DOCSLIB.ORG

Case Studies of Large-Scale Community Health Worker Programs

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Case Studies of Large-Scale Community Health Worker Programs Case Studies of Large-Scale Community Health Worker Programs: Examples from Afghanistan, Bangladesh, Brazil, Ethiopia, India, Indonesia, Iran, Nepal, Niger, Pakistan, Rwanda, Zambia, and Zimbabwe January 2017 Prepared by: Henry Perry Rose Zulliger Kerry Scott Dena Javadi Jessica Gergen Katharine Shelley Lauren Crigler Iain Aitken Said Habib Arwal Novia Afdhila Yekoyesew Worku Jon Rohde Zayna Chowdhury Rachel Strodel Table of Contents Introduction ............................................................................................................................... 1 The Community-Based Health Care System of Afghanistan ...................................................................... 2 Summary ...................................................................................................................................................... 2 What is the historical context of Afghanistan’s Community Health Worker Program? ............................ 3 Key health needs ......................................................................................................................................... 3 Health system structure .............................................................................................................................. 4 Scope of work of the CHWs ......................................................................................................................... 4 Community roles .......................................................................................................................................... 5 CHW selection process and criteria ............................................................................................................ 5 Training of CHWs .......................................................................................................................................... 5 Support and supervision ............................................................................................................................. 6 Linkages with the formal health system ..................................................................................................... 6 Compensation and motivation .................................................................................................................... 6 Monitoring and data use ............................................................................................................................. 7 Demonstrated impact of the CBHC Program ............................................................................................. 7 Financing of CBHC and its development .................................................................................................... 7 Program scale-up ......................................................................................................................................... 8 Impact and continuing challenges .............................................................................................................. 8 The BRAC Shasthya Shebika Community Health Worker in Bangladesh .................................................. 9 Summary ...................................................................................................................................................... 9 What is the historical context of BRAC’s Shasthya Shebika Program? ................................................. 10 What are Bangladesh’s health needs?.................................................................................................... 10 What is the existing health infrastructure? ............................................................................................. 10 What type of program has been implemented? ..................................................................................... 11 What about the community’s role? .......................................................................................................... 12 How does BRAC select, train, and retain Shasthya Shebikas? .............................................................. 12 How does BRAC supervise its Shasthya Shebikas? ............................................................................... 12 How is the program financed? ................................................................................................................. 12 What are the program’s demonstrated impact and continuing challenges? ........................................ 13 References ................................................................................................................................................ 13 The Government Family Welfare Assistant and Health Assistant programs in Bangladesh....................14 Summary ................................................................................................................................................... 14 What is the historical context of Bangladesh’s government CHW programs? ...................................... 15 What are Bangladesh’s health needs?.................................................................................................... 15 What is the existing health infrastructure? ............................................................................................. 15 What type of program has been implemented? ..................................................................................... 15 What about the community’s role? .......................................................................................................... 16 Case Studies of Large-Scale Community Health Worker Programs: Examples from Afghanistan, iii Bangladesh, Brazil, Ethiopia, Niger, India, Indonesia, Iran, Nepal, Pakistan, Rwanda, Zambia, and Zimbabwe How does the government select, train, and retain its CHWs? .............................................................. 16 How does the government supervise its CHWs? .................................................................................... 16 How is the program financed? ................................................................................................................. 16 What are the program’s demonstrated impact and continuing challenges? ........................................ 17 References ................................................................................................................................................ 17 The Community Health Agent Program of Brazil ......................................................................................18 Summary ................................................................................................................................................... 18 What is the historical context of Brazil’s Community Health Worker Program? ................................... 19 What are Brazil’s health needs? .............................................................................................................. 20 What is the existing health infrastructure? ............................................................................................. 20 What type of program has been implemented? ..................................................................................... 21 What about the community’s role? .......................................................................................................... 21 How does Brazil select, train, and retain Community Health Agents? .................................................. 22 How does Brazil supervise its Community Health Agents? .................................................................... 22 How is the Programa Saúde da Família financed? ................................................................................ 23 What are the program’s demonstrated impact and continuing challenges? ........................................ 23 References ................................................................................................................................................ 24 Ethiopia’s Health Extension Program ......................................................................................................26 Summary ................................................................................................................................................... 26 What is the historical context of Ethiopia’s Community Health Worker Program? ............................... 27 What are Ethiopia’s health needs? .......................................................................................................... 27 What is the existing health infrastructure? ............................................................................................. 28 What type of program has been implemented? ..................................................................................... 28 What about the community’s role? .......................................................................................................... 29 How does Ethiopia select, train, and retain Health Extension Workers and Health Development Army Volunteers? ...................................................................................................................................... 29 How does Ethiopia supervise its Health Extension Workers? ................................................................ 30 How is the Health Extension Program financed? ...................................................................................
