Abstract
BackgroundIn 2010, the Ministry of Health in Zambia developed the National Community Health Assistant strategy, aiming to integrate community health workers (CHWs) into national health plans by creating a new group of workers, called community health assistants (CHAs). The aim of the paper is to analyse the CHA policy development process and the factors that influenced its evolution and content. A policy analysis approach was used to analyse the policy reform process.MethodologyData were gathered through review of documents, participant observation and key informant interviews with CHA strategic team members in Lusaka district, and senior officials at the district level in Kapiri Mposhi district where some CHAs have been deployed.ResultsThe strategy was developed in order to address the human resources for health shortage and the challenges facing the community-based health workforce in Zambia. However, some actors within the strategic team were more influential than others in informing the policy agenda, determining the process, and shaping the content. These actors negotiated with professional/statutory bodies and health unions on the need to develop the new cadre which resulted in compromises that enabled the policy process to move forward. International agencies also indirectly influenced the course as well as the content of the strategy. Some actors classified the process as both insufficiently consultative and rushed. Due to limited consultation, it was suggested that the policy content did not adequately address key policy content issues such as management of staff attrition, general professional development, and progression matters. Analysis of the process also showed that the strategy might create a new group of workers whose mandate is unclear to the existing group of health workers.ConclusionsThis paper highlights the complex nature of policy-making processes for integrating CHWs into the health system. It reiterates the need for recognising the fact that actors’ power or position in the political hierarchy may, more than their knowledge and understanding of the issue, play a disproportionate role in shaping the process as well as content of health policy reform.
Highlights
In 2010, the Ministry of Health in Zambia developed the National Community Health Assistant strategy, aiming to integrate community health workers (CHWs) into national health plans by creating a new group of workers, called community health assistants (CHAs)
The policy analysis of the process of developing the Community Health Assistant strategy produced several issues which have been grouped into two broad categories: setting the policy agenda and the policy formulation process
The Directorate of Human Resources and Administration at the Ministry of Health (MoH) headquarters played a key role in placing the issue on the policy agenda
Summary
In 2010, the Ministry of Health in Zambia developed the National Community Health Assistant strategy, aiming to integrate community health workers (CHWs) into national health plans by creating a new group of workers, called community health assistants (CHAs). The World Health Organization (WHO) has estimated that 57 countries face critical health worker shortages, of which 36 (63%) are in sub-Saharan Africa [3]. This crisis has been exacerbated by the stress which the demand for HIV-care places on already overstretched health systems [4,5,6]. The CCF approach requires establishing and supporting the necessary governance structures for inter-sectoral coordination and collaboration in order to plan, implement and monitor health workforce development and retention at the country level. It helps priority countries to ensure that sustainable, motivated and skilled health workers are available to meet healthcare needs and work with partners so as to ensure that funding and technical expertise are available for programmes [2]
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