To support quality CHW program design and implementation, USAID, UNICEF, the Community Health Impact Coalition, and Initiatives Inc. have updated and adapted the Community Health Worker Assessment and Improvement Matrix (CHW AIM) Program Functionality Matrix tool. This tool can be applied at district, regional, and national levels to identify and close gaps in design and implementation and, ultimately, enhance program performance.
This study examines Community Health Workers’ perceptions of how the Zimbabwe study for Enhancing Testing and Improving Treatment of HIV in Children (ZENITH) randomized controlled trial’s structure and management affected their performance. The results of the study showed that CHWs saw the intervention as acceptable, feasible, and expressed overall strong job satisfaction. Long term sustainability of the programme is highlighted as an issue and the future improvement and adoption of the approach in other settings are discussed.
In Zimbabwe Dixon Chibanda, a psychiatrist, created a space called “Friendship Benches” that sets aside medical and technical elements of mental healthcare and engages the community through “grandmothers” or local lay health workers. The grandmothers are trained in a form of cognitive behavioral therapy, but engage their patients in local language which helps reduce stigma associated with mental health in the community. This program was created to address the overwhelming lack of mental healthcare workers in the country. Thus far, the program has reached over 30,000 Zimbabweans. Studies
This resource from USAID and MCHIP provides an overview of large-scale CHW programs from 13 countries: Afghanistan, Bangladesh, Brazil, Ethiopia, India, Indonesia, Iran, Nepal, Niger, Pakistan, Rwanda, Zambia and Zimbabwe. Case studies address the historical context of CHWs, the health needs of the country, the scope of work of the CHWs, CHW training, support and supervision, and financing of CHW programs. The demonstrated impact and continuing challenges of the different programs are also addressed.
CHWs importantly deliver health care services to communities when shortages in the healthcare workforce exist. However, as their workload increases, CHW abilities to provide quality healthcare may be compromised. Using a cluster-randomized trial in Zimbabwe, CHWs were surveyed to assess the association between demographic and work characteristics and task performance. CHWs who made more referrals shared many common demographic and work characteristics, implying that these factors influence performance.
Globally, mental health disorders, including harmful alcohol and substance use, are the leading causes of years lost to disability, accounting for up to 189 million disability-adjusted life years annually. Depression accounts for up to 50% of disability-adjusted life years caused by mental health disorders, while alcohol and substance use accounts for up to 10%. It is estimated that people living with HIV (PLWH) are more than twice as likely to experience a mental health disorder.
Like any other health worker, community health workers (CHWs) need to be supported to ensure that they are able to contribute effectively to health programmes. Management challenges, similar to those of managing any other health worker, relate to improving attraction, retention and performance. Exploratory case studies of CHW programmes in the Democratic Republic of Congo, Ghana, Senegal, Uganda and Zimbabwe were conducted to provide an understanding of the practices for supporting and managing CHWs from a multi-actor perspective.
Integration of mental health and HIV programs has the potential to significantly improve health outcomes for PLHIV. This training package, which is comprised of a training-of-trainers manual, an accompanying presentation, and a standard operating procedure, was developed to support a pilot project for MH and HIV integration at the community level such that health facilities, community-based organizations (CBOs), and traditional medical practitioners (TMPs) can collaborate to support MH screening and service provision for PLHIV in Zimbabwe.
Emerging evidence is demonstrating the accuracy of this statement particularly in the lives of people living with HIV (PLHIV). The occurrence of mental health problems among PLHIV is truly alarming; the prevalence of depression is estimated up to 72%, and anxiety rates are five times higher when compared to those not diagnosed with HIV. Aggravating an already difficult situation, more than 76% of all people with severe mental health issues go without treatment in low- and middle-income countries. (2014)