In light of the projected global shortage of 10 million health workers by 2030, community health programs have been receiving increasing attention as a potential approach to contribute to achieving Universal Health Care. Most of the available evidence comes from LMICs and relatively less from humanitarian settings. Evidence is even scarcer from settings where no government bodies exist.
The governance element of CHW programs is a critical one as it defines the extent to which CHWs are integrated, monitored, and scaled up in a given context. Similar in many ways to CHWs in other conflict settings, CHWs in Syria are a product of the context in which they operate. The Syrian conflict, a prolonged humanitarian crisis, has displaced more than half of the population. Like other conflicts, this war has hardened the non-government-controlled areas’ health systems. Fifty percent of health facilities were destroyed, and 70% of healthcare providers fled the country. Consequently, the workload and mental and physical pressure took a toll on the remaining health professionals. The said conditions have confronted accessibility, equity, service continuity and utilization of health services.
The paper titled “A framework for community health worker optimization in conflict settings: prerequisites and possibilities from Northwest Syria” has explored key elements which allows a maximum benefit of CHW programs in humanitarian protracted settings.
It stresses the paramount role of stakeholder’s perception as an inherent determinant of integration. It also highlights the role of political buy-in when considering a scaled-up program. One of the key findings identified the fundamental role of measuring the impact of CHW interventions in a systematic way. This is particularly important to change perception and for efficient resource utilization. Another key message the study presents is the importance of local ownership of the program. Donors are important stakeholders in these settings. However, it should be a local responsibility in the first place in order to progress from emergency to development phases.