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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-

Strengthening the role of Community Health Representatives in the Navajo Nation

The objective of this study was to evaluate how the Community Outreach and Patient Empowerment (CORE) program has affected Navajo Nation Community Health Representative (CHR) teams over the past 6 years. COPE staff members surveyed CHRs in 2014 and 2015 about their perceptions of and experience working with COPE, including potential effects COPE may have had on communication among patients, CHRs, and hospital-based providers. COPE staff also conducted focus groups with all eight Navajo Nation CHR teams.

Effects of a social accountability approach, CARE’s Community Score Card, on reproductive health-related outcomes in Malawi: A cluster-randomized controlled evaluation

This study evaluated the effects of a social accountability approach, CARE’s Community Score Card (CSC), on reproductive health outcomes in Ntcheu district, Malawi using a cluster-randomized control design. Two independent cross-sectional surveys of women who had given birth in the last 12 months, at baseline and at two years post-baseline were conducted.

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.

Community health worker perspectives on a new primary health care initiative in the Eastern Cape of South Africa

This study sought to understand CHW perspectives on a new primary health initiative in South Africa called Re-engineering Primary Health Care (rPHC). This initiative aims to provide a preventive and health-promoting community-based PHC model. Focus group discussions and surveys on the knowledge and attitudes of 91 CHWs working on community-based rPHC teams in the King Sabata Dalindyebo (KSD) sub-district of Eastern Cape Province were conducted.

The Influence of Community Health Resources on Effectiveness and Sustainability of Community and Lay Health Worker Programs in Lower-Income Countries: A Systematic Review

This review explores the current evidence available to assess if increased levels of integration of community health resources in CHW programs leads to higher program effectiveness and sustainability. 32 articles were chosen for an extensive review, complemented by analysis of the results of 15 other review studies. Analysis found no quantitative data and minimal inclusion of even basic community level indicators.

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