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"'I'm a Health Worker' - Abduaraman Gidi" made by IntraHealth International.

Zambia's Community Health Assistants (CHAs)

This brief is an outline of Zambia’s community health assistant (CHA) program detailing the impact of a nationwide salaried cadre of CHWs.  The report includes how CHAs are recruited, trained, and deployed in rural areas of Zambia.  The impact of CHA programs was found to include: task shifting and uptake of services, evidence-based strategies to recruit high performance CHAs and increased the volume of health services in rural areas by expanding basic access to health services.

Task-shifting impact of introducing a pilot community health worker cadre into Zambia's public sector health workforce

In 2012, a new cadre of Community Health Assistants (CHAs) were deployed as part of Zambia’s National Community Health Strategy.  This study aims to evaluate the impact CHAs have on the volume and type of health services provided.  Results show that the addition of CHAs in rural areas increased health service provision shifting the burden of basic health services away from more highly trained health workers.  This allows policymakers to improve access to care with constrained budgets.

Implementation of the Community Health Assistant (CHA) Cadre in Zambia: A Process Evaluation to Guide Future Scale-Up Decisions

To improve healthcare access in rural areas, in 2010 the Government of Zambia implemented a national CHW strategy that introduced a new cadre of healthcare workers called community health assistants (CHAs). After 1 year of training the pilot class of 307 CHAs were deployed in September 2012. This paper presents findings from a process evaluation of the barriers and facilitators of implementation of the CHA pilot, along with how evidence was used to guide ongoing implementation and scale-up decisions.

An exploration of facilitators and challenges in the scale-up of a national, public sector community health worker cadre in Zambia: a qualitative study

In 2010, Zambia created a cadre of community health workers called Community Health Assistants (CHAs).  This program continues to be scaled up to meet the needs of Zambia’s rural population.  This study summarizes the factors that have aided the scale-up of the CHA program as well as the challenges.  The study determined that CHAs play a critical role in providing a wide range of services to community members.  However, CHAs continue to face challenges such as infrequent supervision, lack of medical and non-medical supplies, and challenges with the mobile data reporting system.  The study c

An exploration of facilitators and challenges in the scale-up of a national, public sector community health worker cadre in Zambia: a qualitative study

In Zambia, the 2010 National Community Health Worker Strategy (NCHWS) created a cadre of salaried Community Health Assistants (CHAs) to work in rural and underserved areas providing access to health care and developing prevention measures.  The Ministry of Health (MOH) is currently in the process of creating a workforce of 5,000 CHAs.  After the first class of CHAs graduated, a process evaluation was conducted.  This study is the second evaluation of the program, which has since grown due to results of the first evaluation.  The goal of this study was to evaluate long-term needs of a large-

Improving access to child health services at the community level in Zambia: a country case study on progress in child survival, 2000–2013

This study on child survival, presents indicators, national document, and qualitative data from key informants and community women describing the factors that have enabled Zambia to successfully reduce under-five mortality over the last 15 years and achieve Millennial Development Goal (MDG) #4. Study results found a Zambian national commitment to ongoing reform of national health strategic plans and efforts to ensure universal access to effective maternal, neonatal and child health (MNCH) interventions, creating an environment that has promoted child health.

Hope and despair: community health assistants' experiences of working in a rural district in Zambia.

This paper explores the motivation to become a community health assistant (CHA) in Zambia, the experiences of working in a rural district, and how these experiences affected CHAs’ motivation to work. To examine CHAs’ experiences, data was collected through in-depth interviews with 12 CHAs and observations were analyzed using a thematic analysis approach. Personal characteristics such as previous experience and knowledge, passion to serve the community and a desire to improve skills motivated people to become CHAs.

Innovation in health service delivery: integrating community health assistants into the health system at district level in Zambia

This paper explores the factors that shaped the acceptability and adoption of community health assistants (CHAs) into the health system at the district level in Zambia. Using thematic analysis, data was collected through a review of documents, 6 focus group discussions with community leaders, and 12 key informant interviews with CHA trainers, supervisors and members of the District Health Management Team. Results found a perceived relative advantage of CHAs over existing community-based health workers in terms of their quality of training and scope of responsibilities.

Case Studies of Large-Scale Community Health Worker Programs

This resource from USAID and MCHIP provides an overview of large-scale CHW programs from 13 countries: Afghanistan, Bangladesh, Brazil, Ethiopia, India, Indonesia, Iran, Nepal, Niger, Pakistan, Rwanda, Zambia and Zimbabwe. Case studies address the historical context of CHWs, the health needs of the country, the scope of work of the CHWs, CHW training, support and supervision, and financing of CHW programs. The demonstrated impact and continuing challenges of the different programs are also addressed.

Community Health Worker Nutrition Advocacy Tool

SPRING, in collaboration with USAID, has created a new CHW Nutrition Advocacy Tool, which consists of a series of PowerPoint slides with important data regarding key nutrition responsibilities for CHWs. Information in these slides identify current gaps in nutrition service delivery and advocates for increased commitment to nutrition in community health programs. Stakeholders can use these materials to identify which nutrition-related services CHWs can provide, prioritizes CHW responsibilities, and builds a stronger foundation of policies, tools, and systems for CHWs to conduct their work.

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