Community Health Workers

This is the long edit (36 pages) of a thematic discussion on HIFA. The discussion is the first of a series of three, supported by WHO. This first discussion looked especially at the issues raised by the first 5 Recommendations in the WHO Guidleine. For background on the discussion see here.

We had 153 contributions from 40 members in 17 countries (Bangladesh, Egypt, Eritrea, Germany, India, Jordan, Kenya, Liberia, Nigeria, Pakistan, South Africa, Switzerland, Tanzania, Uganda, UK, USA, Zambia).
Special thanks to our top contributors: Joseph Ana, Nigeria (14 messages), Sunanda Kolli Reddy, India (10), and Amelia Plant, USA/Egypt (8). And to HIFA volunteer Sam Pakenham-Walsh for collation and synthesis.

From 16 January to 24 February 2017, HIFA hosted a major thematic discussion on CHWs, sponsored by The Lancet, Reachout Project/Liverpool School of Tropical Medicine, World Vision International and USAID Assist Project, around 6 questions. This narrative summary provides an overview of key points made and acknowledges all 65 HIFA members who took part (from Burundi, Cameroon, Canada, Ethiopia, France, Ghana, India, Iran, Japan, Kenya, Malaysia, Netherlands, New Zealand, Nigeria, Pakistan, Rwanda, Switzerland, Tanzania, Uganda, UK, and USA) :

1. The greatest concern identified was the need for respect and recognition from community leaders and health professionals.
2. Other major concerns were lack of training and supervision; access to healthcare information; remuneration; equipment, medicines, and need for mobile phones/computers.
3. CHWs are asked to carry out a wide range and ever increasing number of tasks, but often without the appropriate facilities to enable this.
4. Career progression among female CHWs is limited by gender and transport issues.

This is the final report of the Kampala Symposium (shared with permission from the conference organisers). 

1st International Symposium on 
Community Health Workers 
21st – 23rd February 2017, Kampala, Uganda 
Theme: Contribution of Community Health Workers in attainment of the Sustainable Development Goals 

Q5.  Are we expecting too much of CHWs? Is there a risk of exploitation and/or burn-out? How can their work loads be better rationalised? Four themes emerged:

1. Excessive workload
2. Data collection and administration
3. Job aids
4. Financial compensation

Q6.  How can we meet the information and learning needs of CHWs working in challenging conditions? Four themes emerged:

1. Mobile phones 
2. Information resources
3. Training and knowledge sharing
4. Career development.

Q3.    Are there enough and appropriate avenues for the voices of CHWs to be heard (by the relevant stakeholders / authorities?)
Q4.    What are the mental health and psychosocial needs of CHWs? How can these needs be better addressed?

These two questions elicited very few responses from any of the stakeholders, whether CHWs, trainers or programme managers. This is perhaps an important area for further enquiry?  

1. Recognition, respect, identity and inclusion
2. Logistics and supplies
3. Finance
4. Transport
5. Occupational health
6. Health systems issues: Referral systems
7. Other comments

The responses to this question came largely from CHWs themselves, thanks to HIFA members Kavita Bhatia, Sunanda Reddy and Carol Namata, who facilitated inputs from WhatsApp groups in local languages. They are presented under six subheadings:

1.  Recognition, respect, identity and inclusion
2.  Logistics and supplies
3.  Finance
4.  Gender, hierarchy and transport
5.  Occupational health and preferential health care
6.  Systemic issues: responsiveness, corruption.

This is the final version of the Kampala Statement (shared with permission from the conference organisers). The final, formatted version is in preparation. 

From 16 January to 24 February 2017, HIFA hosted a major thematic discussion on CHWs, sponsored by The Lancet, Reachout Project/Liverpool School of Tropical Medicine, World Vision International and USAID Assist Project, around 6 questions: 
1.    When listening to CHWs needs and priorities, what do they say is needed to enable them to do their work more effectively? 
2.    How are these needs being addressed? Where are the gaps?
3.    Are there enough and appropriate avenues for the voices of CHWs to be heard (by the relevant stakeholders / authorities?)
4.    What are the mental health and psychosocial needs of CHWs? How can these needs be better addressed?
5.    Are we expecting too much of CHWs? Is there a risk of exploitation and/or burn-out? How can their work loads be better rationalised?
6.    How can we meet the information and learning needs of CHWs working in challenging conditions? 

From 16 January to 24 February 2017, HIFA hosted a 6-week thematic discussion on CHWs, sponsored by The Lancet, Reachout Project/Liverpool School of Tropical Medicine, World Vision International and USAID Assist Project. Here are the messages in full from Week Two.

From 16 January to 24 February 2017, HIFA hosted a 6-week thematic discussion on CHWs, sponsored by The Lancet, Reachout Project/Liverpool School of Tropical Medicine, World Vision International and USAID Assist Project. Here are the messages in full from Week Three.

From 16 January to 24 February 2017, HIFA hosted a 6-week thematic discussion on CHWs, sponsored by The Lancet, Reachout Project/Liverpool School of Tropical Medicine, World Vision International and USAID Assist Project. Here are the messages in full from Week Four.

From 16 January to 24 February 2017, HIFA hosted a 6-week thematic discussion on CHWs, sponsored by The Lancet, Reachout Project/Liverpool School of Tropical Medicine, World Vision International and USAID Assist Project. Here are the messages in full from Week Five.

This is the poster for the 1st International Symposium on Community Health Workers, provided by David Musoke for information. The website for the conference is http://chwsymposium.musph.ac.ug/