As part of the ‘Symposium on CHWs and Their Contribution Towards the Sustainable Development Goals’ Makerere University (Uganda), CHW Central, Nottingham Trent University (UK), and World Vision are supporting a series of interviews with academic leaders and experts in international health development and delivery fields to provide their vision of the future of CHWs in a new light.
We will explore: How can CHWs create lasting impacts in the era of the Sustainable Development Goals? What steps need to be taken to scale up, empower, and create changes within in our global workforce?
The interviews will be posted on CHW Central over the next weeks as part of the preparation for the Symposium taking place from February 21st-23rd in Uganda. Past interviews will be posted on the CHW Hub.
Read our sixth interview with Carolyn MacDonald below.
What is your vision of how ‘tomorrow’s CHWs’ will contribute to Goal 2 in the SDGs era?
Tomorrows CHWs need to understand that almost half under five mortality (45%) is due to malnutrition, so they will understand how fundamental nutrition is to health and survival. As a result, they will dedicate about half of their time to support nutrition interventions. There are a number of different cadres of CHWs, and while a few countries have CHWs that focus specifically on nutrition, most countries’ CHW’s are primarily health focused. Tomorrows CHWs need to put a lot more emphasis on supporting nutrition interventions if we are to achieve sustainable development goal 2, shifting from health to an increased focus on nutrition. CHWs will have an understanding that the underlying causes of malnutrition are complex, requiring a complex multidisciplinary response. This will translate into practical actions in their jobs. In addition to tasks traditionally associated with CHWs (e.g., promoting immunization, folic acid, bednets, ORS for diarrhea), tomorrow’s CHWs will have basic competencies in nutrition such as supporting new mothers with breastfeeding, accurately measuring children’s weights and heights, using MUAC, interpreting growth curves, and giving appropriate feedback to the caregiver based on immediate causes of malnutrition. But beyond that they also need to recognize and identify the underlying causes of malnutrition in the contexts in which they work. Training on the underlying causes of malnutrition need to be in the curriculum of CHWs, so that they can link households in a multidisciplinary approach to improving nutrition. This could mean linking families to support services for improving access to diversified diets, local foods, improving food security (e.g., through raising small animals), clean water, sanitation and hygiene, in addition to health services. CHWs will link with other actors in their districts like agriculture extension workers, health workers, social protection, water and sanitation. Then, to go the next step – CHWs will engage in monitoring community prevalence of malnutrition, reporting to higher levels and advocating for change. Tomorrow’s CHWs will monitor and advocate for reductions in prevalence of malnutrition in their communities, similar to tracking prevalence of diarrhea, malaria or other illnesses. Tomorrow’s CHWs will also have supervisors that understand the need for a multi-disciplinary approach to good nutrition and health. Given the current limited formal training on nutrition for most health professionals, health supervisor’s training, like that of CHWs, will need to be delivered through in-service trainings until pre-service curriculums catch-up in the area of nutrition. World Vision is currently using a blended distance education approach to strengthen nutrition capacity (http://wvi.org/nutrition/distance-learning). Supervisors will support and assess CHWs for their nutrition competencies, including supporting families and communities to improve nutrition using a multi-disciplinary approach.
The goal is has broader implications than nutrition goals in the MDG era, what significant change will this bring about at community level?