CHAPTER TWO
LITERATURE REVIEW
The Context of Community Health
Workers
The global policy of providing primary level care was
initiated with the declaration of Alma-Ata in 1978s. The countries signatory to
Alma Ata declaration considered the establishment of CHW program as synonym
with Primary Health Care approach (Mburu, 1994; Sringernyuang Hongvivatana,
& Pradabmuk, 1995). Thus in many developing countries PHC approach was seen
as a mass production activity for training CHWs in 1980s (Matomora, 1989).
During these processes the voluntary health workers or CHWs were identified as
the third workforce of «Human resource for Health» (Sein, 2006).
Following this approach CHWs introduced to provide PHC in 1980s are still
providing care in the remote and inaccessible parts of the world (WHO, 2006a).
The CHWs have evolved with community based healthcare
programme and have been strengthened by the PHC approach. However, the
conception and practice of CHWs have varied enormously across countries,
conditioned by their aspirations and economic capacity. This review identified
seven critical factors that influence the overall performance of CHWs which are
discussed in this section. In discussing these issues, our aim is to (a)
highlight certain empirical knowledge and (b) point out, if any, gaps in the
design, implementation and performance of CHWs(Prasad BM, Muraleedharan
VR2007).The above review highlights several aspects to be kept in mind in
designing and implementing effective CHW schemes. The review emphatically shows
that (a) the selection of CHWs from the communities that they serve and (b)
population-coverage and the range of services offered at the community levels
are vital in the design of effective CHW schemes. It should be noted that
smaller the population coverage, the more integrated and intensive the service
offered by the CHWs(Prasad BM, Muraleedharan VR2007).
Despite advances in reaching remote communities, there are
many opportunities for improvement and expansion of CHW programs, especially
related to the development of new tools and evidence-based policy to
«guide global health policy and implementation.» This is where the
One Million Community Health Workers (1mCHW) Campaign comes into play. By
coordinating existing CHW programs with African governments, and making it
clear where the core interests of local and global organizations fit into
national frameworks, 1mCHW is developing the tools necessary to guide CHW
policies. Moreover, 1mCHW is developing an «Operations Room,» an
online dashboard to provide comprehensive information about CHW activities on
the ground. The «Operations Room» will chart progress in different
countries and contain the compiled evidence demanded by the article's authors
to deepen our understanding of CHW programs and of the most effective means of
implementation.We know the plan works: a comprehensive review of CHW literature
conclusively conveys the effectiveness of CHW programs, especially given the
recent access to mobile technologies. 1mCHW will help turn this promising
literature into life-saving results on the ground(One million community health
workers campaign2013).
In the study conducted by USAID (2010) on Community Health
Worker Programs: A Review of Recent Literature, the research concluded that key
components were identified as central to the design and implementation of
functional and sustainable CHW programs: defined job description with specific
tasks or responsibilities for volunteers, recognition and involvement by local
and national government, Community involvement (especially in recruitment and
selection, by making use of existing social structures, consider cultural
appropriateness, address needs of community, etc.), resource availability
(funding, equipment, supplies, job aids, etc.).
Monitoring and evaluation of programs , linkages with formal
health care system training (including refresher trainings), supervision and
feedback, incentives or motivational component and advancement opportunities
which are all similar to this research.
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