Importance of Community Health Workers

Importance of companionship wellness WorkersDEFINING THE PROBLEMCommunity wellness Workers have been utilise in some(prenominal) countries dating back about 60 social classs ago, to address the bedspread experienced by the underserved members of these communities, with issues of admission fee to wellness sustainment. More importantly in Low and middle-income countries, Community wellness Workers have occurrencely been championful in reducing the impact of the dearth of skilled health workers. Community wellness Workers shadower make valuable contri only whenions to healthc be oddly in the deli genuinely of thunder mugonical health c be however, cross shipway countries and singular programs on that point argon unsettled and inconsistently establish appeales on how they be recruited, teach, monitored, incentivized, as well as the positions and activities they per phase angle. The lack of a standard structure globally and in CMMB countries creates several( prenominal) divisions of Community Health Workers, which may lead to poor supervise, increased grinding, poor planning, bud pretending and sustainable financing.The stamp on Women and ChildrenSeveral programs have reported a high attrition rate which has led to the breakdown of the programs and is mostly due to problems with how these Programmes are organise or maintained. The initial purpose for which the CHW was set up was to link the communities with the ceremonious health system, if the system fails, the underserved especially the vulnerable populations (women and children), in absence of pure tone health care are at risk of poorer health outcomes.BACKGROUND.Community health workers are adjunct health workers with a myriad of appellations across countries. According to WHO, they should be members of the conjunction, selected by the confederacy, trained and work within the company, answerable to the confederation of interests, they should be financinged by the health system nevertheless non obligatory being a protrude of it, and have a shorter line of merchandise of formulation than other captain workers. Although they help more at the off-base of the health system, and their duties widely vary across countries and programs, their roles in the delivery of basic health care can not be overemphasized. In somewhat countries, they likewise get along the role of record keeping.Over the years, the use of CHWs has gained prominence, with several countries adopting the trend to mitigate the growing proportion of infectious diseases and a shortage of health workers, migrating for green pasture, however, not all CHW programs determine the WHOs definition of CHW. In CMMB countries, the climax is in any case unlike across the in the individual countries.RECRUITMENT, TRAINING, AND INCENTIVESIn Peru, the Ministry of health has particularized regulations on how the CHWs program should be structured. CHWs in Peru are usually volunteers, they cou ld arrive incentives but they do not have contracts or salaries. They are appointed by the community governing body at the cosmopolitan assembly or the social grassroots organization to which the community health agent belongs. There is variation in the duration of facts of life the CHWs to receive in Peru. In South Sudan, there are no proper(postnominal) regulations in terms of services, CHW could receive incentives and could also be use. They are trained in Basic health care service for 6 months whereas, in Zambia, the Implementing partners have different policies for teach, recruitment, remuneration, and incentives for CHWs. Programs funded and get byd by implementing partners are typically on contracts of devil-to-five year but their remuneration and incentives vary across programs. The training also varies surrounded by 2-11 weeks supposeing on if it is affiliated with government health facility or an nongovernmental organization and the Ministry of healths CHW hand book, 2005 is used as a guideline.ROLES AND ACTIVITIESSeveral kinds of literature have group the CHWs as being every generalist or specialiser in the way they are trained or work. Generalist perform a wide range of functions patch the specialist has a program specific focus. In the CMMB countries, the CHWs are more generalist than they are a specialist or obscured in between. They are generally obscure in implementing promotive and preventive health activities especially in providing family planning and immunization. In southwestward Sudan, CHWs perform addition roles of supporting capital health care units as health staff to clerk patients and also work in the pharmacy. They company up fraught(p) women receiving ART while in Zambia, CHWS, also stomach basic curative services and refer cases if complicated, they performfollow-up care including home visits for patients with TB, AIDS, pregnant and postnatal mothers, tracing for malnourished children.Most literature about CHWs and what they do, barrack that they are important in improving access to care especially in areas where they are most take oned. However, it is important to consider the local place setting where the CHW program forget operate(culture, language, social norms, and values etc.) for the program to excel. The mode of natural selection of the CHWs, duration of training as well as the roles the CHWs would be playing should also be considered and possibly be unified across programs. In order to extrinsically egg on CHWs, it is important to also Incentivize them and a mechanism for monitoring and evaluating their activities would help assess problems in the program and health care delivery.APPROACHES AND METHODOLOGIESIn order to encourage behavioral qualify and improve the quality of health care victimization CHWs, CMMB will be focusing on theses 3 risees which have been applied in public health and have alter health outcomes Positive deviance approach, Integrated community case counsel approach and make me a change agent approach.Positive difference This is an approach found on the belief that unusual behavioral practices in communities among few members of the community who are called the positive deviants, help them find a better solution to problems and improve their outcomes compared other members of the same community that address similar exposures and resources, but poorer outcomes. The positive deviance is base on the principles that (Pascale, Sternin, Sternin ,2010)Communities birth the solutions and expertise to solve their own problems.Communities are self-organizing and possess the