Dear Dr Massimo, [*see note below]
I agree and appreciate what you are saying about CHWs. It is true that they (of course) work best when they are associated with a well-funded project and once the project ends the CHWs usually are not able to carry on. In my view there are a few key elements of CHW support that we need to advocate for in order for us to continue to exploit this available resource that greatly enhances primary health care as well as disease-specific programs such as HIV programs.
1. We need a government framework to work from. A number of African governments (e.g. Uganda, Kenya, Lesotho) have produced some form of community health strategy under which they spell: a) who can be a CHW; b) how they should be trained; c) how they should be remunerated; and d) which department of the MOH should coordinate CHW activities.
2. With this framework, all of us who work on various donor-funded projects, in each country, province or region, should endeavor to harmonize how we recruit and train and remunerate our CHWs.
3. CHWs should be supervised by someone. In my view they should be supervised by the nurse in-charge of the health facility that they collaborate with. This should be a two-way process involving recognition of CHWs as members of the health care team and supervising them. This should involve exchange of information. For example, if a health facility is using CHWs to trace mother-baby pairs lost to follow up in a HIV prevention of mother to child transmission (PMTCT) project, the CHWs should be provided with the names and contact information of the mothers lost to follow-up. Similarly, the CHWs should report to the nurse in charge with feedback on the follow-up visits they conducted.
4. CHWs should be facilitated to do their work. While we expect CHWs to volunteer their time we should not expect them to pay for transport to go to conduct home-visits and tracing of lost to follow-up clients. We also should pay them money for airtime that they use to contact these clients.
5. CHW work requires continued monitoring and evaluation. We need to report numbers to the relevant MOH department responsible for coordination of CHWs in the country we work in. How many CHWs have we trained? How many are active in our project? How frequently do they report to the sister in charge and how many clients does each contact? Evaluation indicators would include the proportion of clients allocated to CHWs to trace who eventually return to care.
Just a few thoughts.
Dr Samuel Kalibala
HIFA profile: Samuel Kalibala, MD, works on the USAID-funded SOAR project as the senior research utilization advisor. He is based in Washington, D.C. as a seconded staff from Palladium, a partner organization on the SOAR project. Kalibala has nearly three decades of experience conducting and facilitating use of HIV and AIDS research in Africa, the Caribbean and Southeast Asia. He has held various public health leadership positions in Uganda, his native country, at the World Health Organization and UNAIDS in Geneva, and at the Population Council and the International AIDS Vaccine Initiative in Nairobi.
[*Note from HIFA moderator (Neil PW): Samuel refers to Massimo Serventi's message on 22 April 2018: http://www.hifa.org/dgroups-rss/community-health-workers ]