Load more

Recommended publications
  • The Role of the Community Health Worker to Strengthen Popular Education in Health Revista De Pesquisa Cuidado É Fundamental Online, Vol
    Revista de Pesquisa Cuidado é Fundamental Online E-ISSN: 2175-5361 [email protected] Universidade Federal do Estado do Rio de Janeiro Brasil Scherlowski Leal David, Helena Maria The role of the community health worker to strengthen popular education in health Revista de Pesquisa Cuidado é Fundamental Online, vol. 9, núm. 2, abril-junio, 2017, pp. 371-378 Universidade Federal do Estado do Rio de Janeiro Rio de Janeiro, Brasil Available in: http://www.redalyc.org/articulo.oa?id=505754109011 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative REVISTA ONLINE DE PESQUISA CUIDADO É FUNDAMENTALREVISTA ONLINE DE PESQUISA UNIVERSIDADE FEDERAL DO ESTADO DO RIO DE JANEIRO . ESCOLA DE ENFERMAGEM ALFREDO PINTO RESEARCH CUIDADO É FUNDAMENTALDOI: 10.9789/2175-5361.2017.v9i2.371-378 UNIVERSIDADE FEDERAL DO ESTADO DO RIO DE JANEIRO . ESCOLA DE ENFERMAGEM ALFREDO PINTO O papel do agente comunitário de saúde no fortalecimento da educação popular em saúde The role of the community health worker to strengthen popular education in health El rol del agente comunitario de salud en el fortalecimiento de la educación popular en salud Helena Maria Scherlowski Leal David1 FAPERJ Financial Aid Priority Announcement Rio 200. How to quote this article: David HMSL. The role of the community health worker to strengthen popular education in health. Rev Fund Care Online. 2017 abr/jun; 9(2):371-378. DOI: http://dx.doi.org/10.9789/2175-5361.2017.v9i2.371-378 ABSTRACT Objective: To discuss the Community Health Agent (CHA)’s role as a popular educator.
    [Show full text]
  • Factors Impacting the Effectiveness of Community Health Worker Behavior Change
    FACTORS IMPACTING THE EFFECTIVENESS OF COMMUNITY HEALTH WORKER BEHAVIOR CHANGE A LITERATURE REVIEW February 16, 2015 TABLE OF CONTENTS ACRONYMS ............................................................................................................................................................................................2 EXECUTIVE SUMMARY ......................................................................................................................................................................3 INTRODUCTION ...................................................................................................................................................................................4 METHODOLOGY ..................................................................................................................................................................................6 KEY FINDINGS .......................................................................................................................................................................................7 Knowledge and Competency Barriers ..................................................................................................................................7 Structural and Contextual Barriers .........................................................................................................................................10 Attitudinal Barriers .......................................................................................................................................................................15
    [Show full text]
  • Mhealth Tool to Improve Community Health Agent Performance for Child Development: Study Protocol for a Cluster-­Randomised Controlled Trial in Peru
    Open access Protocol BMJ Open: first published as 10.1136/bmjopen-2018-028361 on 6 November 2019. Downloaded from mHealth tool to improve community health agent performance for child development: study protocol for a cluster- randomised controlled trial in Peru Christopher Michael Westgard ,1,2 Natalia Rivadeneyra,2 Patricia Mechael3 To cite: Westgard CM, ABSTRACT Strengths and limitations of this study Rivadeneyra N, Mechael P. Introduction Cultivating child health and development mHealth tool to improve creates long- term impact on the well- being of the ► The intermediate variables will be assessed to mea- community health agent individual and society. The Amazon of Peru has high levels performance for child sure the behaviour changes that occurs along the of many risk factors that are associated with poor child development: study protocol for theory of change. The study will be able to evaluate development. The use of ‘community health agents’ (CHAs) a cluster- randomised controlled the various mediator variables that are expected to has been shown to be a potential solution to improve child trial in Peru. BMJ Open contribute to the final objective. 2019;9:e028361. doi:10.1136/ development outcomes. Additionally, mobile information and ► A process evaluation with qualitative assessments communication technology (ICT) can potentially increase bmjopen-2018-028361 will be used to identify issues of implementation and the performance and impact of CHAs. However, there is Prepublication history for inform the implementation plan for scalability. ► a knowledge gap in how mobile ICT can be deployed to this paper is available online. ► The mHealth tool and the monitoring and evaluation improve child development in low resource settings.
