Stepping into the Spotlight: Reflections on Community Health Workers

Crystal NgThe focus of community health worker (CHW) discourse seems to have changed, and in my opinion, for the better. Whereas it previously seemed to me that global health conferences and literature focused primarily on training and task-shifting for CHWs, a recent meeting sponsored by the CORE Group—the implementing organization for the USAID Child Survival and Health Network Program—demonstrated that the field is now taking a more comprehensive view, including CHWs as a natural and key part of child survival and maternal and child health discussions.

Applying human resources management to community health workers

Throughout the sessions, the need to consider strategies for managing the development and performance of CHWs as part of a community health system came up repeatedly. For example, two breakout sessions were devoted exclusively to CHWs, covering topics including retention, compensation, and effectiveness, as well as their role in community health systems. The Health Care Improvement Project shared the Community Health Worker Assessment and Improvement Matrix, a new tool that facilitates assessing and improving CHW programs through systematically considering such areas as training, supervision, incentives, community involvement, and ownership.

Community health workers
’ role in integrated services
Organizations are taking the time to understand the effects of interventions on health workers. In a session on integration of community-based management of acute malnutrition (CMAM), presenters noted comprehensive approaches that included supportive supervision and performance-based incentives. Save the Children presented a study on Bangladesh in which integrating CMAM into CHWs’ training and scope of work added only two to four children per year to each CHW’s workload. Meanwhile, CHWs reported satisfaction at being able to address a need that they had previously been ill-equipped to handle.

In the public eye
CHWs are also catching the attention of the public. In a plenary session, the Innovations for MNCH Project described its model of holding competitions encouraging the public to submit ideas to address a health challenge. Strikingly, all of the winning ideas in Sierra Leone, one of three countries in which the project has held competitions to date, related to support for health workers. These include establishing counseling/psychosocial and peer learning groups for health workers and developing community scorecards that link CHW performance to rewards. Save the Children has also embarked on a campaign to engage the public to support health workers, highlighting their role in promoting the health of children and families.

Supporting the first line of contact
Often after attending a conference, I place the agenda in a stack of reference papers and shove the glut of free pens, notepads, and keychains into a drawer for theoretical future use. Happily, I walked away from the meeting laden not with stress balls, but with useful tools and resources.

The examples above demonstrate promising trends. The field is recognizing that CHWs are not merely a means to an end, but a vital system component that requires our attention. CHWs are the major and sometimes the only contact with the health system, formal or informal, that families have. With CapacityPlus’s work in Mozambique to strengthen the coordination and management of the national CHW program, we look forward to continuing to the conversations begun at the CORE Group’s spring meeting.

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Photo courtesy of Crystal Ng