Abstract
Community health workers (CHWs) have long played an important role in the management of complex health problems, especially in resource-poor settings. Although there is a large literature regarding the use of CHWs around the world, there is little detail about how these workers are selected, trained and utilized in the field. Lesotho has one of the highest rates of HIV in the world, with an estimated 25% of the general population infected with the disease; at the same time, there is a significant health human resources shortage in Lesotho with an estimated 60% of health posts left vacant. Community health workers have the potential to play a major role in HIV treatment scale-up in the country, and in 2006, a CWH-based project called "The Rural Initiative" was started in the remote mountain regions of the country. More than 1000 CHWs were trained and employed through this program between June 2006 and December 2008. This paper will review the CHW program in detail, with a focus on recruitment, training, ongoing supervision and support, and the larger public health implications of the CHW program in Lesotho. It is hoped this program can serve as a practical model for other programs working with or in need of CHWs.
Highlights
Community health workers (CHWs) are a group of health para-professional that have been used to treat myriad disease problems for decades [1]
CHWs were crucial scaling up HIV treatment in rural Lesotho, much as they have been in other programs throughout the world
This paper discusses the practical implementation of CHW program at Nohana clinic in rural Lesotho, a resource-poor, high burden HIV setting
Summary
Community health workers (CHWs) are a group of health para-professional that have been used to treat myriad disease problems for decades [1]. Programs use varying definitions of CHWs, they are generally defined as individuals with little formal training in health but with great expertise in knowledge of the population and regions in which they work [4] When provided with program-specific training and support, these individuals play a key role in supporting and implementing health programs in the field [5]. Their activities can include disease screening, disease prevention health education, adherence support, and community mobilization [6,7,8]. Women and HIV (including prevention of maternal to child transmission and family planning)
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