    [Show full text]
  • How Effective Are Community Health Workers?
    HOW EFFECTIVE ARE COMMUNITY HEALTH WORKERS? An Overview of Current Evidence with Recommendations for Strengthening Community Health Worker Programs to Accelerate Progress in Achieving the Health-related Millennium Development Goals September 2012 Henry Perry, Senior Associate Department of International Health Johns Hopkins Bloomberg School of Public Health and Rose Zulliger, PhD Doctoral Candidate Department of Health Behavior and Society Johns Hopkins Bloomberg School of Public Health Acknowledgements This report was prepared for the MDG Health Alliance. Funding was provided by the Alliance and the Rockefeller Philanthropy Advisors, Inc. We are grateful for the assistance of Sara Ju, master’s student in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health, for her assistance in collecting information used in this review and in editing this document. We are also grateful for the assistance of Ingrid Friberg, Assistant Scientist in the Department of International Health, with the LiST calculations. How Effective Are Community Health Workers? | i Table of Contents Acknowledgements .......................................................................................................................... i Glossary ........................................................................................................................................... iv I. Introduction ............................................................................................................................. 1 II.
    [Show full text]
  • COMMUNITY HEALTH POLICIES and PROGRAMMES Publication: October 2019 © Cover Photo: Tremeau/Fonds Français Muskoka ANALYSIS REPORT
    ANALYSIS REPORT COMMUNITY HEALTH POLICIES AND PROGRAMMES Publication: October 2019 © cover photo: Tremeau/Fonds Français Muskoka ANALYSIS REPORT COMMUNITY HEALTH POLICIES AND PROGRAMMES ACRONYMS AC Care community agents (in French: Agents EBV Epstein-Barr virus communautaires - Sénégal) ECD Early Childhood Development ACPP Prevention and Promotion Community Actor (in French: Acteur Communautaire de Prévention et de Promotion EMTCT Elimination of mother-to-child transmission of VIH - Sénégal) FGM Female Genital Mutilation ACT Artemisinin-based combination therapy GAC Global Affairs Canada (ex-CIDA) ANC Antenatal Care HPV Human papilloma virus APP Agents for Promotion and Prevention (in French: iCCM integrated Community Case Management Agents pour la Promotion et la Prévention - Niger) IMCI Integrated Management of Childhood Illness ARI Acute Respiratory Infection IPTp Intermittent preventive treatment in pregnancy ASACO Community Health Organizations (Mali) KMC Kangaroo Mother Care ASBC Community-based health workers (in French : Agent de santé à base communautaire - Burkina Faso) LGA Local Government Area (Nigeria) BEPC First Secondary school diploma in francophone LLI(T)N Long-lasting insecticidal(-treated) nets education systems - 14/15 years old (in French: Brevet d’Etudes du Premier Cycle) LMIS Logistics management and information system CAC Community organization unit (in French: Cellule MAM Moderate acute malnutrition d’animation communautaire - DRC) M&E Monitoring and Evaluation CBC Community Birth Companion (The Gambia) MNP Micronutrient
    [Show full text]
  • Report on the 'Think-In' on Community Health Worker Voice, Power, And
