Community Health Workers

  • Blog post
    Female Community Health Volunteers in Nepal

    Female Community Health Volunteers (FCHVs) in Nepal pretest materials developed for the distance education Radio Health Program (RHP), promoting key behaviors related to Family Planning and Maternal Health.

    © 2004 Khemraj Shrestha, Courtesy of Photoshare

    During the second annual World Health Worker Week, April 7-11, 2014, we are celebrating the women and men who save lives and raising awareness of health workforce issues. This post by Ram Shrestha and Rhea Bright, originally appearing on the USAID ASSIST Project's Blog, explains the integral role community health workers play in increasing service coverage - and ultimately achieving universal health coverage.

    In this post, Rhea Bright interviews Dr. Ram Shrestha.

    As a health professional, whenever I visit a rural village in a low-or middle-income country, several thoughts come to mind. Knowing that the formal health system usually ends at a health center, dispensary, or health post in these rural communities, does everyone in this village have access to health services? How can we ensure that there are enough health workers in nearby facilities to provide needed services? Are there community health workers (CHWs) in this village, and are they well supported? I started thinking more and more about these questions as World Health Worker Week (April 7-11, 2014) approached…consequently even more questions came to mind.

  • Blog post

    The integration of mHealth into community health programming has been integral toward improving health delivery in low performing areas that are unreachable by facilities and clinics. Emily Lanford has highlighted the ASSIST Project’s work in the enabling effect of mobile phones  in strengthening the performance of community health workers in Uganda. You can access the original entry on the ASSIST Project’s knowledge portal.

    Community improvement team member reporting during the meeting

    Community improvement team member reporting during the meeting.

    A component of Uganda’s national strategy since 2001, Village Health Teams (VHTs) serve as an initial point of health system contact for much of the country’s population.  Unfortunately, the number of available VHTs and the scope of their duties are not sufficient to reach all households needing services.  Further exacerbating the problem is that Uganda is plagued by grave disparities between the number of patients requiring medical care and the number of available doctors able to provide those services (the ratio is estimated to be 1:24,000 by the World Health Organization).  

    The ASSIST Project’s community support activity in Uganda has focused on improving the engagement and performance of VHTs to provide self-management support for people living with HIV. A major gap in current health system support for VHTs is the lack of supportive supervision and vehicles to transport facility workers to the community level. 

  • Uganda: Job aid for community health workers

    Job aid for community health workers

  • Blog post

    This post by Sirina Keesara and Grace Lesser originally appeared on the Bill and Melinda Gates Foundation's Impatient Optimists blog. Keesara and Lesser are with Jacaranda Health in Kenya, which is "developing a replicable model to provide affordable, high-quality maternal health services to low-income women worldwide. Jacaranda Health is a stellar example of how the global community is working towards meeting the unmet need for family planning. Here, they share five lessons on integrating postpartum family planning services in their maternity services.

    What lessons have you learned about integrating family planning into health services? Tell us in the comments.

    Jacaranda Health Maternity and Family Planning Integration

    Photo © Jacaranda Health

    Source: Impatient Optimists

    Jacaranda Health is working to change the way that maternity care is provided in Africa. We are developing a replicable model to provide affordable, high-quality maternal health services to low-income women worldwide. Our goal is to become a global laboratory for some of the most exciting innovations in maternal and child health service delivery.

    Family planning is one of the most cost-effective ways to reduce maternal mortality, and at Jacaranda we are committed to integrating high quality family planning services to the spectrum of our maternity services. We hope to contribute to the community by sharing what we are learning about providing postpartum family planning services in resource-constrained settings.

    1. Integrate family planning into maternity services

    Jacaranda Health

    Photo © Jacaranda Health

    Source: Impatient Optimists

    Pregnant women have so much to think about during pregnancy – where to deliver, how to save for the costs, the baby clothes – that preventing the next child is often the last thing on their mind. But studies from around the world have shown that nearly 80 percent of women do not want a pregnancy in the two years following a delivery. Half of these women would like to start contraception within six weeks after delivery. In Kenya, 90 percent of women in the three months postpartum and 68 percent of women at one year postpartum still have an unmet need for family planning. Most health care facilities design maternity care and family planning as separate services; we believe the two should be married.

    Integration of family planning into antenatal, postpartum, and child wellness services is proven to help women meet their contraceptive desires. At Jacaranda, we’ve integrated family planning cues into documentation so that providers do not have to struggle with multiple forms, and can respond to built-in prompts to initiate family planning dialogue throughout the continuum of care. We’ve also designed educational materials for our antenatal clients to take home, which plant the family planning seed early and equip clients with the knowledge they’ll need to make a decision after delivery. The postpartum period is often a missed opportunity for family planning, so we’re also considering helping our antenatal clients build a personal postpartum contraception plan, analogous to a “birth plan,” to encourage them to start planning early.

