How to Support Community Health Workers? Reflections on a year of global learning

This month, mPowering will be responding to the World Health Organization’s call for public input into the development of guidelines on community health worker (CHW) programs. In preparing our response, we’ve been reflecting on our last 12 months of global learning activities on the roles, needs, and potential of community health workers.

Over the last year, we have heard from governments, health workers, trainers, donors, private sector, and more. Three international events coordinated by mPowering have provided opportunities for dialogue between major actors in the health sectors in both West and East Africa. Even with the diversity of CHW roles and programs around the world, key messages have emerged.

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Image: A CHW in Mozambique greets a patient at her home.

Well-supported CHWs make an impact.

The Ebola crisis highlighted communities’ critical need for health care from a trusted, accessible source. CHWs can fill this need, but they in turn need support – like training, supervision, and supplies.  When these supportive elements are weak or missing, CHWs are less able to give the care their communities need.

Writes Shelby Wilson, Program Officer at the Bill and Melinda Gates Foundation, “Ebola highlighted the need to understand what makes a community health worker program successful, and how the design of those programs should be influenced by the structure and financing of primary health care in those countries. Not having a clear answer to these questions undermines the work of countries, partners and donors, and, as a result, limits our collective capacity to have a real impact.”

At our  Unlocking the potential of the community health workforce conference at Wilton Park, governments, training implementers, and donors came together to move towards true collective impact for CHWs. Delegates presented successful CHW models including effective training; supporting health workers through structured supervision and mentorship; and recognizing and rewarding CHWs. The challenges, participants acknowledged, lie not only in implementing each of these models, but in tying these lessons together into a comprehensive approach.

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Image: Health workers in Ghana play an educational game.

 

Technology presents new opportunities to support health workers.

Technology can and should be an integral part of this comprehensive approach. Information and communication technologies (ICTs) can help community health workers learn and use information, collect and share data, and communicate with their supervisors and each other. Three major factors make this possible: a well-functioning health system, a strong ICT system, and a diverse set of genuinely engaged partnerships.

At our (Re)Building Health Systems after Ebola event at Wilton Park, delegates discussed  the importance of CHWs in rebuilding health systems in West Africa, and the role of ICT and mobile to support them in their  work. Key points included the high degree of coordination required, not only between Ministries of Health and ICT, but also between donors and implementing partners, to develop and sustain strong health systems.

In April, mPowering convened senior level representatives from the Ministries of Health and ICT in Malawi and Senegal together with donor agencies, private-sector partners, and implementing partners. The Collaboration for Scaling Digital Health event discussed how to create stronger cross-sector collaboration between health and ICT authorities to improve health service delivery and health outcomes.

Over two days, participants addressed the systems and infrastructure required to support a comprehensive digital strategy, including investment in frontline health workers to use digital health tools and make decisions using health data.  There was strong agreement that country investment strategies require greater coordination between government ministries, as well as between funders, to avoid duplication and ensure smart investments.

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Image: A CHW in Kenya at a weekly mothers’ meeting.

Work Remains to Build the Systems that CHWs need.

CHWs work in the face of enormous challenges. Technology shows great promise to help address well-documented and long-standing problems around training, supervision and other support. Many governments are making progress, and increasingly integrating the use of mobile as part of health systems strengthening at the community level. But as participants have told us, across many conversations and events, much more needs to be done.

One of the major recommendations from our expert interviews on CHWs was to “Invest in health systems so that…care given by CHWs is amplified by a skilled, trained workforce.” Experts noted that the sustainable funding of these systems remains a challenge in the context of growing health worker shortages and evolving public health needs. They urged a need to explore new and non-traditional ways of funding health systems and workforces.

As Katie Taylor, former Deputy Assistant Administrator, Global Health, at USAID wrote, “[There is a] need for national governments and development partners to substantially increase investment in Community Health Workers as part of integrated health care systems. We need financing solutions to be shared, adopted and adapted, as well as spur thinking on new ones.”

Join the Conversation.

WHO’s guidelines aim to advise governments and their partners as they design and support CHW programs that advance progress towards universal health coverage. Your experience and perspective can help frame their guidance.  WHO’s online hearing is open through August 31, 2016. To learn more or to submit your response, click here.

All photographs used in this post credited to Kate Holt/ MCSP.