HSG Hub

By: Ateeb Ahmad Parray, Sophia Kaufman, Md. Imtiaz Khalil Ullah and Saha Naseri From July 2019 to December 2019, I worked in Afghanistan for a project funded by the Bill and Melinda Gates Foundation. During these six months, I visited many Afghan health care facilities: sub-health centres, comprehensive health centres, district hospitals, and a tertiary level hospital. Across these spaces, I met with health workers who were providing life-saving services in the country’s most conflict prone zones. I was especially moved by the experiences shared by the female community health workers (CHWs during a training session in Helmand – one of the most fragile provinces of Afghanistan where access to basic health services has been rendered poor due to on-going conflict. The purpose of this feature is to convey a new understanding of what motivates women to work as CHWs and the experiences and challenges they face, while working in the conflict prone zones of Afghanistan. Who are the CHWs in Afghanistan? CHWs are mostly community volunteers nominated by a Village Health Council (VHC) or a Health Shuara – a community based advisory committee dedicated to the smooth operation of local health facilities. They are involved in the implementation of…

COVID-19 and CHWs in South Africa South Africa had timely and decisive action in response to COVID-19. Most significant was the lockdown, delaying spread and preventing surge. Community-based public health has been a major focus: 28,000 CHWs were deployed across the country for community screening and door-to-door testing and contract-tracing. CHWs are a key part of South Africa’s COVID-19 response. There are approximately 70,000 CHWs in the country employed by over 3,000 non-governmental organisations (NGOs). As part of commitments to National Health Insurance (NHI), Ward-Based Primary Healthcare Outreach Teams (WBPHCOTs) were introduced in 2011 as part of a significant primary health care (PHC) revival connecting people with services. Despite significant government efforts to formalise and integrate CHWs into the public health system, however, multiple obstacles exist. Implementation of WBPHCOTs has been slow and uneven and there is low coverage. By 2017, only 42% of the required teams had been established, with many inadequately staffed. There is also relatively low awareness of the expanded CHW roles and functions in communities. Moreover, despite recognition of the potential for WBPHCOTs to promote local action on the social determinants of health, these roles are not well-defined, valued or supported. South Africa’s COVID-19 response has in large part relied on community-based preventative approaches….