Video Spotlight

"'I'm a Health Worker' - Abduaraman Gidi" made by IntraHealth International.

As the world is now looking at country MDG results - what effect have they had on your countries, communities and services?


MDGs made our government tried to correlate almost all programs have effects on MDGs. 

Regard to community, their involvement in reaching the MDGs target really low. Everything almost rely on government effort.

Our services in district general hospital does not really affected by MDGs except we got more medical equipment and receiving training for health workers.

Hi Jumatil, Thank you for sharing.  Can you say what country or region you are in?  It sounds like you are disappointed that community health workers and communities do not feel they are playing a role in helping to achieve the MDGs.   Is that true?   Are  CHWs working with children under 5, pregnant mothers, or newborns?   Does that contribute to the overall government plan?   

This is a critically important question for global health equity.  In every country I work (Mexico, Rwanda, Haiti, Lesotho, Guatemala), I have seen how government officials and NGO workers alike are keenly aware of how their country is moving towards the MDGs.  Poor performing countries feel pressure to improve.  High performing countries have reason to celebrate, and some have even been inspired to set yet better internal goals.  If the MDGs were created to inspire improvements in how we change the health of populations, and how that business it conducted, then the whole project has certainly been successful.

In 2015, we have a new opportunity to reboot the MDGs.  What will come next?  Will it be new targets with the same measures?  Will it be new measures, perhaps some that are more "up stream" like: measures of equity, inequality, or scope and scale of public services?

This question about the MDG reboot is going to be very important for our growing CHW science.  If the new goals are more up stream, I wonder if we will reenvision the role that CHWs play in achieving those goals.  For example, the desire to improve under 5 mortality has certainly contributed to the vision of the CHW as an under 5 mortality reduction agent - one with the tools and training necessary to attack the big causes of mortality (i.e. antibiotics and a stop watch for pneumonia, ORS for diarrhea, etc.).  

What would be the job of a CHW if the goal was to lower the GINI coefficient?

or if the goal was to increase civic engagement?

I'm not advocating for these more upstream measures per se, but it's an interesting thought exercise.  What do others think?

Elias Ngizwenayo, Community health program coordinator at

PIH/IMB in Rwanda responds:

In Rwanda, CHWs have been central for the country's MDG results.  I would like to explain how CHWs can contribute to achieving each goal.  Hopefully, this can help the greater understanding of where to work, how to work, and how to identify the area / sectors that must work well to achieve these goals.

Goal 1: Eradicate extreme poverty and hunger.
Note: if CHWs are based on small level of population structure (village / mountain has between  50 to 250 households : number of CHWs can 4 to 6 persons; men and women).
CHWs can contribute to achieving this goal by:
-          Teaching all families (house per house) on nutrition when they geographically distribute well and trained adequately.
-          Demonstrating how the families prepare balanced diet and administrate all nutrients on time.
-          Screening malnutrition cases in the families treat it in the community and referring complicated cases to the health facilities (health centers and hospitals).
-          Creating and develop the coming back project in the families (needed by pooers) to have themselves access to food and money.
-          Harmonize and make have access to the food (food security) by nutrition policies at villages (partnership, relationship with local government).

Goal 2: Achieve universal primary education.
The children can’t study with diseases, hunger and power families facilities related to family planning as manifested by number of children and small number of school and teachers. Chws can help to prevent the diseases by
-  Identifying every case who couldn’t finish theirs immunization and teaching all families why immunization and respect immunization calendar.
-  Work with hierarchic systems of ministry of education to identify all children olphans, children with different problems relatively with education and proposal the solutions.
-  Communicate barriers: education policies, school fees, and availability of services at small levels.

Goal 3: Promote gender equality and empower women.

The CHWs are the keys in the communities for health, when they will be trained on human rights, they can teach others their roles and responsibilities in gender equality and empower women. Increase the number women in all levels of government / leaderships.

Goal 4: Reduce child mortality rates and Goal 5: Improve maternal health
Depending the national policies on Family planning, Nutrition, education, availability of health facilities, of health workers and of health professionals; CHWs can teach all families (Man and woman)on important of antenatal care, of family planning. Decentralization of health facilities at CHWs levels and improves relationship between chw and health facilities that have health professionals. CHWs can increase the knowledge of population (in the families by home visit) if they are guided well, oriented well.

Goal 6: Combat HIV/AIDS, malaria, and other diseases
If CHWs are geographically distributed well and trained well on those diseases: definitions, transmissions / contamination, preventions and some promotion activities can be applicable on those diseases; the CHWs can help by teaching and make decision at the family level. Examples: using bed net by family for malaria area, referring Tb suspected cases to health facilities, Community Cases management of Malaria, pneumonia, Diarrhea and others at CHWs levels, etc.

Goal 7: Ensure environmental sustainability
Harmonize the sanitation, hygiene and environmental health at all levels by capacity building: based on person, family, geographical area, etc.
Chw has be involved in the process.

Goal 8: Develop a global partnership for development
CHWs must use Household register / charts adapted  and updated on families needs on health and others related to health , that Household Registries can monthly  provide the data / information can be chaired,  discussed help in making decision by multi displinalies leaders / sectors. Sharing the chws experienced between countries.


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