Community health agents can take many forms and are increasingly used by Ministries of Health to extend the presence of the health system to local settings to reach all households. These agents might be known as “Frontline Workers” and generally include Community Health Workers (CHWs), known by many different names, Community Health Volunteers, Community Social Workers, Traditional Birth Attendants (TBAs), Community Midwives, and other health-related resource persons who live in the community. Community Health Agents may conduct health promotion activities, provide basic health and medical care for their communities, and/or mobilize communities for health. These workers may be government-funded employees or government-supported volunteers assisting with and extending health services from the most peripheral governmental health facility. They may also be volunteers working on a limited basis out of their homes, often under the support of an NGO, making home visits to their neighbors to support health education or provide basic treatment and care for live-threatening illnesses.
Each community may have one or several types of Community Health Agents. In fact, the World Health Organization has recommended that different kinds of Community Health Workers with different levels of trainings and tasks may be needed in order to be flexible and responsive to local needs. Some may be para-professional workers responding to multiple diseases, while others may be disease-specific workers, while others may be community mediators or patient advocates. To be successful, a Community Health Agent must be supported by a “community support group”, such as a village development council or village health committee. By definition, a Community Health Agent is part of the social setting of both the health system and community system, which brings with it strengths and weaknesses. On the one hand, these workers are empowered by belonging to both systems, while on the other hand, they may be torn by where their loyalties and interests lie. They serve not a solitary social group of unified purpose, but rather a population whose commitment to an activity varies according to its members’ expectations of the benefits and social and political context of the activity.
Successful community health work requires a locally-tailored social and behavioral change approach that is often delivered by one or more community health agents. Within the community, the social environment has an indirect but powerful effect on the practice of personal behaviors that promote good health. Among marginalized populations, risk factors such as isolation, poverty, low self-esteem, discrimination, lack of social support, nomadic living, language barriers and dysfunctional power dynamics are common. These risk factors may limit knowledge, bias attitudes, and prevent the practice of lifesaving, preventive home and care-seeking practices.
CORE Group's Community Health Network organizations and individuals work in varied community settings -- training and supporting Community Health Agents and building the capacity of the community to support them. We are committed to sharing best practices, tools, and resources that can help us be more effective in our work.
Video
Most health care happens in the home, throughout the course of every day, six billion times over. It happens when a mother washes her hands before cooking dinner. When a community comes together to rush an endangered delivering mother to the hospital.
Most don't take place in a clinic or a doctor's office, but their cumulative effect on the health of women and children is far greater than even a hospital can achieve.
Resources
New! CHW Evidence Summit Final Report
The report is a comprehensive record of the three phases of the Evidence Summit on CHWs held May 30 – June 1, 2012: preparation, implementation, and post-Summit analysis.
New! Review of CHW Effectiveness for MDGs (full report, condensed version and illustrated version)
Dr. Henry Perry and Johns Hopkins Bloomberg School of Public Health PhD student, Rose Zulliger recently completed a review of the potential contributions of Community Health Workers to achieving the Millennium Goals for Health.
The Joint Statement on Scaling Up the Community-based Health Workforce for Emergencies
The Joint Statement aims to:
- draw attention to the vital role that the community-based health workforce plays in all phases of emergency risk management (prevention, preparedness, response and recovery
- promote the scale-up of the community-based health workforce by recognizing all those who make up this workforce, training and equipping them for action at the local level, and including them in planning for all types of emergencies.
- encourage governments and supporting partners to reinforce the community-based health workforce by strengthening and preparing existing health systems, and providing resources in support of local action to reduce health risks and manage emergencies.
- provide examples of actions that the community-based health workfoce can do before an emergency to reduce underlying vulnerability, increase access to primary health care (PHC) and for prevention and preparedness and then after the onset of an emergency for response and recovery.
Management of Sick Children by Community Health Workers
This report examines the approaches for the community management of sick children, specifically antimicrobial treatment, through the use of community health workers (CHWs) or their equivalent. It is based on an extensive review of the literature, including peer-reviewed studies, reports, programme descriptions and programme evaluations.
How Social Capital in Community Systems Strengthens Health Systems: People, Structures, Processes
Communities play instrumental roles in improving health outcomes within the scope of national health systems. However, the role of the community in health system strengthening, as well as specific components of the community health sub-system itself have not been systematically documented. This paper, written by CORE Group Executive Director Karen LeBan, explores the relationship among the community, the community health sub-system and the national health system, and propose a set of actors, structures and processes critical for promoting positive health outcomes, especially in underserved areas.
Partners in Health Program Management Guide: Sharing Lessons Learned
Based on Partners in Health experiences, this program management guide offers an approach to starting, revamping, or expanding a health program in the field. Its aim is to help program managers solve challenges commonly faced in resource-poor settings. It consists of 14 chapters, starting from learning about the local context and understanding legal issues to setting up programs and human resources and finance systems, to working with and training CHWs, and establishing monitoring, evaluation and operations research systems for data impact followed by maximizing impact for advocacy.
Global Experience of Community Health Workers for Delivery of Health Related Millennium Development Goals
Participation of community health workers (CHWs) in the provision of primary health care has been experienced all over the world for several decades, and there is an amount of evidence showing that they can add significantly to the efforts of improving the health of the population, particularly in those settings with the highest shortage of motivated and capable health professionals.
With the overall aim of identifying CHWs programs with positive impact on Millennium Development Goals (MDGs) related to health or otherwise, a global systematic review was undertaken of such interventions, as well as eight in-depth country case studies in Sub-Saharan Africa (Ethiopia Mozambique and Uganda), South East Asia (Bangladesh, Pakistan and Thailand) and Latin America (Brazil and Haiti). The focus of this review was on key aspects of these programs, encompassing typology of CHWs, selection, training, supervision, standards for evaluation and certification, deployment patterns, in-service training, performance, and impact assessment. This review was authored by the Global Health Workforce Alliance and the World Health Organization.
Websites:
CHW Central- an online resource for information and dialogue about Community Health Workers (CHWs). CHW central supports community health workers and strengthens CHW programs by connecting experts, practioners, and supporters in interactive discussion forums and sharing the lested developments in CHW research, practice, and policy.
The World Health Organization’s recommendations on optimizing the roles of health workers aim to help address critical health workforce shortages that slow down progress towards the health-related Millennium Development Goals (MDGs). A more rational distribution of tasks and responsibilities among cadres of health workers can significantly improve both access and cost-effectiveness – for example by training and enabling ‘mid-level’ and ‘lay’ health workers to perform specific interventions otherwise provided only by cadres with longer (and sometimes more specialized) training. This website presents the OptimizeMNH recommendations in an interactive format.
