One Million Community Health Workers
Across the central belt of sub-Saharan Africa, community health workers (CHWs) deliver life-saving health care services where it’s needed most, in poor rural communities. In this region, 10 to 20 percent of children die before reaching the age of 5. Maternal death rates are high. Many people suffer unnecessarily from preventable and treatable diseases, from malaria and diarrhea to tuberculosis and HIV/AIDS. Many of these residents would otherwise have little or no access to the most fundamental aspects of modern medicine. Many countries are struggling to make progress toward the health related MDGs partly because so many people are poor and live in rural areas beyond the reach of modern health care.
Community health workers have been recognized for their success in reducing morbidity and averting mortality in mothers, newborns and children. These workers are most effective when supported by a clinically skilled health workforce, and deployed within the context of an appropriately financed primary health care system. However, they have proven crucial in settings where the overall primary health care system is weak. They also represent a strategic solution to address the growing realization that shortages of highly skilled health workers will not meet the growing demands of the rural population. And, they are a vital part of primary health systems that will last well into the post-Millennium Development Goals period for other health issues like non-communicable diseases.
As we approach 2015, many nations are working towards achieving the health-related Millennium Development Goals. Community health worker programs have been in place for a number of years, through government health programs and other non-governmental initiatives, like the Millennium Villages Project. In addition to providing basic treatment and preventative care, CHWs help keep track of disease outbreaks and overall public health, and offer a vital link between undeserved residents and the primary health care system.
We are launching a new campaign that aims to expand and accelerate community health worker programs in sub-Saharan African countries, scaling them up to district, regional, and national levels to meet the health-related Millennium Development Goals. With the use of the latest communications technology and diagnostic testing materials, these frontline workers link the rural poor to the broader healthcare system of doctors, nurses, hospitals and clinics.
Close the gap on achieving systematic rural healthcare coverage across rural Sub-Saharan Africa by supporting governments, global partners and national actors dedicated to CHW scale-up in the context of primary health care systems.
How to do it?
The effort begins with the training of national core groups that would be equipped to train others on the regional level, on down to the actual community health workers. While they have limited clinical training, the frontline workers would be supervised by more clinically skilled members of the health care system. Scaling in this way allows an opportunity to tailor the program to each nation’s particular needs and systems.
At the same time existing community health worker programs operating in countries such as Ethiopia, Kenya, Malawi, Nigeria, Rwanda, Senegal and Tanzania, should be upgraded to become national systems, including deployment of standardized protocols and use of mobile devices such as smartphones to integrate community health practices with national health information systems.
The systems should include ways to monitor progress on key metrics, such as maternal and child mortality, antenatal care rates, fever detection, HIV prevention, tuberculosis and malaria control, and nutrition. They should also include databases of community health workers to help track the program’s progress in spreading better health care to rural areas.
The new campaign will work with governments and aid agencies to finance and train the cadre of health workers, each of whom would serve an average of 650 rural inhabitants, at an estimated cost of $6.58 per patient per year. this adds up to an estimated $2.5 billion, which includes funding already being spent by NGOs and governments on these programs. These estimates fall within projected governmental health budgetary constraints and are within the boundaries of donor assistance already pledged and anticipated.
How it works
Biomedical technology has now produced rapid home test kits for malaria and HIV diagnosis, sputum collection for the detection of tuberculosis by genetic amplification, and pregnancy tests. These innovative instruments have enormous potential for impacting healthcare provision in the developing world, especially at the periphery of the health system and in rural areas.
Broadband access and smartphones can link community health workers to the national health system and allow for real-time disease surveillance, child and maternal health monitoring, mobile training, supply chain management and capturing of vital events.
Arming lay health workers with consistent supplies of life-saving medicines and easy-to-follow treatment protocols guarantees a minimum quality of services delivered to these clients. Active care and disease detection according to rigorous guidelines has greater benefit to the formal health system than the usual passive case detection and referrals to upper levels of care.
There is persuasive evidence that short-term intensive trainings on the most critical competencies for community healthcare delivery can be effective for deploying on-the-ground, functional frontline health workers at scale, without a large initial time lag between recruitment and deployment.