Community health workers: a paramount force on the path to universal health coverage
By Sarita Panday (Communications Coordinator) and David Musoke (Co-Chair) of the HSG Thematic Working Group on Supporting and Strengthening the Role of Community Health Workers in Health Systems Development.
Human resources for health continue to be a great challenge in both developed and developing countries. This is especially true in low-income countries. Evidence suggests that community health workers (CHWs) play a crucial role in the provision of primary health care services in resource poor areas. This blog is dedicated to show the paramount role CHWs play in the provision of universal health care through examples of their work in maternal and child health care in Nepal and Uganda.
Nepal’s Female Community Health Volunteers
The roles of CHWs are crucial in remote villages where skilled health workers and primary healthcare centres are not readily available or accessible. In a recent paper, Panday et al. (2017) studied the roles of CHWs, known as Female Community Health Volunteers (FCHVs), in maternity care in Nepal. When trained volunteers provide services to community members they exceed expectations. Not only do CHWs share health information and refer women for health checks, they also distribute paracetamol, antacid and some vitamin tablets. Such services are important in the absence of immediate access to skilled health care professionals.
Another main role of CHWs is to provide temporary means of family planning, such as pills and condoms. In some places, they reported that they counsel women on the availability of safe abortion services and provide emergency contraception. Such services are important especially given that abortion is a socially tabooed issue despite being one of the major causes of deaths among women of reproductive age. In situations, when women are often hesitant to talk about such an issue in public, having a female CHW from the same village is far more helpful for the services users, as she understands the issue and provides confidential services.
Similarly, the volunteers provide some key services to children under the age of five. They treat children who suffer from diarrhoea and simple respiratory illnesses. Every six months and yearly, they distribute vitamin A and deworming tablets to prevent children from night blindness and worm infestation which are common problems in Nepal. Whilst CHWs have been successful in delivering key maternal and child health services even in the remote corners of Nepal, their work is not without challenges.
A key challenge is to maintain a strong link between the volunteers and the health centres so that the volunteers are well trained and supported at all times. As in the other developing countries, issues of irregularities of training and access to medical supplies are noted, which not only hinder volunteers’ services but also reduce their work morale. Another equally important challenge is payment to the volunteer CHWs. Although volunteers are praised for their voluntary services, they strongly want compensation in order to function effectively. We need to understand that these women are often amongst the poorest, do not have other paid jobs, and have other competing household work to fulfil.
Uganda’s Village Health Teams
In Uganda, CHWs – locally referred to as Village Health Teams (VHTs) – were introduced by the Ministry of Health in 2001. They are the first point of contact for health in the community. The CHW strategy was introduced to enhance the capacity to mobilise individuals and households for better health. CHWs in Uganda comprise of community volunteers selected by local leaders, and trained by health professionals, to provide accurate health information and appropriate linkages to health services. Specifically, CHWs in Uganda carry out health education, mobilise the community for public health interventions such as immunisation, and conduct household visits to promote sanitation and hygiene. They also treat children under the age of five under the integrated community case management of childhood illnesses (iCCM), and refer patients to health facilities. The diseases that the CHWs treat are malaria, diarrhoea and pneumonia. Some of the challenges faced by CHWs in Uganda include irregular training, limited support supervision, and low motivation which all affect their performance.
From these examples in Nepal and Uganda, we could learn that volunteer CHWs provide key primary health care services to their population, including the most marginalised and the vulnerable populations across the globe. If we want them to work towards achieving universal health coverage, then we need to listen to them and address the issues faced by these volunteers.
