Community Health Worker - Scope of Community Health Worker Programs

Scope of Community Health Worker Programs

The World Health Organization estimates there are over 1.3 million community health workers worldwide. In addition to the large scale implementation by countries such as China, Brazil, and Iran, many countries have implemented CHW programs in small scale levels for a variety of health issues.

In India, community health workers have been utilized to increase mental health service utilization and decrease stigma associated with mental illness. In this program respected female members of the community were chosen to participate. All of the women were married, came from a good social standing, displayed a keen interest in the program, and were encouraged by their family to participate. The women chosen were then trained in identification and referral of patients with mental illnesses, the common myths and misconceptions prevalent in the area and in conducting community surveys. The training lasted 3 days and included lectures, role plays and observation of patient interviews at the psychiatry outpatient department at St. John’s Medical College Hospital. A population of 12,886 were surveyed using a brief questionnaire. Out of this population 574 were suspected patients. Out of this 242 suspected patients visited the clinic after follow up from the community health worker.

In Tanzania, village health workers were part of a community-based safe-motherhood approach. The VHWs assisted pregnant women with birth planning, which included timely identification of danger signs, preparation and accumulation of two or more essential supplies such as soap, razors, gloves for clean delivery, and mobilizing household resources, people and money to manage a possible emergency. Approximately one year after the CBRHP's major interventions ceased in these communities, most of the VHWs continued to do health promotion by visiting pregnant women, teaching them about birth planning and danger signs, and assisting them in obtaining both prenatal and obstetric services. Local VHW associations are forming with support from local political leaders, the Ministry of Health, and the non-governmental organization CARE to sustain the work of the VHWs. The community development officers, some of who were also the master trainers, are involved in spearheading the formation of VHW organizations.

In Mali, community health workers with the Mali Health Organizing Project in Bamako have helped reduce child mortality (under 5 years old) in their community to less than 1%, compared to a national average of 19%.

The use of CHWs is not limited to developing countries. In New York, CHWs have been deployed across the state to provide care to patients with chronic illnesses like diabetes that require sustained, comprehensive care. They work in both rural communities where access to primary care is sparse, and in urban communities where they are better able to bridge communication gaps that may arise between patients and doctors. They are seen to play an important role in assisting patients with navigating a complex, uncoordinated health care system.

A randomized controlled intervention on the U.S.-Mexico border, used promotoras or “female promoters” to increase the number of women utilizing routine preventive examinations. The control group received a postcard reminding women to get preventive screening. The free comprehensive clinical exam included a Pap test, a clinical breast exam, human papillomavirus (HPV) testing, blood draw for total cholesterol and blood glucose, and a blood pressure measurement. The other group received the same postcard and a follow-up visit from a promotora. The group that was followed up by a promotora saw a 35% increase in visits to get the free screening.

A program in Karnataka, India took a slightly different approach now referred to as the "link worker" model. The Samastha project developed a network in which trained workers, village health committees, government facilities, people living with HIV (PLHIV) networks, and participating NGOs collaborated to improve recruitment and retention of PLHIV while strengthening and supporting their adherence to treatment. Link workers were PLHIV who were selected by Samastha from a small number of HIV-positive candidates proposed by their community; they received an allowance for their work. The link workers' key tasks revolved around prevention, stigma reduction, and support for PLHIV that included adherence support to both treatment and care. Ultimately, the link workers' coordinating role became a hallmark of Samastha's interventions in high prevalence rural areas. Link workers formed the essential connection between PLHIV, government and community structures, and HIV care and treatment services, commonly accompanying persons from their catchment area to these services.

Community health workers have also been utilized to assist in research. Martin et al. found that the Latin-American population in the United States frequently does not benefit from health programs due to language barriers, distrust of the government, and unique health beliefs and practices, and specifically that providing effective asthma care to the Latino population is an enormous challenge. In addition they found that Latinos are also often excluded from research due to a lack of validated research instruments in Spanish, unsuccessful study recruitment, and a limited number of Latino researchers. Thus, Martin and colleagues decided to used community health workers to recruit participants. To gauge the effectiveness of their recruitment strategy to other more traditional recruitment models they looked at two studies. Both these studies offered significant monetary incentives for participation while the CHW study offered nothing for the initial participation. Martin et al. found that individuals who chose not to participate in the study went on to receive other services in the areas of diabetes and cancer prevention, which was not the case for the other studies.