I think there is ambivalence in the guidelines.
On the one hand it talks of the importance of ‘integration’ within the health system
On the other hand it talks of ‘supportive supervision’- without in any way defining who these supervisors are from or repport to.
CHWs remain in a silo in too many health systems
My observation is that to be effective they MUST be an integrated part of the district health team.
Keeping children with diarrhoea OUT of hospital ought to be as important to the District Medical Officer as treating them in hospital.
Providing essential antenatal care in the community and identifying possible complications ahead of time is far better than receiving emergency presentations at the hospital at 3am in the morning
Helping old people manage their diabetes in the community is far better than having to cope with someone presenting with a gangrenous foot and associated complications in hospital.
In short, public health imperatives should be as important to the district physicians and nurses as treating the patients who present.
If CHWs are recognised as ‘real’ health professionals, integrated into the district health team (and remunerated) - then progress can and will be mmade.
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HIFA profile: Bryan Pearson was editor/publisher of Africa Health journal for 40 years before passing ownership across to ACHEST in Kampala. He now works as a freelance consultant on health and associated issues; as well as tending a mango and pineapple farm in Ghana’s Volta Region.