CHWs (111) Family physicians

1 July, 2019

Thanks Neil for the active consultation on CHWs.

I do wonder where is the equivalent discussion, given the very welcome new attention to primary care and the value of CHWs, to family physicians and diagnosticians?

For example I did a quick word search on Perry's papers and the word "diagnosis" appears just 3 times in all the papers. But when communities are dealing with NCDs as well as infection, diagnosis is really important, and needs trained professionals. Then treatment can follow protocols. This rapid response from Donald Li is relevant. [*see note below]

What are colleagues expecting in terms of responsibilities for diagnosis in LMICs, particularly given likelihood and complexity of multiple morbidity? Secondly, what about responsibility for communicating the diagnosis, which is a major challenge, particularly for NCDs regarding longterm care, behaviour change and maybe treatment.



HIFA profile: Sian Williams is Executive Officer at the International Primary Care Respiratory Group in the UK. Professional interests: Implementation science, NCDs, primary care, respiratory health, education, evaluation, value, breaking down silos. AT

[*Note from HIFA moderator (Neil PW): For the benefit of those who may not have immediate web access, here are the opening paragraphs:

Re: Primary healthcare is cornerstone of universal health coverage

'With reference to the editorial “Primary health care is cornerstone of Universal Health Coverage” published in the BMJ of 3rd June 2019 []...

We completely support the position that primary health care (PHC) is THE cornerstone of universal health coverage (UHC). PHC is the most effective and inclusive means to deliver health services and certainly does need wise investment. Current PHC systems are indeed inflexible and without resources to address social determinants of health. There is a need to re-invent primary care such that communities are at the centre of healthcare. We are convinced that community health workers (CHWs) are an essential part of the PHC team.

However, the statement on Rwanda that ‘stand-alone’ community health workers (CHWs) acting as “the functional link between communities and health care facilities, SUCH AS HOSPITALS” is expected to provide sustainable UHC disturbs us. The editorial does not mention that good quality primary care for patients before they reach hospitals is more cost-effective and that PHC is essentially a team approach...']