Most countries in sub-Saharan Africa have now adopted integrated community case management (iCCM) of common childhood illnesses as a strategy to improve child health. In March 2014, the iCCM Task Force published an Indicator Guide for Monitoring and Evaluating iCCM: a ‘menu’ of recommended indicators with globally agreed definitions and methodology, to guide countries in developing robust iCCM monitoring systems. The Indicator Guide was conceived as an evolving document that would incorporate collective experience and learning as iCCM programmes them- selves evolve.
Community health workers are reemerging as an essential component of health systems in low-income countries. However, there are concerns that unless they are adequately supported, their motivation and performance will be suboptimal. mHealth presents an opportunity to improve support for community health workers; however, most interventions to date have been designed through a top-down approach, rarely involve the end user, and have not focused on motivation.
Scaling up interventions that increase access to timely and appropriate treatment at the community level could prevent more than 60% of these deaths. As a way of increasing access to treatment for sick children, several African countries are investing in community health workers (CHWs) as a cost-effective way of extending health services to people living beyond the reach of the health facilities.
Mozambique launched its revitalized community health programme in 2010 in response to inequitable coverage and quality of health services. The programme is focused on health promotion and disease prevention, with 20% of community health workers’ (known in Mozambique as Agentes Polivalentes Elementares (APEs)) time spent on curative services and 80% on activities promoting health and preventing illness. We set out to conduct a health system and equity analysis, exploring experiences and expectations of APEs, community members and healthcare workers supervising APEs.
Numerous countries around the world have established community health programmes as a means to expanding access to health services among vulnerable populations, and these programmes are considered a vital component of reaching the health-related Millennium Development Goals. With the shift towards the sustainable development goals and emphasis within these on equitable universal health coverage, there is an increasing need to understand how best to implement community health worker (CHW) programmes.
Many global health practitioners are currently reaffirming the importance of recruiting and retaining effective community health workers (CHWs) in order to achieve major public health goals. This raises policy-relevant questions about why people become and remain CHWs. This paper addresses these questions, drawing on ethnographic work in Addis Ababa, the capital of Ethiopia, between 2006 and 2009, and in Chimoio, a provincial town in central Mozambique, between 2003 and 2010.
The aim of this paper is to demonstrate how a behavioural theory, which accounts for the influence of group identification, in combination with data generated from qualitative interviews with CHWs and stakeholders, can be used to inform the design of interventions to improve CHW motivation, retention and performance in two settings—Uganda and Mozambique—with diverse, government-led CHW programmes.
Participation of community health workers (CHWs) in the provision of primary health care has been experienced all over the world for several decades, and there is an amount of evidence showing that they can add significantly to the efforts of improving the health of the population, particularly in those settings with the highest shortage of motivated and capable health professionals.