By: Kate Hawkins
Kate Hawkins, REACHOUT Consortium and Secretary of the Thematic Working Group (TWG) on Supporting and Strengthening the Role of CHWs, summarizes the research priorities generated in the 3rd Global Symposium on Health Systems Research in Cape Town. The TWG includes academics, policy makers and implementers who will undertake and share research on the existing evidence base on CHWs and generate new knowledge to guide decision makers on developing accessible, equitable and efficient CHW programs.
What happened at our community health worker meeting in Cape Town?
An international audience of around 40 people attended a side meeting organized by the HSG Thematic Working Group to discuss CHWs. It was a chance to strategise about research priorities that we should address as well as brainstorm activities for the coming year. The meeting was chaired and facilitated by Diana Frymus (USAID) and Lilian Otiso (LVCT Health).
Research Priorities
Meeting attendees suggested ideas for the TWG research agenda.
- Build on what we know: Communicating existing knowledge from research projects and programme monitoring and evaluation systems could help to fill gaps in the evidence base, for example how to go to scale, what skill sets are needed and how to strengthen quality of care in CHW programmes.
- Standardisation: There is no standard across countries in terms of the minimum package CHWs should deliver. Nor is there much clarity on typologies of CHWs. Although the Frontline Health Workers Coalition just published a brief on this, more work is needed.
- Scale up and integration into the health system: We need to understand how to institutionalise and operationalise CHW programmes that may start as a research or disease-specific project and how these can be integrated into the health system. There has been much attention paid to the apparent success of large scale CHW programmes in Rwanda and Ethiopia from which we can learn and consider how to ensure realistic workloads for CHWs who are being asked to carry out more and more health-related tasks.
- Community-health system interface: Much has been said about the role of CHWs in linking community and health systems. But there are still unanswered questions. For example, there’s a big question around the ‘professionalisation’ and payment of CHWs. Will they remain the voice of the community, if so, how? To what extent should CHWs be agents of social transformation and work on the social determinants of health?
- The inner dynamics of programmes: Often monitoring and evaluation systems within CHW programmes are weak and data utilization is minimal. We need to know more about: performance and productivity; CHW interactions and relationships with other cadres of health staff; supply chains; retention, career progression and retirement; costs; and the ways that gender and other axes of inequality play out within CHW programmes.
- Understanding change: More needs to be done to understand the historical trajectories of programmes. How are new information and communication technologies changing the landscape for CHWs? What effect does increasing urbanization bring?
- Diversifying the Member Base: Additionally, emphasis should be placed on increasing membership from the south and building the capacity of local investigators by helping them make in-country connections to share learning and collaborate on turning evidence into action.
What should the TWG do?
In addition to generating evidence it was suggested that the group should try and foster greater discussion and collaboration within and across different countries. This could include exchanges, and a data base of experts who could be called upon to answer particular queries. We were charged with summarising existing papers and evidence in an accessible way. Members also wanted a focus on the voices of CHW. One route to this is through our proposed collaboration with CHW Central. Linking CHWs, researchers, and policy makers with donors to encourage evidence informed action was also considered a priority.
Many thanks to Caitlin Whittmore (USAID) and Esther Richards (Liverpool School of Tropical Medicine) for their help with this. If you wish to join Googlegroup please contact Faye Moody (Faye.Moody@lstmed.ac.uk).
Photo courtesy of UNICEF Ethiopia\2013\Westerbeek
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