adult male resources with necessary assets to solve community problems.communities have a Collective intelligence which is every bit distributed and is not dependent on the leadership of a community totally or in external experts.This collective intelligence is what the approach amaze to draw out and capitalize on to solve community problems.The fundament als of the approach is sustainability. The community is encouraged to observe and develop sustainable solutions based on observed positive deviants within the community.Practicing encourages behavior change.This approach has been used successfully in communities in the management of malnutrition and has contributed immensely to reducing the blame of malnutrition in communities where it is being practiced. The community health and families later an observation do by a positive deviant inquiry, practice better ways to cook their food with a particular interest in quality, feeding, and hygienics when managing malnourished children using local resources and technologies.It is a proactive measure harnessing the strength, knowledge, human resources locally available within the community to solve their community health problems. This approach ensures fast, sustainable, affordable, culturally acceptable solutions to solve community health problems and it also encourages local employmen t.Integrated community case managementThis approach was follow by WHO and UNICEF. The ICCM has been piloted in many underserved countries, where there is a major gap in access to care. The aim is to bring health care next to the doorstep of these population and strategically increasing coverage of discussion using Community health workers who are appropriately trained, supervised and monitored. The CHWs are adequately supported with medical supplies. They are trained to identify, promptly and correctly manage or refer cases of common community diseases like malaria, pneumonia, diarrhea and malnutrition in children under 5 years.ICCM uses interventions that are evidence based and it focuses on diagnosis, the community health workers are trained to make a quick diagnosis using portable diagnostic tools and appropriate treatment. common interventions used are antibiotics for dysentery and pneumonia, ORT for diarrheal diseases, antimalaria for malaria, nutritional rehabilitation for malnutrition.The approach employs the use of CHWs who are members of the community and perform their duties either from their homes or selected community building, which is easily accessible to members of the community. exploitation CHWs from the community encourages trust and sustainability.Make me a change agentTo efficaciously improve the quality of health by encouraging behavior change, this approach which is used multi-sectorally will help the CHWs to become an effective change agent by developing their skills of effective communication, showing empathy, individual counseling. It also teaches the approach of using their individual testimonies and storytelling ability to encourage health behavioral change.CHWs after acquiring skills from health training, have to effectively communicate their training to the community which is critically important in encouraging the patient to adhere to treatment and adopt preventive health behaviors. The CHWs are engaged in several activitie s that include role playing to help them understand the importance of respecting patient, safe(p) communication, active listening during conversations. There are several barriers that mitigate against behavioral change, the ability to circumvent these barriers would help the CHWs reach their target population and help them make them make the right behavior change. In order to effectively do this, the CHWs needs to be able to put themselves in the aspect of their audience, sharing their experiences which help foster a personal relationship and makes the change easier to communicate.The approach also emphasizes the importance of storytelling and the use of individual testimonies to assist a particular health behavior by changing preformed misperceptions about the particular health behavior. The testimonials offer the audience the chance to appreciate changes made by someone else who is not different from them, who has had a positive result. These approach as a skill for encouragin g behavioral change is easily remembered, the audience can relate to the story and have a pictural correspondence of what the change is about. Moreso, it can be a source of external motif to encourage change.INTERVENTIONSThe growing adoption of community health workers as part of the health system as a means to reach the underserved communities is met with the need to understand how to implement a sustainable CHW program in different countries across different programs. As field workers in underserved communities, we would also be employing the services of the CHWs in executing our goals. An effective change for managing (recruitment, training, direction and support, Incentives) community health workers will help sustain the program.RECRUITMENTRecruiting community health workers is dependent on the proposed health need they are supposed to meet. close to ministries of health have an established protocol for recruiting health workers. It is important to cross out that to sustai n the program, several papers as well as WHO has suggested that community health workers should be selected by and from the community they are to work in. However, the primary criteria in selecting CHWs is that they should be members of the community they serve. This to harness the establish connections within the individual members of the community and the individual interest of the health worker towards the community.The recruitment go may require the use of different social structures or organization within the communities like the clinics, community-based organizations e.g market women association, religious organizations, the ruling council, other CHWs etc. as sources of referral for the appointment of community members into several CHWs position. Recruitment should be formal, individuals should follow a process of recommendation, interview, and screening.General characteristics of CHWs vary across countries and programs. Literacy is an important measuring rod for recruiting a CHW. Although not all programs require their CHWs to have any form of education, most programs require a primary train of education while some require a higher level of education. The least literacy level should be required however, the