Based on an interview with Dr. Prabhjot Singh, Professor at Columbia University and Chair of the 1 Million Community Health Worker Technical Taskforce.
By Kris Reinhardt
Community Health Worker (CHW) integration into the wider health system has been happening in low-resource settings globally since the 1970s. However, the progress has been inconsistent and on a small scale, which still leaves widespread disparities in health outcomes and health systems in many settings. The One Million Community Health Worker Campaign calls for the rapid scale up of CHW programs across sub-Saharan Africa. Like many other movements, such as the Millennium Development Goals, the campaign aims to gather international support and financial resources for national-level CHW programs. In January of this year, the campaign was announced at the World Economic Forum, championed by President Paul Kagame of Rwanda, Novartis CEO Joseph Jimenez, and Professor Jeffrey Sachs. The approach has been top-down during the initial process of gathering international support; however, much of the potential success and scalability of the project depends on the country-specific, bottom-up mechanisms that are being built into the implementation process.
When asked about the wider foreseen impact of the campaign, Dr. Singh said that the wider impact goes beyond the improved health outcomes by providing local communities with a voice on a global scale. CHWs’ primary role is to improve local health outcomes, but they also can serve as a connection between a government and the local community. Dr. Singh says, “CHWs are important members in the community creating that tangible linkage to formal institutions.” CHWs can be an integral part of identifying broader environmental health practices and bringing them to the attention of institutions. This integral link between the community and formal institutions creates a community foundation system that enables top-down global-level goals to address needs as informed by the community. Going further, CHWs can be a catalyst for institutions to change as they can better identify a community’s changing needs and can see first-hand the effect of programs on a local level.
To be clear, the One Million Community Health Worker Campaign is not reinventing the wheel. In scaling, the campaign’s goal is to build and improve upon current systems, so that CHWs can and do reach the most vulnerable across a whole country. The campaign is about to begin the process with an initial set of countries, who have signed on including Senegal, Nigeria and Tanzania among others, with the idea that more countries will begin improving on and implementing CHW programs in the stages to follow. According to Dr. Singh, these initial countries will work as a catalyst for the CHW programs in the rest of the countries in the African Union.
One of the challenges of bringing CHW programs to a national level, according to Dr. Singh, is “how to effectively scale training and tie in performance measures” of CHWs. Performance measures are important because they look at the quantity and quality of what CHWs are doing in the field. The success of a national program is not just based on how many CHWs it trains, but also what it trains them to do and how it adapts to feedback on their performance and impact. As can be seen in programs around the world, CHWs can perform many different tasks and can have many different skill sets. There are common broad skill sets in identifying and counseling according to protocols around malnutrition, diarrheal disease, maternal and child care, and fever. In addition, each country may require CHWs to meet other needs specific to that country. The three major building blocks which determine the focus of a country’s training programs are: (1) the priorities of the epidemiological profile; (2) the task load of the CHW; and (3) the strength and support of the surrounding health system. These can differ between regions within a country, and thus training programs may have to vary at the local level. With CHWs potentially performing different tasks depending on their region, performance measures will also have to be locally-tailored. Dr. Singh recognizes these challenges, and says that a CHW program should not be one-size-fits-all. The One Million Community Health Worker Campaign will work with local communities to implement CHW programs tailored to meet their needs.
Kris Reinhardt is a first year MPA in Development Practice student at Columbia University’s School of International and Public Affairs.