From the early years of primary health care, community-based health workers and volunteers (CHWs) have played a key role in satisfying the need and demand for essential health services. This article proposes that CHWs need to be supported and recognized as a pivotal part of health care. CHW programmes need be comprehensive rather than vertical and they should rely on both the community and the formal health system for supplies, communications and referrals.
In Senegal, an HMM pilot study in 2008 demonstrated the feasibility of integrated use of RDTs and ACT in remote villages by volunteer Home Care Providers (HCP). This paper reports the results of the scale-up in the targeted communities and the impact of the strategy on malaria in the formal health sector. Results show home-based management of malaria including diagnosis with RDT and treatment based on test results is a promising strategy to improve the access of remote populations to prompt and effective management of uncomplicated malaria and to decrease mortality due to malaria.
This report provides a systematic review of the literature to document evidence on characteristics of community health workers (CHWs) and CHW interventions, outcomes of such interventions, costs and cost-effectiveness of CHW interventions, and characteristics of CHW training. CHWs can serve as a means of improving outcomes for underserved populations for some health conditions. The effectiveness of CHWs in numerous areas requires further research that addresses the methodological limitations of prior studies and that contributes to translating research into practice.
Diverse opinions have emerged about the best way to scale up malaria interventions. Three controversies seem most important: (1) should the scale-up focus on a broader target of febrile illness (including infectious disease and pneumonia)? (2) should the scale-up feature a single intervention or be targeted to the situation? (3) should scale-up have a preference for one kind of delivery mechanism or another?
Community health workers are recognized in the Patient Protection and Affordable Care Act as important members of the health care workforce. The evidence shows that they can help improve health care access and outcomes; strengthen health care teams; and enhance quality of life for people in poor, underserved, and diverse communities. This article traces how two states, Massachusetts and Minnesota, initiated comprehensive policies to foster far more utilization of community health workers and, in the case of Minnesota, to make their services reimbursable under Medicaid.
The New York State Community Health Worker Initiative has researched the role of community health workers (CHWs) and identified how to advance this workforce through state-level recommendations on employment and practice, training and certification, and financing. In order for CHWs to be better integrated into the health care and social service systems, the Initiative recognizes that a fundamental infrastructure must be established or created in order to build and sustain this vital workforce.
This article compares and contrasts 3 national studies of the US Community Health Worker (CHW) field spanning 15 years. Findings cover 4 areas of overlap among the 3 studies: CHW Demographics, Core Roles and Competencies, Training and Credentialing, and Career Advancement and Workforce Issues. Implications for the future development of research, practice, and policy are discussed.
This paper documents progress in the scale up of a program to train an existing cadre of community based health workers, known as health surveillance assistants, to provide integrated community case management of childhood illness between 2008 and 2011. It describes some critical challenges that affect the effectiveness and sustainability of the program, and proposes solutions.
This paper urges scaling up the communityhealth workforce in the United States to improve health outcomes, reduce health care costs, and create jobs. The most crucial lesson from global CHW programs is that the community rootedness of CHWs should be retained through careful, representative selection and by ensuring that CHWs spend most of their time in the community. In the United States, certain structural advantages, such as the strong network of community health centers, could facilitate CHW integration into the health system.