One Million Community Health Workers

As the new Government works out a formula for delivering on the campaign pledge regarding provision of health care, experts say that deployment of community health workers holds the key to extending health care delivery and improving health outcomes.

They say there is good evidence that when implemented well, community based health programs reduce infant and child mortality and morbidity; increase numbers of women delivering in health institutions and increase immunization rates.

Writing in the current issue of the Bulletin of the World Health Organization, the authors say their findings had shown that community health workers (CHWs), who currently work virtually as volunteers, can be particularly effective for addressing the most common causes of pediatric mortality and morbidity, such as pneumonia, diarrhea, under-nutrition, malaria and HIV/Aids.

CHWs are lay people who live in the communities they serve. They function as a critical link between those communities and the primary- health-care system.  However, they receive little recognition, training or remuneration.

Much of the hesitation in incorporating them into the formal health system has been brought about by lack of data on what it would cost, even though the positive impact of their work has been recognized in many pilot programs.

For instance, Kenya recently experimented with allowing them to provide long-term contraception methods to bridge the need for modern family planning methods.  Previously, CHWs were only allowed to distribute contraceptive pills and condoms.

The CHWs were also given basic equipment to facilitate their work, such as a mobile smart phone, a solar charger and a data plan.  To reduce costs, it was envisaged that such a national CHW program could establish a user group network that would allow free calls and short message service between identified health staff.

They would also receive one-year of training: Three months in a classroom and nine months while in service, plus supervision and feedback. In addition, the model worked with each CHW receiving a monthly salary of about Sh7,000. This is the average CHW salary that is being used in the successful Millennium Village Projects such as Sauri in Kenya.

The authors studied a system where CHWs visit households to provide community case management for diarrhea, malaria and malnutrition, management of pregnancy and health promotion.

Unlike what prevails in many countries, robust supervision, information-driven management, and a provider network within the formal health system supported the system in the study.

Analysing the costs related to offering various services, the study found for instance that while the average cost of providing family planning services to a woman in Africa is around Sh2, 300 per year, a CHW-based program would reduce this to about Sh560. The study provides a guide on the cost to deploy one CHW, including costs related to equipment, training, salaries, management and overhead.

In the model, CHWs were used to perform primary health care services such as monitoring for under-nutrition, treating diarrhea, testing for and treating malaria and pneumonia, screening for TB and de-worming.
It would take about Sh320, 000 annually to train, equip and support each CHW between now and 2015.   The authors estimate that using the above model, the costs would amount to approximately five per cent of the total cost of a primary- health-care system. “We recommend that countries wishing to develop a CHW strategy perform a similar costing exercise to design program budgets,” said the authors.

Bernard Muhtaka is a media consultant in Nairobi, Kenya.

This article was originally posted in Standard Digital News.