We recently sat down with Dr. Sonia Ehrlich Sachs, Director of the One Million Community Health Workers (1mCHW) Campaign to talk about the important work that CHWs do and the pressing need for the scale-up of CHW programs. Dr. Sachs is a pediatrician and public health specialist. She has practiced medicine for over 20 years, 14 of which she spent at Harvard University Health Services. In 2004, she joined the Earth Institute and currently also serves as the Director of Health for the Millennium Villages Project.
What are the most pressing challenges in the development of scale-up of CHW programs today?
The single biggest obstacle standing in the way of national CHWs programs in countries of sub-Saharan Africa is the unwillingness of official international donors to partner with low income countries in helping finance their evidence-based, and feasible roadmaps to deploy and manage outreach health workers at national scale. We confronted this obstacle first hand in the Campaign’s work in Liberia just prior to the Ebola outbreak. We worked closely with the Liberian Ministry of Health on a strategy for a national scale outreach Roadmap and on assisting with donor outreach. Ironically the international community did not make the funding available, considering CHW program scale-up in Liberia to be a low priority. Unfortunately, a few months later the whole world learned that CHW program scale-up in Liberia was a priority beyond imagining in the face of the galloping epidemic of the Ebola virus. Our work at the Campaign, whether in response to the Ebola epidemic or in the day-to-day scale-up discussions with the Ghanaian government, reinforces one key message: CHWs save lives and should be a high priority of all African governments and their international partners.
Why is data on frontline health workers, particularly CHWs, important?
CHWs are an important cadre responsible for reducing disease burden and saving children’s and maternal lives in low-income settings. The outreach cadre offers a vital link between households and the clinics but they can also help keep track of disease outbreaks at the very earliest occurrence i.e. at the households before the escalating diseases come to the attention of the health system at the clinic level which is often in the advanced stages of a disease spread. So CHWs are a key component of public health surveillance.
When planning a scaled CHW program it is crucial to know the demography, topography, infrastructure of the communities, and the existing programs of what is mostly volunteer village health workers. It’s impossible to achieve successful scale-up of CHW programs unless the government knows exactly where CHWs are needed, and what resources, training, supervision and remuneration to provide them in order to service the assigned communities..
We promote integration of broadband and mobile health technologies into primary care health system as a low cost way to improve the quality of health service delivery. CHW’s use of smart phones with an application of, for example, CommCare provides decision makers, managers with near real time information facilitating continuous quality improvement. The rapid turn around of data allows adaptive management, quality control supervision, and surveillance that can quickly detect emerging diseases.
In your opinion, what type are the largest gaps in data on frontline health workers, particularly CHWs, right now?
Two main data gaps exist. One is the survey-based data that would help with situation analysis on the basis of which a national professional outreach cadre would be planned. The second is the on-going, real time data that informs the day-to-day functioning of the program, such as provided by CommCare and similar smart-phone based applications. To encourage the international community to fill these gaps and support the strategic expansion of CHW systems, the Campaign built the Operations Room, a data platform that is an interactive online inventory of public, private, and NGO-operated CHW programs in sub-Saharan Africa. We foresee expanding the Operations Room to include health workforce analytics and real time data on CHW activities.
In what ways is your organization using innovative solutions to collect data on frontline health workers?
Our goal is to promote the informatics system that has proven to be effective in Millennium Villages, where CHWs are provisioned with a smart phone based application, CommCare which has been effective in reducing child and maternal mortality by providing: (1) decision support at point-of-care, (2) performance monitoring and (3) data-based adaptation and surveillance all of which improve the quality of care of health care delivery in the community. This actionable data flow is in the context of an existing package which consists of curriculum, job aids, training and supervision for CHWs and their supervisors.