In places where there are no nurses or doctors or people have to travel a distance to see one, community health workers play an invaluable role of offering basic health care and information to often isolated or remote communities.

Countries like Nepal and Ethiopia have capitalized on this mechanism for offering basic care with their systems of volunteer village health workers or health extension workers. In Ethiopia, we have seen how the more than 30,000 health extension workers—many of them women—can reach people with services, information, and referrals by going door-to-door, getting to know their clients, gaining their trust, and treating them.

In Kenya, too, significant improvements have been made in districts that have health workers and even in nomadic communities. For example, in Turkana, a nomadic pastoralist community in Northern Kenya, community health workers move with their communities as they migrate. These health workers are aided by well-equipped health facilities along the way. This has resulted in fever treatment increasing from 18% to 56%; antenatal care up from 17% to 33%; a rise in immunizations from 0.8% to 33%; and more women delivering in health facilities [1].  

These countries, and others such as Uganda, have reported great success with systems that formalize the roles of community health workers by giving them specific training (sometimes up to a year of training), paying them or offering incentives for the work—including tools, such as a bicycle or mobile phone, that are necessary for the work—and clearly defining the community health workers’ scope of practice.

Last week, during a seminar on community health organized by John Snow, Inc., IntraHealth International, and FHI, we heard evidence that some of these programs are working. It is exciting to have confirmed what we have seen in practice: community health workers are reaching communities with essential lifesaving services such as immunizations, skilled attendance for labor and delivery, and information about family planning and contraceptives.

Even as we look to grow other cadres of workers, we should also continue to invest in community health workers and collect the evidence we need to effectively plan for, manage, and support these health workers who reach people where they are.

Like the more traditional clinical care providers, high-performing community health workers need:

• To know what job is expected of them
• Timely and supportive supervision
• A constellation of financial and non-financial incentives 
• The potential for career advancement 
• To be appropriately credentialed, trained, and tracked.

The seminar made clear to us that there are very real and similar human resource challenges in community health care but also that it is an important way to reach people who might not otherwise see a health worker. Community health requires political will, strong leadership, and well-conceived plans to continue to support these health workers and the communities they serve.

Reference

1. Kenya Community Health Convention Report, December 2010.