By Girija Sankar, Global Health Action
A million community health workers (CHWs): that is the stated target of the WHO. The US Global Health Initiative’s target is 250,000. Whatever the specific target may be, CHWs are a critical resource in addressing global health issues. With the 2015 Millennium Development Goal (MDG) deadline fast approaching, much attention has been focused on community-based health systems as a proven strategy for addressing global public health problems such as maternal and infant mortality. Community-based health workers are also increasingly seen as crucial to service delivery in areas with little or no institutional/facility-based health care. Different contexts have different definitions of health workers. In some countries, health workers tend to be volunteers, whereas in others, they are considered full-time, salaried workers. In all cases though, these CHWs (community health workers) are often the only point of contact for families and communities with the public health system.
In Haiti, CHWs have long been recognized as crucial to health service delivery and access. CHWs there are provided comprehensive training in disease identification, prevention, sanitation, hygiene, family planning, clinical referrals etc. Once trained, they often have to serve anywhere between 500 to 700 families.
Of the eight Millennium Development Goals, three are health-related and two deal directly with infant and maternal mortality rates. Lack of adequate nutrition is one of several factors that contribute to high rates of morbidity and mortality. While public health experts argue that nutrition has often been considered the stepchild of public health programs, there is now increasing attention on integrating nutrition into larger and broader health programming, especially at the community level. Health workers once again prove crucial to this effort. In Haiti for instance, the Children’s Nutrition Program (CNP) of Haiti hires and trains community nutrition workers to collect information on every household, including weighing children under five. Households with children who are moderately malnourished are invited to participate in the (Positive Deviance) Hearth program. The CHWs work with volunteer mothers in the community to teach others how to prepare foods and meals that can nourish the child using locally available supplies. During this time, mothers also receive important messages on breastfeeding, hygiene, and family planning. Thus, not only does the CHW encourage positive behavior change through the Hearth Program, they also disseminate other vital information on health and health practices. CNP has been able to demonstrate marked improvements in children’s weight and health statistics as a result of this program.
Health workers are also the driving force in Community Case Management of disease and illness, a strategy to address several childhood illnesses including acute to severe malnutrition. This strategy “sends community-based health workers out to find, diagnose, and successfully treat sick children, in partnership with their families” (CORE group et al. 2010).
But CHWs don’t just provide services specific to children. They monitor the entire community’s health status, beginning from birth and death records, to periodic census-taking, health posts, home visits, and more. In fact, CHWs are the primary (and often sole) link between a rural population and the health system that serves it. Thus, a cadre of local health workers is vital to building an effective community-based health system. With adequate training and support, including supervision, monetary support, and health supplies, CHWs can do much to reduce the incidence of disease and illness and to promote desirable behavior change (WHO 2010).