth ceremony, death ceremony, etc.), festivals, disaster, emergency, fire etc. without external support. To manage the above activities, the community requires effective and efficient system of Communication, support, mobilization, management, coordination and collaboration. We all know that Villagers have been managing all the above events through an informal system which is not visible from outside. This informal system is not a part of the formal system.
Understanding the social networks/community groups as a community system to support CHW/CHVs to address community health care delivery services will be useful for developing countries to develop CHW program. Have any organization/program utilized social network as a system to support CHWs? I would be interested to learn how they have used it.
I am sharing an implementation of a community system model developed based on the concept of existing social/community system.