By: Amelia Brandt of Medicines for Humanity
The importance of CHWs in improving community health has been widely recognized by governments, NGOs, and international organizations. However, there is still significant variation in training, supervision, and expectations for CHWs. While each context is different and what works in one setting may not work in another, sharing stories of success and challenges is one way in which we can build our knowledge of best practices.
Medicines for Humanity (MFH) is a non-profit organization dedicated to saving the lives of vulnerable children worldwide. CHWs are a key element of our work and in 2012 we reached almost 115,000 children under five with needed services through CHW activities.
One of our most well-established CHW programs is located in San Pedro de Macoris, Dominican Republic. San Pedro is a semi-rural area that has many small communities called “bateyes” that house migrant agricultural workers, mostly from Haiti, and their families. Many of the bateyes lack basic amenities such as indoor plumbing or electricity. About 70% of people living in bateyes exist on an income of less than $2 per day. The two overwhelming problems they face are malnutrition and the lack of access to medicines and health services. The distance from the bateyes and the travel expense often prohibit parents from getting medical help for their sick children at health facilities. MFH introduced mobile clinics to provide care to these neglected communities but realized more onsite help was needed; we decided that CHWs, as members of the community, could address prevention and care needs.
Through support from the Major League Baseball Player’s Trust in 2010, we were able to begin a CHW training program in San Pedro called “La Loma.” The La Loma project provides weekly training for nine months to CHWs selected by their communities. The La Loma curriculum emphasizes maternal and child health but also teaches important skills in communication and public speaking. Trained CHWs currently serve nearly 34,000 people in the Dominican Republic and work closely with the mobile clinics, both referring patients and providing necessary follow-up and monitoring between mobile clinic visits.
Melis, a CHW in a batey called Los Montones, is a shining example of the impact these projects can have on a person’s life. When she was selected to become a CHW, her own child was suffering from undernourishment. However, through the training and support that she received at La Loma she not only improved the health of her own family, she worked with the mobile clinic team to eradicate child malnutrition entirely in her community. In addition to her work with undernourished children, she educated mothers with children suffering from fever and diarrhea, helping them to prevent dehydration.
Her education at La Loma inspired Melis to pursue other educational opportunities. She applied for and received a secretarial position for one of our mobile clinic projects, which now allows her to pay for college. The excellent training provided through the La Loma project is essential for skilled and motivated Community Health Workers like Melis to meet their full potential.
Medicines for Humanity (MFH), based in Rockland, MA, is a non-profit organization dedicated to saving the lives of vulnerable children worldwide. MFH is active in Angola, Rwanda, Kenya, Cameroon, Haiti, Guatemala, Guyana, and the Dominican Republic. Collaboration is at the heart of MFH’s work and they work closely with in-country partners in each of their projects.
Questions for consideration:
What experience have you had in linking community health workers to mobile or stationary clinics?
What training and supervision models have you found to be most effective?
What challenges have you faced?
Do you provide remuneration or other incentives?