Can CHWs be effective advocates?

By: Adugna Kebede

CHWs serve as an interface between the community and the public health system. Almost all CHWs are trained either by the government Ministry of Health and/ or non-governmental organizations (NGO) and community-based organizations (CBO). Whether the CHW is trained as a generalist to  provide community-based health interventions or specially trained for a specific health intervention, CHWs are mainly recognized as community mobilizers and service providers. Indeed, most trainings for CHWs focus on the above two roles.

The American Public Health Association states that one of the seven roles of CHWs is “advocating for individual and community needs.[1] Similarly, WHO recognizes the role of CHWs as advocates for the community and as agents of social change.[2] However, it is very rare, especially in the developing world, to see CHWs functioning as a voice for communities, fighting against inequities and advocating for community rights and needs to government structures.

World Vision’s Citizen Voice in Action (CVA) program empowers communities to advocate for themselves by holding community level government service providers accountable for the quality and quantity of services, including health services that they deliver. The evidence collected is then used for constituency level engagement with local authorities and for higher level policy dialogue at state and national levels, to influence government policies and resource allocation.

A recent example of a CVA success is in Stepanavan, Armenia where World Vision works in partnership with local NGO Real World Real People. There was low utilization of voluntary counseling and testing (VCT) services; so, to determine why, CHWs met with the community to hear their concerns. The reasons discovered were poor awareness of the VCT service and concern about confidentiality; many participants believed that attending the service would lead to gossip. This information was relayed to the health centers. In response to the community concerns a plan was formulated: increase knowledge of the VCT service and its benefits through the media, relocate the VCT service to a less visible room in the building, and train health care workers in patient confidentiality.

Despite their proven role as an effective arm of the health system, CHWs have not been tasked with determining if communities are receiving the services they need, and if services are reaching the appropriate audiences. By having CHWs hold dialogues with the communities and relaying the information back to the health centers, the quality and use of local health services can improve.

• What experience do you have with using CHWs as community advocates? 
• Have they been effective?
• How can CHWs be empowered to be effective advocates for the community?