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It’s been over two years since we’ve gathered in person and we can’t wait to convene in Bethesda, MD from October 3rd -5th for the Global Health Practitioner Conference 2022!
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I was interested to see this new publication from the CORE Group, which ‘improves and expands community health practices for underserved populations, especially women and children, through collaborative action and learning’, with support from USAID. Below are some extracts of particular relevance to HIFA, for further discussion:
Strengthening Community Health Systems through CHWs and mHealth
‘Community health workers (CHWs) have been called the “world’s most promising health workforce resource” in terms of enabling health systems in resource-constrained settings.’
‘What seems like a straightforward health promotion and service delivery strategy, of recruiting, training and supporting local people to supplement health professionals at the community level, is in fact quite complex.’
‘Increasingly, there is a trend towards using mobile technology to train and support CHWs.’
‘Amref Health Africa looked at whether they could reduce face-to-face training time and still retain the quality of the CHW’s training using mLearning in Kenya. Before getting started, Amref tackled key questions such as, what type of phone to use, basic or smart; whether to develop a platform independently or build
partnerships; what curriculum to use; and what the guiding principles of their mLearning initiative should be. At the start of the initiative, 97% of CHWs in Kenya had mobile phones, with about 70% of CHWs having a basic phone. Thus, Amref decided to leverage current technology (basic phones) in the hands of CHWs for scalability and sustainability reasons. Additionally, Amref established partnerships with Accenture, Safaricom/Vodafone, Mezzanine, and the Kenyan Ministry of Health (MOH). With Amref taking the lead, they developed the Health Enablement and Learning Platform (HELP).’
Governments are increasingly reliant on community health workers to undertake health promotion and provide essential curative care. In 2003, the Government of Ethiopia launched the Health Extension Programme and introduced a new cadre, health extension workers (HEWs), to improve access to care in rural communities. In 2013, to inform the government’s plans for HEWs to take on an enhanced role in community-based newborn care, a time and motion study was conducted to understand the range of HEW responsibilities and how they allocate their time across health and non-health activities.
The study was administered in 69 rural kebeles in the Southern Nations Nationalities and People’s Region and Oromia Region that were intervention areas of a trial to evaluate a package of community-based interventions for newborns. Over 4 consecutive weeks, HEWs completed a diary and recorded all activities undertaken during each working day. HEWs were also surveyed to collect data on seasonal activities and details of the health post and kebele in which they work. The average proportion of productive time (excluding breaks) that HEWs spent on an activity, at a location, or with a recipient each week, was calculated.
The self-reported diary was completed by 131 HEWs. Over the course of a week, HEWs divided their time between the health post (51%) and the community (37%), with the remaining 11% of their time spent elsewhere. Curative health activities represented 16% of HEWs’ time each week and 43% of their time was spent on health promotion and prevention. The remaining time included travel, training and supervision, administration, and community meetings. HEWs spent the majority (70%) of their time with individuals, families, and community members.
HEWs have wide-ranging responsibilities for community-based health promotion and curative care. Their workload is diverse and they spend time on activities relating to family health, disease prevention and control, hygiene and sanitation, as well as other community-based activities. Reproductive, maternal, newborn, and child health activities represent a major component of the HEW’s work and, as such, they can have a critically important role in improving the health outcomes of mothers and children in Ethiopia.
Councillor Meisie Maluleke had a Ward 11 Community Meeting. She discussed housing, bylaws (including dumping) and crime (including the set up of street committees under the Community Policing Forum and discussions on drug addiction especially Nyaope from Efavirenz, a key antiretroviral). There were loud claps as the Councillor asked Dr Moosa to provide a report on progress at the Chiawelo Community Practice. Dr Moosa spoke of the increase of Community Health Workers from 9 t0 18 due to revision of the number of families from 2200 in March 2014 to 5500 in June 2014. He urged families to use the practice for all their health needs. He informed of the monthly meeting with the ward committee and the planned community workshop on health priorities. He said that all the items on the agenda affected health. The community was very grateful and had warm words repeatedly. An NGO from the more affluent part part of Ward 11 (Klipspruit West) provided a lunch, wheelchairs and presents to the old and disabled.
In this short video, supervisors of community health workers (CHWs) discuss the value that CHWs bring to their organizations for health promotion. This video was made possible by the support of the Cambia Health Foundation and the Oregon Community Health Workers Education & Research Consortium. For more information, please visit the Oregon Community Health Workers Association (ORCHWA)’s website: http://www.orchwa.org
AfroPHC 