    January 2018 Learning Exchange Report Number 3 Report on the ‘Think-in’ on Community Health Worker Voice, Power, and Citizens’ Right to Health Marta Schaaf Caitlin Warthin Amy Manning Stephanie Topp Report on the ‘Think-in’ on Community Health Worker Voice, Power, and Citizens’ Right to Health 1 About Accountability Research Center (ARC) The Accountability Research Center (ARC) is an action-research incubator based in the School of International Service at American University. ARC partners with civil society organizations and policy reformers in the global South to improve research and practice in the field of transparency, participation and accountability. For more information about ARC, please visit the website: www.accountabilityresearch.org. About ARC Publications ARC publications serve as a platform for accountability strategists and researchers to share their experiences and insights with diverse readers and potential allies across issue areas and sectors. These publications frame distinctive local and national initiatives in terms that engage with the broader debates in the transparency, participation and accountability (TPA) field. Research publications include brief Accountability Notes, longer Accountability Working Papers and Learning Exchange Reports. Rights and Permissions The material in this publication is copyrighted under the Creative Commons Attribution 4.0 Unported license (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/. Under the Creative Commons Attribution license, you are free to copy, distribute, transmit, and adapt this work, including for commercial purposes, under the following conditions: Attribution—Please cite the work as follows: Schaaf, Marta, Caitlin Warthin, Amy Manning, and Stephanie Topp. 2018. “Report on the ‘Think-In’ on Community Health Worker Voice, Power, and Citizens’ Right to Health.” Accountability Research Center, Learning Exchange Report 3.
    [Show full text]
  • Assessment of the Knowledge of Brazilian Community Health Workers Regarding Cambridge.Org/Phc Prenatal Care
    Primary Health Care Research & Development Assessment of the knowledge of Brazilian Community Health Workers regarding cambridge.org/phc prenatal care Lívia P. Bonifácio, João M. A. Marques and Elisabeth M. Vieira Research Social Medicine Department, Ribeirão Preto Medical School, University of São Paulo FMRP/USP, Brazil Cite this article: Bonifácio LP, Marques JMA, Vieira EM. (2018). Assessment of the Abstract knowledge of Brazilian Community Health Workers regarding prenatal care. Primary Aim: To evaluate prenatal care knowledge of Brazilian community health workers (CHWs). Health Care Research & Development Background: Routine prenatal care is critical for reducing health risks in women and their 20(e21): 1–7. doi: 10.1017/S1463423618000725 children. One of the responsibilities of primary healthcare providers is the provision of prenatal care. The CHWs, with their frequent contact with populations, work to improve Received: 10 October 2017 health outreach efforts and therefore may be key role players in prenatal care. Methods: This Revised: 27 May 2018 Accepted: 3 September 2018 was a cross-sectional study. A questionnaire was developed to ascertain the degree of knowledge regarding prenatal care of CHWs, including: (1) general responsibilities of CHWs; Key words: (2) the initial contact with a pregnant woman; (3) examinations and vaccinations community health agent; community health recommended for pregnant women; (4) pregnancy complications and signs of labor; and workers; knowledge; prenatal care; primary healthcare (5) lifestyle considerations for pregnant women. Responses were categorized into levels for knowledge. Demographic data were also collected. Descriptive analyses were conducted. Author for correspondence: Proportions of subjects with different levels of knowledge were compared according to each Lívia P.
