To achieve universal health coverage, health systems will have to reach into every community, including the poorest and hardest to access. Since Alma-Ata, inconsistent support of community health workers (CHWs) and failure to integrate them into the health system have impeded full realization of their potential contribution in the context of primary health care.
In 2015, the One Million Community Health Workers (1mCHW) Campaign and mPowering Frontline Health Workers (mPowering) conducted a series of interviews and held an online discussion, hosted on the Healthcare Information for All forum, on the need of improved data on community health workers (CHWs) to help achieve the Sustainable Development Goals.
Mobile phones can be transformative for community health workers (CHWs) in enhancing their influence and status and helping to solve practical problems. While formal intervention research can help advance mHealth application, most progress will come through a "diffusion of innovation" process.
Care Group projects resulted in high levels of healthy behavior, including use of oral rehydration therapy, bed nets, and health care services. Accordingly, under-5 mortality in Care Groups areas declined by an estimated 32% compared with 11% in areas with child survival projects not using Core Groups.
Care Groups use volunteers to motivate mothers to adopt key MCH behaviors. The volunteers meet as a group every 2-4 weeks with a paid facilitator to learn new health promotion messages. Key ingredients of the approach include: peer-to-peer health promotion, selection of volunteers by the mothers, a manageable workload for the volunteers (no more than 15 households per volunteer), frequent (at least monthly) contact between volunteers and mothers, and regular supervision of the volunteers.
Demonstrating that a health service, such as providing contraceptive implants, can be safely task shared to less highly trained workers is crucial but is only one step toward effective implementation at scale. Providers need dedicated time, enough clients, supplies, supervision, and other system support, allowing them to maintain their competency, confidence, and productivity.
During the past 10 years, community health workers (CHWs) have emerged as a focal point of international discussions on primary health-care systems. Although lay community-based health workers have been active for at least 60 years, the Millennium Development Goals (MDGs) in 2000 prompted new discussion of how these workers can help to extend primary health care from facilities to communities. CHWs have since been part of an international attempt to revise primary health-care delivery in low-income settings, and CHW programmes have been changed accordingly.
