This newly released report, titled ‘Practitioner Expertise to Optimise Community Health Systems: Harnessing Operational Insight’ examines how CHWs can successfully be integrated into national health systems, subsequently contributing towards efforts to achieve Universal Health Coverage.
This paper explores the factors that shaped the acceptability and adoption of community health assistants (CHAs) into the health system at the district level in Zambia. Using thematic analysis, data was collected through a review of documents, 6 focus group discussions with community leaders, and 12 key informant interviews with CHA trainers, supervisors and members of the District Health Management Team. Results found a perceived relative advantage of CHAs over existing community-based health workers in terms of their quality of training and scope of responsibilities.
This review explores the current evidence available to assess if increased levels of integration of community health resources in CHW programs leads to higher program effectiveness and sustainability. 32 articles were chosen for an extensive review, complemented by analysis of the results of 15 other review studies. Analysis found no quantitative data and minimal inclusion of even basic community level indicators.
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.
The hypertensive disorders of pregnancy and postpartum haemorrhage are responsible for nearly 40% of all maternal deaths in India. Most of these deaths occur in primary health settings which frequently lack essential equipment and medication, are understaffed and have limited or no access to specialist care. Community health care workers are regarded as essential providers of basic maternity care; and the quality of care they provide is dependent on the level of knowledge and skills they possess.
While task shifting to CHWs is widely practiced to address healthcare provider shortages, it can add to an already heavy workload for CHWs. In order to reflect how CHWs perceive and react to their circumstances, this study combined perception and objective measures of workload to examine quality of services, worker performance, and job and client satisfaction.
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.
Humanitarian crises are often marked by large-scale, externally funded, and vertically managed responses. National health systems, already weak, are often bypassed by international organizations in the interest of rapid response to save lives. There is growing recognition, however, of the importance of employing more sustainable approaches through existing health system infrastructure to ensure services continue as the emergency subsides and organizations and their resource flows end.
This report, developed in The Center for the Health Professions at the University of California, San Francisco, explores the role of community health workers and promotores in California. It reviews the history and background of the movement, work and practice patterns such as education, demographics, wages and training, and issues of credentialing and certification, regulation, and policy concerns for Latino promotores in California.