[*Note from HIFA moderator (Neil PW): The message from Massimo below was originally sent off-list and is forwarded with his permission]
You are right [see below] about the need for existing cadres to be remunerated well and taken care of. I am all for it.
It is also true that communities do not pay the salaries to CHW. Often they are paid under projects of non-governmental sector when not part of the Government system.
However, there have been suggestions for village heads to sustain the salaries from the funds allocated to them. We are also advocating for CHWs to form Self helps groups as in Bangla Desh but it may not be easy to sustain in India. ASHAs are there for specific work and many of us have voiced our opinions at various fora that they need to be paid well. It goes without saying that existing cadres at PHCs need to be paid even better. I endorse your view that Health care personnel should all do what they are expected to do, and we should be looking at task sharing and not task shifting.
Let us face it, task shifting is needed only because Health facilities are poorly staffed in the first place. If we need CBR workers in disability related Health Initiatives, it is because of a shortage of rehabilitation professionals; poor urban slum communities cannot afford the costs of transdisciplinary care (early intervention) the children require.
If slim budgets prevent good remuneration for front line workers, will Governments even have the finances to create health infrastructure everywhere to meet the doctor/ nurse- patient ratio better? I believe that it is not an "EITHER- OR" situation. We need both to achieve UHC. Increasing allocation for health in National budgets is a priority and WHO recommendations, I hope, will serve to strengthen political will.
Thanks and best wishes,
HIFA profile: Sunanda Kolli Reddy is a Developmental Paediatrician from New Delhi,India, with a special interest in Early Child Care and Development of children with neurodevelopmental problems in underserved communities. She is actively involved in health promotion, community-based research, care provider training for promoting abilities of children with special needs, through the various programmes of Centre for Applied Research and Education on Neurodevelopmental Impairments and Disability-related Health Initiatives (CARENIDHI), which she heads (www.carenidhi.org). Her work in the community settings to widen the disability-in-development model of CBR encompasses the wider determinants of health and human capabilities and issues which impact the lives of the poor. She combines her experience in developmental paediatrics with the core work of CARENIDHI's grassroots convergence programmes in partnership with groups working in the area of Implementation research and policy. She is a member of the HIFA working group on Community Health Workers.
write2sunanda AT gmail.com
Dear Sunanda [re: CHWs (137)], you should add to your points the following
CHWs are nowhere recognized/remunerated by their communities (as it should be - my note).
Formal health workers are already trained, are respected by their communities and above all CAN DO AND SHOULD DO THE SAME WORK EXPECTED FROM CHWs(in capital letters!).
Dear friends in the world, when budgets are slim one should concentrate on what is already in place, support-refresh personnel that already is employed and NOT create new cadres that wont be able to sustain on the long run. This is the case of CHWs.
Greetings from Dodoma
[HIFA profile: Massimo Serventi is a long-standing Pediatrician working in Africa since 1982. He currently works on a volunteer basis in an excellent missionary/credited hospital in north Uganda, St. Mary's Hospital-Lacor-GULU. He has worked for several NGOs in 6 African/2 Asian countries. His interests include clinical and community pediatrics, adherence to clinical guidelines and school education as the major determinant of good health. massimoser20 AT gmail.com]