HSG Hub

Community health workers (CHWs) are at the interface between the formal health system and the community. As a result, they are in a unique position to observe and understand the factors that influence health, improve access to health services for vulnerable or hard-to-reach groups, and help strengthen health services by tailoring them to meet the needs and realities of the community. However, CHWs’ interface role also brings tensions. Health system and community expectations of CHWs’ tasks are not always well aligned. Health managers may see CHWs as representing the voice of communities, while community members see them as government or NGO representatives. Managing expectations and demands from health professionals and managers on one hand, and community members on the other, is a balancing act that requires CHWs to build trusting relationships (Kok et al. 2017). Such trusting relationships are the base for CHWs’ contributions to improving everyday access to health services – and are also instrumental when preparing and responding to shocks. Health systems and communities increasingly face shocks, such as epidemics, conflict, and climate-related emergencies. In such circumstances, resilience is needed – the systems need to maintain core functions and minimize negative consequences of disruptions. Resilience is a system’s…

Fiji faces a growing burden of diseases, especially non-communicable diseases (NCDs), compounded by a significant out-migration of nurses, which has impacted community health. These challenges have added pressure on community health workers (CHWs) who live in communities and are the key link between the community and the health system. Effective training is important for CHWs to strengthen their capacity to provide quality healthcare. While training policies are well-established in Fiji, there is lack of implementation and no training related to NCDs which are the leading causes of premature mortality in Fiji.  In 2023, we (University of New South Wales [UNSW] and The George Institute for Global Health, Australia) undertook a research study with the Fiji Ministry of Health and Medical Services to understand the role of CHWs in the prevention and control of NCDs (See Figure 1). The study, using the CHW-AIM toolkit, helped us understand the challenges faced by CHWs in delivering care to the communities. It also helped us to use human-centred design thinking to revise training for CHWs, aiming to address these challenges and strengthen primary health care. Figure 1: Discussion about the role of CHWs in community health Why use a human-centred design thinking process? A…