This full version of a previous feature goes into detail about CHWs and mental health. CHWs encounter psychosocial issues on a daily basis, but their training does not cover this area. This paper discusses the role CHWs can potentially fill in regards to mental health care, the evidence showing the effectiveness of such care, and World Vision’s approach to training CHWs in mental health care issues.
Tuberculosis is one of the leading causes of death throughout the globe, though treatment exists and is effective. In order to combat drug resistant tuberculosis, community-based directly observed treatment (DOT) is recommended by the World Health Organization, in which a supervisor observes the patient swallow their anti-tuberculosis medication. While highly praised, this method has been inconsistent in the past. This study looked at the effectiveness of community-based DOT for tuberculosis treatment.
A randomized trial evaluates the effectiveness of a CHW program in Kenya which implements home visits or calls to new mothers three days after delivery. Surveys were utilized to measure compliance, self-reported health problems, care-seeking behaviors, and postnatal knowledge and practices among new mothers who received one of three randomly assigned postnatal care practices. Results showed that mothers who received CHW home visits were more likely to recognize postnatal problems and seek care for those problems than mothers who received a phone call or standard care.
World Vision’s Access – Infant and Maternal health (AIM Health) Program met its five-year goal of reducing infant and maternal mortality in most of the ten Area Development Program (ADP) sites in which it was implemented.
Using a life history approach, 26 Northern Ugandan health workers with experience working in the public and private not-for-profit (PNFP) sectors were interviewed to reveal their experiences both during and after the Northern Uganda conflict and to better understand what influenced these health workers to move between these two sectors. Most workers moved from the PNFP to the public sector, as during the conflict PNFP was more stable and offered better quality training. After the conflict, the public sector was rebuilt and offered more for health care workers.
Case studies in eleven countries including Zambia, Armenia, and Senegal, utilized World Vision’s social accountability approach, Citizen Voice and Action (CVA), to address public service improvement. This approach aims to link community members and organizations with each other and also to link these communities with service providers, local governments, and national policies. CVA empowers communities to influence and improve access to quality public services such as health, education, and child protection.
Using mobile job aids can help CHWs deliver integrated counseling on family planning and HIV/STI screening by following a step-by-step service delivery algorithm. Lessons learned during the pilot led to the development of additional features during scale-up to exploit the other major advantages that mHealth offers including:
· Better supervision of health workers and accountability for their performance
· Improved communication between supervisors and workers
· Access to real-time data and reports to support quality improvement
Deployment of resident female Community Health Extension Workers (CHEWs) to a remote rural community led to major and sustained increases in service utilization, including antenatal care and facility-based deliveries.
Key components for success include:
1) providing an additional rural residence allowance to help recruit and retain CHEWs;
2) posting the female CHEWs in pairs to avoid isolation and provide mutual support;
3) ensuring supplies and transportation means for home visits; and
4) allowing CHEWs to perform deliveries.