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Breaking Barriers is an implementation research project focusing on social and behavioural change. It is conducted in conflict-affected communities in Cameroon. The project explores three innovative, community-based interventions designed to improve
...
health behaviours. This presentation outlines the project's context, methodology and implementation process. It also shares qualitative insights and field perspectives, reflecting on key lessons learned for future SBC efforts in fragile settings.
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This preliminary report summarizes the impact of the Ebola epidemic on the health workforce of Guinea, Liberia and Sierra Leone. It investigates the determinants of infection and describes safe practices put in place to protect
...
health workers during the epidemic. The report covers the period from 1 January 2014 to 31 March 2015 and is presents findings from the 815 confirmed and probable cases for whom individual case reports were available.
more
Facilitator's Guide. This guide is designed to assist facilitators in training community health workers (CHWs) and community volunteers (CVs) in in
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tegrating community-based TB services into their work. The training will help community workers who already provide numerous services to understand TB and contribute to prevention, care and support services in their communities
more
PLoS ONE 11(1): e0144662. doi:10.1371/journal.pone.0144662
Community health workers, recipients’ experiences and constraints to care in South Africa – a pathway to trust
Nonhlanhla Nxumalo, Jane Goudge & Lenore Manderson
AIDS Care Psychological and Socio-medical Aspects of AIDSHIV
(2016)
CC
The objective of the evaluation is to understand whether the CHW program has achieved its intended objectives, thus contributing to the overarching objectives defined in the HSSP III of improving the health status of the population by “Ensuring un
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iversal accessibility of quality health services for all Rwandans”.
This evaluation has focused on CHWs, who are selected, trained and deployed by the MoH to deliver a defined set of tasks at community level. CHWs are the central element of the Community Health Policy and of the community health strategy plan (CHSP) of the MoH.
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The seven essential features of practice for scaling up are described with great clarity. They are practical and universal, and encourage local innovation. They include policy, funding and local management structure, as well as working with all possible partners and developing local context adaptati
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ons. The case studies give ideas and inspiration to develop new programmes and find ways around obstacles in existing programmes, especially through involving those with most at stake including users and their families and local community leaders
more
This report makes the case for a major new initiative—to rapidly recruit, train and deploy 2 million community health workers in Africa. Drawing on a vast body of evidence and substantial regional
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experience, the report shows how community health workers save lives and improve quality of life and how investments in community health workers effectively harness the demographic dividend, reduce gender inequality and accelerate economic growth and development. Indeed, the benefits of community health workers stretch from one end of the Agenda for Sustainable Development to the other.
more
This is the sixth of our 11-paper supplement entitled “Community Health Workers at the Dawn of New Era”. Expectations of community
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health workers (CHWs) have expanded in recent years to encompass a wider array
of services to numerous subpopulations, engage communities to collaborate with and to assist health systems in responding to complex and sometimes intensive threats. In this paper, we explore a set of key considerations for training of CHWs in response to their enhanced and changing roles and provide actionable recommendations based on
current evidence and case examples for health systems leaders and other stakeholders to utilize.
more
This is the ninth paper in our series, “Community Health Workers at the Dawn of a New Era”. Community
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health workers (CHWs) are in an intermediary position between the health system and the community. While this position provides CHWs with a good platform to improve community health, a major challenge in large-scale CHW programmes is the need for CHWs to establish and maintain benefcial relationships with both sets of actors, who may have diferent expectations and needs. This paper focuses on the quality of CHW relationships with actors at the local level of the national health system and with communities.
more
Shortages of healthcare workers is detrimental to the health of communities, especially children. This paper describes the process of capacity building Community
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Health Volunteers (CHVs) to deliver integrated preventive and curative package of care of services to manage common childhood illness in hard-to-reach communities in Bondo Subcounty, Kenya
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Since the Alma Ata Declaration in 1978, community health volunteers (CHVs) have been at the forefront, providing health services, especially to und
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erserved communities, in low-income countries. However, consolidation of CHVs position within formal health systems has proved to be complex and continues to challenge countries, as they devise strategies to strengthen primary healthcare. Malawi’s community health strategy, launched in 2017, is a novel attempt to harmonise the multiple health
service structures at the community level and strengthen service delivery through a team-based approach. The core community health team (CHT) consists of health surveillance assistants (HSAs), clinicians, environmental health officers and CHVs. This paper reviews Malawi’s strategy, with particular focus on the interface between HSAs, volunteers in community-based programmes and
the community health team. Our analysis identified key challenges that may impede the strategy’s implementation:
(1) inadequate training, imbalance of skill sets within CHTs and unclear job descriptions for CHVs; (2) proposed community-level interventions require expansion of pre-existing roles for most CHT members; and (3) district authorities may face challenges meeting financial obligations and filling community-level positions. For effective implementation, attention and further deliberation is needed on the appropriate forms of CHV support, CHT composition with possibilities of co-opting trained CHVs
from existing volunteer programmes into CHTs, review of CHT competencies and workload, strengthening coordination and communication across all community actors, and financing mechanisms. Policy support through the development of an addendum to the strategy, outlining opportunities for task-shifting between CHT members, CHVs’ expected duties and interactions with paid CHT personnel is recommended.
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Background: Community Health Workers (CHWs) have a positive impact on the provision of community-based
primary
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health care through screening, treatment, referral, psychosocial support, and accompaniment. With a
broad scope of work, CHW programs must balance the breadth and depth of tasks to maintain CHW motivation for
high-quality care delivery. Few studies have described the CHW perspective on intrinsic and extrinsic motivation to
enhance their programmatic activities.
Methods: We utilized an exploratory qualitative study design with CHWs employed in the household model in Neno
District, Malawi, to explore their perspectives on intrinsic and extrinsic motivators and dissatisfiers in their work. Data
was collected in 8 focus group discussions with 90 CHWs in October 2018 and March–April 2019 in seven purposively
selected catchment areas. All interviews were audiotaped, transcribed verbatim, coded, and analyzed using Dedoose.
Results: Themes of complex intrinsic and extrinsic factors were generated from the perspectives of the CHWs in
the focus group discussions. Study results indicate that enabling factors are primarily intrinsic factors such as positive
patient outcomes, community respect, and recognition by the formal health care system but can lead to the chal-
lenge of increased scope and workload. Extrinsic factors can provide challenges, including an increased scope and
workload from original expectations, lack of resources to utilize in their work, and rugged geography. However, a posi-
tive work environment through supportive relationships between CHWs and supervisors enables the CHWs.
Conclusion: This study demonstrated enabling factors and challenges for CHW performance from their perspec-
tive within the dual-factor theory. We can mitigate challenges through focused efforts to limit geographical distance,
manage workload, and strengthen CHW support to reinforce their recognition and trust. Such programmatic empha-
sis can focus on enhancing motivational factors found in this study to improve the CHWs’ experience in their role. The
engagement of CHWs, the communities, and the formal health care system is critical to improving the care provided
to the patients and communities, along with building supportive systems to recognize the work done by CHWs for
the primary health care systems.
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