Abstract
BackgroundThis is the ninth paper in our series, “Community Health Workers at the Dawn of a New Era”. Community health workers (CHWs) are in an intermediary position between the health system and the community. While this position provides CHWs with a good platform to improve community health, a major challenge in large-scale CHW programmes is the need for CHWs to establish and maintain beneficial relationships with both sets of actors, who may have different expectations and needs. This paper focuses on the quality of CHW relationships with actors at the local level of the national health system and with communities.MethodsThe authors conducted a selective review of journal articles and the grey literature, including case study findings in the 2020 book Health for the People: National CHW Programs from Afghanistan to Zimbabwe. They also drew upon their experience working with CHW programmes.ResultsThe space where CHWs form relationships with the health system and the community has various inherent strengths and tensions that can enable or constrain the quality of these relationships. Important elements are role clarity for all actors, working referral systems, and functioning supply chains. CHWs need good interpersonal communication skills, good community engagement skills, and the opportunity to participate in community-based organizations. Communities need to have a realistic understanding of the CHW programme, to be involved in a transparent process for selecting CHWs, and to have the opportunity to participate in the CHW programme. Support and interaction between CHWs and other health workers are essential, as is positive engagement with community members, groups, and leaders.ConclusionTo be successful, large-scale CHW programmes need well-designed, effective support from the health system, productive interactions between CHWs and health system staff, and support and engagement of the community. This requires health sector leadership from national to local levels, support from local government, and partnerships with community organizations. Large-scale CHW programmes should be designed to enable local flexibility in adjusting to the local community context.
Highlights
This is the ninth paper in our series, “Community Health Workers at the Dawn of a New Era”
Our findings are organized in three categories that can help health actors understand the unique bridging role community health worker (CHW) play in advancing community health
We present a description of the “interface landscape” at the boundary between the distinct health system and community social spheres that is the operational context of the unique CHW bridging role
Summary
This is the ninth paper in our series, “Community Health Workers at the Dawn of a New Era”. WHO continues: This...does not imply any degree of integration, nor that anyone is in overall charge of the activities that compose it In this sense, every country has a health system, fragmented it may be among different organizations or unsystematically it may seem to operate. Various examples have been documented of how multiple, nonintegrated (and often vertical) CHW programmes, established with the best intentions, contributed to fragmented health systems that underperform [3]. This has led to the recognition that there is a need for government policy alignment across all CHW programmes, supported by a national community health strategy, with harmonization at the community level [4]
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