Community health workers for ART in sub-Saharan Africa: learning from experience

Authors: Katharina Hermann, Wim Van Damme, George W Pariyo, Erik Schouten, Yibeltal Assefa, Anna Cirera and William Massavon

This article investigates whether present CHW programmes for antiretroviral treatment are taking into account lessons learnt from past experiences with community health worker programmes in primary health care and to what extent they are seizing the new antiretroviral treatment-specific opportunities. Our appraisal of six CHW programmes, identified during field work in Ethiopia, Malawi and Uganda in 2007, shows that while some lessons from the past have been learnt, others are not being sufficiently considered and antiretroviral treatment-specific opportunities are not being sufficiently seized. In particular, all programmes understand that without adequate remuneration, community health workers cannot be retained in the long term. Yet we contend that insufficient attention to issues such as quality supervision and continuous training will lead to decreasing quality of the programmes over time.