The widely accepted World Health Organization’s (WHO) definition of community health workers states: “Community health workers should be members of the communities where they work, should be selected by the communities, should be answerable to the communities for their activities, should be supported by the health system but not necessarily a part of its organization, and have shorter training than professional workers” (WHO 1989).
Community health workers can be found all over the world, having administered basic health services to their communities for at least 50 years, and they all share the same goal which is to facilitate access to services and improve the quality and cultural competence of service delivery However, the strategies, techniques and approaches used by community health workers vary greatly from place to place. These reflect the unique and changing needs of regions and highlight how community health worker jobs represent both the specific individuals they serve and the challenges of the job. This post will illustrate workers in two regions: Thailand and Uganda.
There are distinct differences between community health workers, which vary depending on the region they providing services in. Within the African nation of Uganda, there are different names for community health workers depending on what role they fulfill such as: community drug distributor and community resource person. Despite having a profoundly positive effect on the individuals they serve, Ugandan health workers face many obstacles. In one report that explores the challenges of working as a community health worker in this region, Thompson states, “staff shortages, inadequate pay, poor worksites, risk and insecurity in the
workplace, limited and poor-quality staff accommodation, and harassment.” The report further illustrates how staff endure “poor supervision, leadership and a lack of promotion” which greatly impact the opportunities for career growth and advancement.. The facilities are also a major issue, often in poor condition and not conducive to proper care. With only 14 health workers available for each 10,000 people, this isn’t surprising, though it is still unsettling.
With their population increasing quickly, Ugandans and their health workers face challenges related to disease and health, but also in combating the lack of funding and support needed to even begin tackling such issues. One study by Chandler et al concludes that there needs to be a fundamental change in how health workers are treated in order to impact patient care, saying, “professionalization of health workers, particularly of mid-level cadres, whose jobs, resources and reputations are subject to those in higher positions of power, could lead to a greater confidence, self-esteem and value. It is likely that such attempts will be most successful if basic monetary needs of health workers are met first. In turn, better motivated health workers may have more inclination to deliver better care to patients.”
Without adequate funding, the effectiveness of community health worker programs is extremely limited. Economic struggles negatively affect community health worker programs in nations around the world, but the effect on Uganda and other African countries is visible. As such, changes are being made in order to accommodate the community health workers. A three part strategy was implemented by the Ministry of Health with the hope that it would improve the work environment and positively impact the productivity of community health workers. The three parts were: opposing policies that negatively impact the public service work environment, support organizations and identify ways to improve the work environment overall and lastly, improve record management. Although the strategy has shown small improvements in Uganda, it didn’t achieve the widespread change that the ministry was hoping for. Ideally more improvements will be made in the future.
Another area benefiting from community health workers is Thailand. The World Health Organization provides a thorough overview of health workers in Thailand, from which the following overview is based. Thailand is one of many developing countries to launch a Community Health Worker program which has been in place at a national level since 1977. In Thailand Community Health Workers divided into two groups: Village Health Volunteers (VHV) and Village Health Communicators (VHC). VHV and VHC were ordinary villagers who were recruited for the job; there was one VHV and 10 VHC per 100 household members in the Thailand community.
VHCs are responsible for putting together development activities in the village, spreading information on health problems that affected the village and relaying the health needs of the village to VHV and the local health officials. VHVs are chosen among the VHC after a 3-4 month work period. VHV are highly qualified and are expected to be willing to work devotedly for the community. VHV are expected to have enough time, be trusted by villagers, have good health and maintain good economic status. VHV are responsible for following up with patients, take blood samples for malaria, dispense condoms and contraceptive pills, and be the leaders of all VHC’s in the village. One health care strategies defined by WHO which applies to this region, is that essential drugs should be available at the various levels of primary health care at the lowest feasible cost. The main goal of Village Health Volunteers and Village Health Communicators in Thailand is adequate drug provision in communities by distributing essential drugs at a low and affordable cost to all villagers.
However, despite the developed plan for distribution of drugs in Thailand by community health workers, there is need for improvement. One remaining need is to develop policies regarding limits on distribution quantities and limits on how much of the provided drug is consumed by villagers. Also, there needs to be more education for the villagers to enable them to self-medicate as well as agents within the villages to supervise the distribution of the drugs. Another problem these villages in Thailand are facing is the high Village Health Communicator drop out rate and difficulties in maintaining active Village Health Volunteers. Although free medical services are offered to community health workers and their families there are still many obstacles in retaining CHWs. Some of these obstacles include the lack of a work schedule for the CHWs, lack of education/training to let CHWs work confidently and CHWs willingness to work endlessly.
In looking at both regions, we recognize notable success but also the struggles community health workers face around the world. Lack of resources and support contribute to stressful jobs which negatively impacts retaining the needed number of health professionals. However, there is agreement that community health workers provide a vital role in global health, and efforts are continually being made to better reflect this.
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