The World Health Organization (WHO) estimates that approximately 500,000 children each year are diagnosed with tuberculosis (TB) and 64,000 HIV-negative children die annually due to TB. The true burden of childhood TB is unknown; children are often undiagnosed and therefore do not receive appropriate care. Childhood TB is often seen with other common childhood illnesses such as HIV/ AIDS, pneumonia and malnutrition, and should be considered in sick children, particularly in areas of high TB burden.
Despite the progress some countries have made in scaling up CHW programs, many countries that would benefit from strong CHW cadres currently have only ad hoc, sub-scale programs. This problem extends even to high-income countries that would benefit from CHW programs to provide cost-effective care and battle chronic disease. Countries wishing to scale these programs using a coordinated national strategy face many challenges.
In view of the slow progress being made in reducing maternal and child mortality in many priority countries, new approaches are urgently needed that can be applied in settings with weak health systems and a scarcity of human resources for health. The Care Group approach uses facilitators, who are a lower-level cadre of paid workers, to work with groups of 12 or so volunteers (the Care Group), and each volunteer is responsible for 10–15 households. The volunteers share messages with the mothers of the households to promote important health behaviors and to use key health services.
There is robust evidence that community health workers (CHWs) in low- and middle-income (LMIC) countries can improve their clients’ health and well-being. The evidence on proven strategies to enhance and sustain CHW performance at scale, however, is limited. Nevertheless, CHW stakeholders need guidance and new ideas, which can emerge from the recognition that CHWs function at the intersection of two dynamic, overlapping systems – the formal health system and the community. Although each typically supports CHWs, their support is not necessarily strategic, collaborative or coordinated.
In this commentary, we discuss a photography competition, launched during the summer of 2014, to explore the everyday stories of how gender plays out within health systems around the world. While no submission fees were charged nor financial awards involved, the winning entries were exhibited at the Global Symposium on Health Systems Research in Cape Town, South Africa, in October 2014, with credits to the photographers involved. Anyone who had an experience of, or interest in, gender and health systems was invited to participate.
In recent years, community health workers (CHWs) have received renewed attention in light of critical shortages in the health workforce and emphasis on strengthening primary healthcare systems for achieving global health goals. CHWs are generally assumed to be a less expensive alternative compared with other cadres of health workers, notably with regard to salary and incentives as well as training costs. In parallel, more and more evidence has accumulated in recent years on the effectiveness of CHWs in delivery of essential health services in low- and middle-income countries (LMICs).
Remarkable gains have been made in global health in the past 25 years, but progress has not been uniform. Mortality and morbidity from common conditions needing surgery have grown in the world's poorest regions, both in real terms and relative to other health gains. At the same time, development of safe, essential, life-saving surgical and anaesthesia care in low-income and middle-income countries (LMICs) has stagnated or regressed.
This report outlines a series of workshops convened by mPowering Frontline Health Workers and partners to consider whether the global health community is following the most beneficial route to provide relevant and effective health training for FLHWs.
The question of remuneration for community health workers (CHWs) in low--‐income countries remains contentious. Programs use a variety of monetary and non--‐monetary incentives to motivate CHWs. The most successful programs, however, pay their workers, and there is little evidence to suggest that volunteerism in low--‐income countries is sustainable over the long term. Adequate compensation improves health worker motivation, retention and performance. Additionally, fair and consistent wages ensure a stable income and livelihood for CHWs. Although paying workers requires a modest invest
The 2014 Ebola outbreak in West Africa demonstrates key deficiencies in investment in health systems. Despite some modest investment in health systems, our field has instead largely chosen to pursue shorter-term, vertical efforts to more rapidly address key global health issues such as smallpox, polio, malaria, and HIV/AIDS. While those efforts have yielded substantial benefits, we have paid a price for the lack of investments in general systems strengthening. The Ebola deaths we have seen represent a small portion of deaths from many other causes resulting from weak systems.