    [Show full text]
  • Effects of Urban Violence on Primary Healthcare: the Challenges Of
    Journal of Community Health (2019) 44:569–576 https://doi.org/10.1007/s10900-019-00657-2 ORIGINAL PAPER Efects of Urban Violence on Primary Healthcare: The Challenges of Community Health Workers in Performing House Calls in Dangerous Areas Hugo Cesar Bellas1 · Alessandro Jatobá1 · Bárbara Bulhões2 · Isabella Koster3 · Rodrigo Arcuri4 · Catherine Burns5 · Kelly Grindrod5 · Paulo Victor R. de Carvalho6 Published online: 4 April 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Community health workers in developing countries usually perform house calls in degraded and violent territories. Thus, in this paper we study the efects of urban violence in the performance of CHWs in poorly developed territories, in order to understand the challenges of delivering care to dangerous communities in developing countries. We conducted telephone surveys for 5 months in 2017, within a systematic sample of 2.000 CHWs based on clinics distributed along the health regions of the city of Rio de Janeiro, Brazil. We completed 766 interviews, approximately 40% of the sample, 86% man and 14% women. Most participants are 30 to 39 years old (35%), followed by 27% of 40 to 49 years old participants. As CHWs work on the sharp end of the healthcare system, responsible for outreaching, community education, counseling, and social support, our study presents contributions to government and management levels on working conditions inside communities, constraints in assistance, and difculties in implementing primary care policies. Keywords Community health workers · Primary health care · House calls · Exposure to violence Introduction inequality, and community health [3–5]. As defned by this document, “primary health care” involves, in addition to the The Declaration of Alma-Ata [1, 2] is a milestone for health sector, all aspects of national and community devel- implementation and institutionalization of the role of the opment.
    [Show full text]
  • How Effective Are Community Health Workers?
    HOW EFFECTIVE ARE COMMUNITY HEALTH WORKERS? An Overview of Current Evidence with Recommendations for Strengthening Community Health Worker Programs to Accelerate Progress in Achieving the Health-related Millennium Development Goals September 2012 Henry Perry, Senior Associate Departments of International Health Johns Hopkins Bloomberg School of Public Health and Rose Zulliger, PhD Doctoral Candidate Department of Health Behavior and Society Johns Hopkins Bloomberg School of Public Health Acknowledgements This report was prepared for the MDG Health Alliance. Funding was provided by the Alliance and the Rockefeller Philanthropy Advisors, Inc. We are grateful for the assistance of Sara Ju, master’s student in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health, for her assistance in collecting information used in this review and in editing this document. We are also grateful for the assistance of Ingrid Friberg, Assistant Scientist in the Department of International Health, with the LiST calculations. How Effective Are Community Health Workers? | i Table of Contents Acknowledgements .......................................................................................................................... i Glossary ........................................................................................................................................... iv I. Introduction ............................................................................................................................. 1
    [Show full text]
  • Community Health Worker Assessment and Improvement Matrix
    Community Health Worker Assessment and Improvement Matrix (CHW AIM) Updated Program Functionality Matrix for Optimizing Community Health Programs Contributing Authors: Community Health Impact Coalition: Madeleine Ballard, Matthew Bonds (PIVOT), Jodi-Ann Burey (Village Reach), Jennifer Foth (Living Goods), Kevin Fiori (Integrate), Isaac Holeman (Medic Mobile), Ari Johnson (Muso), Serah Malaba (Living Goods), Daniel Palazuelos (PIH), Mallika Raghavan (Last Mile Health), Ash Rogers (Lwala), and Ryan Schwarz (Possible) Initiatives Inc.: Rebecca Furth and Joyce Lyons (CHW Central) UNICEF: Hannah Sarah F. Dini and Jérôme Pfaffmann Zambruni USAID: Troy Jacobs and Nazo Kureshy This toolkit builds on the original work (“Community Health Worker Assessment and Improvement Matrix (CHW AIM): A Toolkit for Improving CHW Programs and Services”) prepared by Initiatives Inc. and University Research Co., LLC (URC) for review by the United States Agency for International Development (USAID). It was authored by Lauren Crigler, Initiatives Inc. Kathleen Hill, University Research Co., LLC, Rebecca Furth, Initiatives Inc., and Donna Bjerregaard, Initiatives Inc. CHW AIM was originally developed under the USAID Health Care Improvement Project, made possible by the generous support of the American people. Design: Sonder Design Released: December 2018 1 Background and Opportunity As the global community aims to fulfill its commitments to the UN Sustainable Development Goals, and the achievement of universal health coverage, dozens of countries have committed to the expansion of community health workers (CHWs) as the front line of their healthcare systems [1, 2]. Robust research demonstrates CHWs improve access to care, reduce maternal, newborn, and child mortality, improve clinical outcomes for chronic diseases, and prevent disease outbreaks [3].