    Evidence from Kenya and other countries suggests that once women have been fully counseled on family planning usage and side effects, satisfaction and uptake increases while unmet need drops.

  • Blog post

    As a researcher, it has been rare for me to interact directly with the women and men whose lives are intended to be impacted by our work. Typically, my interactions go no further than the data collectors I train. However, when my research was based in Latin America and the Caribbean, I could unobtrusively participate in pilot testing of data collection instruments. Not so in sub Saharan Africa (SSA) where I do not resemble the locals, and as a “muzungu” (foreigner) could be disruptive to the data collection process. Nevertheless, it was in Zambia that I experienced the closest, and some of my more memorable, interactions with health care providers and family planning clients.

    Dawn Chin Quee ties the legs of a chicken in Zambia

    Dawn Chin Quee ties the legs of a chicken in Zambia.

    My experiences in Zambia were gained through a pilot study conducted in Mumbwa and Luangwa districts. The study in Zambia is described in detail in a recently published Global Health: Science and Practice online article that reports on the safety, feasibility, acceptability, and cost-effectiveness of community health worker (CHW) provision of Depo Provera as well as its impact on family planning uptake. Our study found very high uptake of injectables when the method was added to the contraceptive method mix provided by CHWs: during the study period, the CHWs provided protection against pregnancy for one year (couple-year of protection) to 2,206 Depo Provera clients compared with 51 condom clients and 391 pill clients. Of the 1,739 clients new to family planning, 85% chose Depo, and continuation rates were high. Collaboration with our partner, ChildFund Zambia, as well as with the Ministry of Health and many other stakeholders were as rewarding as they were integral to the success of the pilot and scale up.

  • Provider/CHW Survey

    This survey for both skilled providers and CHW is to be used with all trained in the distribution of misoprostol. This questionnaire assesses health provider’s and CHWs knowledge on BPCR and misoprostol Health providers and CHWs.

  • Flipcards: Birth Preparedness and Complication Readiness (illustrations only, designed for illiterate CHWs), South Sudan

    One flipchart developed for use in South Sudan portrays several different scenes- with corresponding text- related to Birth Preparedness and Complication Readiness. These materials are desgined for illiterate CHWs, so there are only illustrations (no text).

  • Blog post

    As resource-constrained countries struggle with the brain drain of medical workers, overcrowding of hospitals, weak health systems, and the reluctance of trained health personnel to work in rural areas, a New Solutions Initiative of the United Nations Sustainable Development Solutions Network is underway to put in place 1 million community health workers (CHWs) by 2015.

    Health educators in rural Madagascar

    Health educators in rural Madagascar display contraceptives they distribute to people living in villages far from health centers.

    © 2005 Nathalie Raharilaza, Courtesy of Photoshare

    In rural areas of sub-Saharan Africa, CHWs have for many years provided selected rural populations with basic medical care, contraceptive supplies, and information that they otherwise would not be able to access. But these efforts have not been widespread and have often run out of funding after the initial investment. In other countries such as Brazil, Bangladesh, China, and Nepal, CHW efforts have been more successful, according to a recent report, (PDF), “How Effective Are Community Health Workers?” by Henry Perry and Rose Zulliger from the Johns Hopkins Bloomberg School of Public Health.

    Answering their own question, Perry and Zulliger conclude that “CHWs provide the world’s most promising health workforce resource for accelerating progress in achieving the health related MDGs (Millennium Development Goals).”

  • Blog post

    The global shortage of health workers has created cracks in the bridge to health services for Africa’s communities. Many countries and donors are looking toward community health workers (CHWs), who have a vested interest in the health of their communities, to fill the gaps.  Although CHWs have played a role in prevention and care for over 50 years, we have not had a way to evaluate whether the programs are meeting communities’ needs. We also don’t know the level of support CHWs receive to help them provide quality services. 

    A community health worker in Dhaka, Bangladesh, follows up on a child with fever


    A community health worker in Dhaka, Bangladesh, follows up on a child with fever.

    It was this thinking that led Initiatives Inc. and the USAID-funded HCI Project to develop the Community Health Worker Assessment and Improvement Matrix (CHW AIM). Through a literature review and repeated testing, 15 components of a well-functioning program emerged, ranging from recruitment and training to community involvement and country ownership. 

    We designed the process to be used by program managers, CHWs, donors, and stakeholders. Led by a facilitator, the group engages in discussions about where they stand on each programmatic component on a scale from 0 (non-functional) to 3 (highly functional or best practice). In many cases, this is the first time ideas are shared from so many different perspectives. This can lead to awareness and sometimes confrontation, but the process also creates understanding and builds team spirit and commitment to improve. The group builds an action plan for the changes needed based on the assessment. Sue England of World Vision Australia observed, “The tools make it clear to all participants that we are assuming a lot and that’s why many programs fail.”