Dear HIFA colleagues,
I fully endorse Joseph Ana's opinion.
Many of the CHWs are affiliated to specific projects addressing some area of HealthCare as much as being a part of the community.
Except when drawing a salary/stipend from a National program of Health (e.g.National Health Mission, Ministry of Health and Family Welfare in India), they frequently move on to a new project which offers better remuneration and benefits. As such, they have a general awareness of the local health systems without a high level of expertise required for the overall programme.
I see them as the front-line workers in community settings and as dedicated workers for Community health. Even if we were to take the case of Mental Health, the CHWs are trained to support the Specialist or the expert who is guiding the program or the professional in- charge, and serve as a bridge between the doctor/nurse at the health centre and the patient. The value of CHWs lies less in the expertise and more in the close contact established with the families for promoting health seeking behaviours improving service coverage.
The current thread of conversation on CHIFA about immunisation coverage also reminds one of the remarkable role played by the CHWs in the success of the Pulse Polio program in India - designed by experts (doctors, bureaucrats) and conducted with a camp approach for implementation at primary care and community level.
Yes, the contribution of CHWs is vital to the Health systems of all developing countries with a paucity of experts ...and where there is no doctor with dedication to work in underserved areas.
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