higher the level of education the more preferable the CHW. The gender of the CHW should meet the cultural norm especially in places where there are limited interactions between males and females. The age of CHWs differ across programs but ranges from 20 45years. Finally, marriage status is an encouraging criterion for selection. CHWs with a wed status are more likely to remain in the familiarity for a longer period of judgment of conviction than those that are single.TRAININGThe achiever and quality of a CHWs program also depend on the process of training and continuous assessment of training. breeding program varies across programs which depend on the length, depth, element, approach and authority. In some countries, a manual for training of CHWs have been developed where necessary, it should be employed.The length of training varies across programs and it is based on the services the community health worker would be rendering. It could be from days to weeks to years however, it is important to space the training so that the CHW can have time in between training to have an in-depth check up on of the material. A process of a continuous training after the initial training can help improve the performance of CHWs through lapse and adding additional knowledge to the CHW.The use of an interactive, skilled based setting that encourages participation should be employed as a style for training considering the varying educational background among the CHWs. The training material could be categorized into ternary major topics skilled- based knowledge, relevant health knowledge, and research implementation knowledge. Training authority may vary, although WHO prefers the government of the countries to be involved in the train ing but more experienced CHWs, nurses and doctors can be part of the training team.SUPERVISION AND SUPPORTLong term sustainability of health programs involves active supervision and mentorship of the CHWs.The executive programs also provide support to CHWs. In most cases, the supervisor will be provided by the programs main authority. They are usually of different professional backgrounds but have an understanding of the program, the roles of the CHWs and the aim of the program. They evaluate the performance of the CHWs, place their roles and expectations and also answer questions raised by the CHWs. The frequency of supervision which is variable across programs depends on the target goal of the program, the available funds e.tc. oversight as a general term could be practice in different styles and approaches. Group supervision involves a group of CHWs with a supervisor and has been implemented in many programs. Community supervision is another approach for CHWs. The innovative ap proach involves communitys participation by providing feedback and guidance to CHWs and their supervisors. Other methods that can be used are the peer supervision, clinical mentoring and mobile electronic devices.It is also important to note that the supervisors also needs to be actively supported by the programs main authority by providing material support e.g medical supplies, transportation etc. supporting the supervisors will help them perform their functions regularly.INCENTIVESThe incentives for CHWs is one of the most controversial topics but it plays a significant role as it has been shown to be associated with CHWs performance, motivation and retention. many studies have debated on how compensations should be structured for the most effective way to incentivize CHWs. There are two categories of CHWs the Volunteers and Full-time employees.Some countries have a process for how the community health workers should be paid based on the type of appointment and who employs them. C HWs employed by the government on a full-time basis are on paid salaries while most, especially the volunteers are given either monetary or non-monetary incentive however, it is important to recognize that an opportunity for passage advancement in this field can be an incentive.Full-time CHWS are comparatively rare to the part-time CHWs because of the financial implication on programs. A small amount of incentive is more commonly implemented in community-based programs. common monetary incentives are small monetary compensation for their time and transportation subsidies. How much monetary incentive is enough is unknown but it is important to give the CHWs some monetary incentives. The non-monetary incentive is also common. CHWs could get meals during training, bicycles for transportation, umbrellas etc. like the monetary incentive, there are no rules on how the authorities should incentivize their CHWs, or what item will effectively attract CHWs and motivate them.ROLES AND ACTIVIT IES IN MATERNAL AND CHILD HEALTHThe CHWs globally have been very effective in improving maternal and child health as well as reducing mortality especially in low-income countries. Their function varies across countries and programs while in some countries, it is just preventive, in others it also involves diagnosis and treatment. The table below highlights how and areas where CHWs can work effectively to promote maternal and child health.PREVENTIONDIAGNOSISTREATMENTOBSTETRIC look atAnemia*Nutrition Supplement, *Routine HaematinicsNutrition Supplementhuman immunodeficiency virus*HIV Counseling* dissemination of condomRoutine Followup on PMTCTMalaria*Distribution of Insecticide-treated net*Prevent therapy with sulfadoxine-pyrimethamineRapid Diagnostic kitAntimalariaObstetric venerationRoutine Tetanus toxiodRoutine ANC VisitPost partum carePPH* pinhead feeding counselling*Distribution of misoprostol at home births.GYNAECOLOGICAL handleFamily planning*Use of contraceptivePEDIATRIC CA REDiarrhea*Health education on handwashing, food preparation and packagingORSZinc accoutrementMalaria*Distribution of Insecticide-treated netRapid Diagnostic kitAnitmalariaAntipyreticsPneumoniaAntibioticsMalnutrition*Breast feeding Education*Growth monitoringNutrition supplementRoutine immunization of ChildrenINFECTIOUS DISEASESTuberculosisDirect observation of tuberculosis treatmentCHWs roles and activites are not limited to the above, there are also actively involved in diseases surveillance, home visits, record keeping, community health education, monitoring masses with chronic diseases e.g hypertension , diabeties.INTEGRATION INTO CMMB PROJECTS AND PROGRAMSReferencesPascale, Sternin, Sternin. (2010) The Power of Positive Deviance How unlikely Innovators Solve the Worlds Toughest Problems. Harvard Business Press. Print.