One Million Community Health Workers

2 Comments

1. 

   Cyril Pervilhac

   September 16, 2013 at 12:22 pm

   1. How do we build relationships between already established small-scale programs and larger governmental programs? What do you see as key elements to the success of such
   collaborations?
   1.1 Learn and document the lessons of scale-up from Districts to the Regions or Provinces. Key element of success: present movement to Governance, decentralization, local tax raising, district and provincial planning (ex. Nigeria)
   1.2 Place priority on a few selected Regions/ Provinces in each country (current strategy in many countries, e.g. with GF in Nigeria on HIV/AIDS, TB and Malaria programmes) and learn the lessons from these scale-up efforts to apply to national replication. Key element: joint partnerships between the Government/ local authorities and international partners (bi, multi-lateral, for ex the sub-recipients of the GF, and private) in joint planning and joint documentation of the lessons learned (for ex. as part of the joint reviews/ evaluations efforts). Synthesize the lessons learned at sub-national level to include them into national strategic plans of diseases in a coherent way. Key element: strong national guidance, commitment over time (ex. Ethiopia)
   1.3 For some key technologies, such as medical education or e-health, build-up on a special joint venture between public and private partnerships at country level. Key element: use/ adapt current success stories, ex in India with INTEL on Medical education (p. 21) or BHARTI AIRTEL (p. 24) as per “Private Enterprise for Public Health” A Short Guide for Companies, 2012
   http://who.int/pmnch/topics/part_publications/private_enterprise_for_public_health_guide.pdf

   2. Based on your experiences, what do you see as the best way to structure these relationships between small and large-scale programs? (i.e. should they be partners, should smaller organizations serve as a resource, should they be consolidated, etc.)
   2.1 Relationships should be structured such as the Global Fund with sub- Recipients (SRs) feeding and supported by Principal Recipients (PRs) BUT PRs should be responsible to learn the lessons and disseminate those, given smaller organizations may never share the lessons learned for one reason or another. Strategy: incorporate this in reviews/ evaluation terms of reference, create in-country learning platforms, feed those into the local or national strategic plans
   2.2 Map out the smaller and larger organizations from private and the public sectors and their roles and responses at local level using existing tools/ experiences (ref. UNAIDS, WHO, GTZ, “Local Responses to HIV/AIDS” in late 1990s in 5 countries in Africa with example in Burkina Faso as a research study/ thesis, available at: http://pub.uni-bielefeld.de/pub?func=drec&id=2305617 ), or “Bridging the gap between the communities and the service provides by the way of local responses: the District Response Initiative in Uganda” (2003, pp. 37-40 in http://www.who.int/hiv/pub/prev_care/en/37564_OMS_interieur.pdf )

   3. Besides relationship building, what do you see as a main challenge in effective CHW scale-up? What are some to successfully address these challenges?
   3.1 Dispel the myth of high costs and unsustainability. To address these challenges, see experience of Ethiopia. Wide distribution and advocacy campaigns in MoHs and Ministries of Finance, partners. Separate the costs in investments and recurrent costs (the latter supported by local taxes, e.g. Uganda). Show return in investments and shared costs, e.g. CHWs working commonly in infectious and chronic diseases (e.g. Rwanda)
   3.2 Document carefully and disseminate examples of scale-up of CHWs and the HOW, WHY it succeeded. See for ex. scale-up of ART in the early days of the 3 by 5 Initiative under Jim Kim at WHO/HIV
   3.3 Build-up in the costed strategic plans advocated by large Initiatives (e.g. GAVI, GF) the costs of CHWs scale-up for national and district plans
   3.4 Include CHWs training and support into the present efforts launched of training and updating health professionals with current efforts or opportunities such as the recently released 2013 WHO ARV guidelines
   3.5 Documenting “effective” CHW scale-up by documenting the outcomes and impact attributed to the CHWs vs. presently the health services taking direct benefits of those (under operational research in various countries) and disseminating and using existing tools such as the Global Fund Community Systems Framework (2011) available at:
   http://www.google.fr/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=2&ved=0CE8QFjAB&url=http%3A%2F%2Fwww.theglobalfund.org%2Fdocuments%2Fcivil_society%2FCivilSociety_CommunitySystemsStrengthening_Framework_en%2F&ei=iTc3UtjAItHSsga_3YGABg&usg=AFQjCNHvzIP_Ld1PHfGZSittQYkSqGho6Q&bvm=bv.52164340,d.Yms

2. 

   Hannah Sarah F. Dini

   October 2, 2013 at 2:08 pm

   Check out our response to Cyril’s comments over at the CHW Central conversation!

   http://www.chwcentral.org/blog/building-relationships-effective-chw-scale-one-million-chw-campaign