"'I'm a Health Worker' - Abduaraman Gidi" made by IntraHealth International.
The following feature is an excerpt of a report written by the Clinton Health Access Initiative in Zambia. The full report can be found in our Resources section.
The Community Health Assistants (CHA) Program was established in Zambia through the 2010 National Community Health Worker Strategy1. The CHA program is aimed at recruiting, training, and deploying Community Health Assistants to be attached to rural health posts across the country. The CHAs are trained for 12 months at two CHA training schools situated at Mwachisompola Health Demonstration Zone, in Central Province, and Ndola Central Hospital, in the Copperbelt. The Clinton Health Access Initiative (CHAI) committed to support the training of 2,100 CHAs by March 2018 through a DFID-supported Human Resources for Health strengthening grant. To date, 2,124 CHAs have been trained and 1,403 CHAs deployed in over 105 rural districts of Zambia.
Despite the country’s gains in recruiting, training, and deploying CHAs, evidence from Zambia2 mirrored the global literature outlining large gaps in CHA supervision. To address these performance issues, CHAI worked closely with districts to identify key gaps and develop practical solutions to address them. The results show improved CHA supervision, better facility staffing, increased community case management at household level, and strengthened systems for CHA supply and commodity disbursement.
From June 2017 to January 2018, the Ministry of Health in Zambia, with support from CHAI and financial assistance from DFID, embarked on a capacity-building initiative at 11 health posts in Kapiri Mposhi district to follow up on the implementation of supportive supervision and mentorship of CHAs. In total, 34 visits were conducted, an average of three visits to each of the 11 health posts. During the initiative, gaps in implementation of supportive supervision and mentorship for CHAs were actively addressed and localized solutions were designed in partnership with the MoH to strengthen the district health system and ensure that effective supervision and mentorship of CHAs were being carried out. This was done through one-on-one discussions with CHAs and with supervisors and through group discussions with staff at the facility and community members. A meeting for all the CHAs was held to give them an opportunity to share experiences and learn from one another. This meeting also gave CHAs an opportunity to interact with the Ministry of Health at national, provincial and district levels.
Recommendations and lessons learned
- To achieve positive health outcomes from the CHA program, there is a need to build capacity across the whole system. The program invested in orientation of staff at national, district and facility levels through training in supportive supervision and mentorship of CHAs. During the capacity-building initiative, CHAI’s technical support to the District Health Office identified weaknesses and implemented proposed solutions. Some solutions were targeted at the whole community health system while others were for specific individuals.
- Regular supervision and coaching from the District Health Office, which helps to advocate for the CHAs, is key. The district should include CHAs during facility performance assessments and reviews.
- The approach of tailoring capacity-building interventions towards the needs of a specific facility was effective in enhancing learning. There were varying issues contributing towards weaknesses in the program components across the eleven facilities. Analysis of the contributing factors and development of interventions specific to each health post made it easier for the facilities to relate and come up with sustainable solutions.
- To achieve improved health outcomes, CHAs need to be provided with medical supplies. These supplies contribute to CHAs reaching more community members with health education and a reduction in the number of people that have to walk long distances to the facility for treatment of less complicated issues such as malaria and diarrhea.
- Neighbourhood Health Committees and Health Centre Committees should be revitalized and supported to become functional. CHAs working in communities with functional community health structures experience less difficulty in mobilizing communities for health.
- Through enabling CHAs to spend more time at the community level, facilities where CHAs have conducted community action planning processes built up better working relationships with community health agents. Through the CHAs, all facilities should ensure that communities engage in the community action planning process to build trust and ownership. Community members begin to appreciate that the CHAs are there to promote health in their communities and can be trusted with resources, thus contributing to more sustainable health promotion programs.
 Ministry of Health, 2010. National community health worker strategy in Zambia
 Phiri, Sydney Chauwa, Margaret Lippitt Prust, Caroline Phiri Chibawe, Ronald Misapa, Jan Willem van den Broek, and Nikhil Wilmink. "An exploration of facilitators and challenges in the scale-up of a national, public sector community health worker cadre in Zambia: a qualitative study." Human resources for health 15, no. 1 (2017): 40.