Community Health Worker

Community health worker

The community health worker programme mushroomed in the 1980s in the reverberation of the Alma Ata declaration as the formation of a necessary link to promote health awareness and deliver select health services at the community level. The village or community health worker is often referred to as the focal strength of the PHC system and is regarded of major significance in meeting the goals set for primary care within the community. The inspiration for CHWs can be traced to China's barefoot doctors who appeared in substantial numbers during the Cultural Revolution beginning in 1965 (Sidel and Sidell, 1982). China provided an example of how health care could be expanded to reach the rural poor by using local people for

The roles and tasks that a CHW performs would be responsive to the specific health needs of the community which in most cases is established either at the PHC level or within the community. CHWs carry out one or more functions related to health care delivery and are trained in a way that is coherent with the health services they are meant to deliver and monitor. CHWs may receive training, which is recognized by the health services and national certification authority, but this training does not form part of a tertiary education certificate. For the purposes of this review we follow the definition used by Lewin et al. in their Cochrane review (Lewin et al., 2005): “a health worker assists in carrying out health care delivery; is trained in some way in the context of the intervention; and holds no formal professional or paraprofessional certificated or degreed tertiary education”. Perhaps the most prevalent role of the CHW is to act as a bridge between the community and the formal health services mandated at the PHC in all aspects of health development. The bridging activities of CHWs may provide opportunities to increase both the effectiveness of curative and preventive services and, perhaps more importantly, community engagement and ownership of health-related

Ofosu-Amaah, in her extensive 1983 review of CHW programmes based in 46 countries, wrote: the CHW is expected to perform a wide range of functions, which as per the country reports generally include: home visits, environmental sanitation, provision of water supply, first aid and treatment of simple and common ailments, health education, nutrition and surveillance, maternal and child health and family planning activities, communicable disease control, community development activities, referrals, record-keeping, and collection of data on vital events (Ofosu-Amaah, 1983). This finding highlights a key tension in the conceptualization of CHWs in the post-Alma Ata period. While developmental and educational activities are considered important, curative services are demanded by communities that do not have access to these services. There is substantial evidence in several countries that CHW programmes floundered due to disappointment among the community about the range of health services the CHWs could provide. One such example is documented in Burkina