Dear Neil and Massimo Serventi,
Sharing a weblink hoping you will find it useful as evidence, even though it may not be high on the heirarchy of evidence. The appendix is particularly about the evidence base.
An excellent project on scale, the 1 million Health workers project, shows the way.
However, my main reservations about saying it can be replicated to optimise CHW programs to meet the goal of UHC are twofold.
1. It had a huge budget (more than the annual health budget of many LMIC) that may pose a problem in sustainability when such an investment is not possible.
2. This Columbia University project was not built into the existing Health Systems in a way that we could say is cost effective.
Stand alone vertical programs in a project mode have good pre-job training, effective evaluation and monitoring mechanisms throughout the duration of the project, and above all, a decent remuneration to ensure there is no attrition in numbers. (The challenges will come to the fore once the external funding ceases).
Having said that, there are a lot of lessons for countries that wish to prioritise CHW programs to strengthen the efforts towards UHC.
Thanks and regards,
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
[*Note from HIFA moderator (Neil PW): The original message had an attachment. Attachments are not carried on HIFA. The document can be frely downloaded here: http://www.millenniumvillages.org/uploads/ReportPaper/1mCHW_TechnicalTas... ]