The Scalability and Sustainability of CHW Programs

By: Dr. Henry Perry

To be sure, many questions exist pertaining to the scalability and sustainability of CHW programs. Despite the presence of country examples, not a lot is known about large-scale CHW programs that have been sustained over a relatively long period of time. Documentation of these programs, including how they were scaled up and how they have been sustained, is limited. Large-scale and sustained CHW programs in Afghanistan, Bangladesh, Brazil, Ethiopia, India, Nepal, and Rwanda all offer interesting insights into issues of scalability and sustainability.  They are all very different with respect to:

• The degree to which the national political climate affects them (and how the programs change over time as a result of that),
• The scope and nature of local community engagement in the programs,
• The extent to which the programs engage with or are run by NGOs,
• The turnover of CHWs and the manner of payment of CHWs, and
• How the programs are sustained financially.

Questions:

1. How can countries with limited resources move toward well-costed, long-term, national program frameworks for CHWs (that includes strong training, supervision, and logistical support components) and away from short-term, external, donor-dependent project frameworks?
2. What other key components are necessary for successful scale-up?
3. What is your experience with scalability and sustainability of CHW programs?

Henry B. Perry III, MD, PhD, MPH, is a Senior Associate in the Health Systems Program of the Department of International Health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. Over the course of his career he has worked with Future Generations, Curamericas Global, ICDDR,B, the BASICS Project, and Hôpital Albert Schweitzer. His work has taken him to many countries, including Bangladesh, Bolivia, Haiti, Afghanistan, Tibet (China), India, and Peru. Dr. Perry’s research focuses on community-based primary health care.