    [Show full text]
  • Community Health Agent Programme Toolkit
    COMMUNITY HEALTH AGENT PROGRAMME TOOLKIT A PRACTICAL FRAMEWORK FOR THE DEVELOPMENT AND IMPLEMENTATION OF DOOR-TO-DOOR HIV TESTING SERVICE PROGRAMS IN RURAL AND URBAN SETTINGS LIST OF ABBREVIATIONS APP APPLICATION THE PROGRAMME MSF COMMUNITY HEALTH AGENT PROGRAM HCT HIV COUNSELING AND TESTING HIV HUMAN IMMUNO-DEFICIENCY VIRUS KZN KWAZULU-NATAL MSF MÉDECINS SANS FRONTIÈRES NDOH NATIONAL DEPARTMENT OF HEALTH NGO NON GOVERNMENTAL ORGANIZATION SHINE SHINTSHA HEALTH INITIATIVE SOPS STANDARD OPERATING PROCEDURES TB TUBERCULOSIS CONTENTS INTRODUCTION AND BACKGROUND 2 CHALLENGES OF HCT COVERAGE IN HIGH HIV PREVALENCE SETTINGS 2 ACHIEVING 90-90-90 IN ESHOWE AND MBONGOLWANE WITH DOOR-TO-DOOR TESTING AND OTHER STRATEGIES 3 POPART: USE OF COMMUNITY HEALTH WORKERS IN ACHIEVING POPULATION-LEVEL REDUCTIONS IN HIV INCIDENCE 3 COMMUNITY HEALTH AGENTS PROGRAMME 5 AN OVERVIEW 7 DEVELOPING A DOOR-TO-DOOR TESTING PROGRAMME 9 STEP 1: RESEARCH, DESIGN & CONSULTATION 11 1.1 Assess healthcare gaps 11 1.2 Mapping 12 1.3 Consultation 13 1.4 select a partner for community-based implementation 14 1.5 Finalize details of the program 15 1.6 organise the programme in collaboration with health authorities and partnering facilities 16 1.7 Validation of program by local authorities 17 STEP 2: RECRUITMENT AND TRAINING 19 2.1 Finalize HR structure 19 2.2 Develop job descriptions 21 2.3 Recruitment 22 2.4 Develop guidance tools 22 2.5 Procure uniforms and necessary equipment 23 2.6 Training and mentorship of community health agents 25 STEP 3: ACTIVATION 27 3.1 Community awareness
    [Show full text]
  • Case Studies of Large-Scale Community Health Worker Programs
    Case Studies of Large-Scale Community Health Worker Programs: Examples from Afghanistan, Bangladesh, Brazil, Ethiopia, Niger, India, Indonesia, Iran, Nepal, Pakistan, Rwanda, Zambia, and Zimbabwe January 2017 Prepared by: Henry Perry Rose Zulliger Kerry Scott Dena Javadi Jessica Gergen Katharine Shelley Lauren Crigler Iain Aitken Said Habib Arwal Novia Afdhila Yekoyesew Worku Jon Rohde Zayna Chowdhury Rachel Strodel Table of Contents Introduction ............................................................................................................................... 1 The Community-Based Health Care System of Afghanistan ...................................................................... 2 Summary ...................................................................................................................................................... 2 What is the historical context of Afghanistan’s Community Health Worker Program? ............................ 3 Key health needs ......................................................................................................................................... 3 Health system structure .............................................................................................................................. 4 Scope of work of the CHWs ......................................................................................................................... 4 Community roles .........................................................................................................................................
    [Show full text]