Video Spotlight

"'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

The Path to 2020: Delivering transformative, rights-based family planning

In July of 2012, CARE partnered with other organizations to provide 120 million women and girls with family planning information and services by the year 2020.  This report reflects on the first half of the initiative, evaluating what has been accomplished thus far.  The evaluation shows that many barriers to providing women and girls with more family planning support remain.

How to Support Community Health Workers? Reflections on a year of global learning

In this article, mPowering reflects on learning from pre-existing CHW programs.  First, they recognize CHWs who have support are more likely to make an impact on the communities they serve.  In addition, the introduction of technology into many programs has presented opportunities to improve communication and data collection.  The reflection concludes by stating current CHW programs need to be strengthened, which can be done by increased investment in health systems.

Is incentive-based pay for India's community health workers working?

This article provides background information on the incentive system for India’s Accredited Social Health Activists (ASHAs).  India has created an outcome-based incentive system which creates a clear difference in payment per patient.

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-

Sustainable Financing Models for Community Health Worker Services in Connecticut: Translating Science into Practice

The focus of this report is on the financial sustainability of Community Health Worker (CHW) programs in the state of Connecticut.  The goal of this research is to find a way in which Connecticut can develop an effective program that utilizes CHWs to improve patient health outcomes and achieve a level of positive financial return.  This report worked within the boundaries of Connecticut’s State Innovation Model (SIM), a federally funded grant to aid in transforming healthcare systems from state to state, in order to ensure a possible funding source for the resulting new programs.  The repor

A comprehensive description of three national community health worker programs and their contributions to maternal and child health and primary health care

This is an in-depth review of the effectiveness of CHW programs in Ethiopia, Brazil, and Nepal. The main objective of this report is to provide insight and examples of successful CHW programs for other countries that are looking to build and strengthen their own CHW programs, specifically in the maternal and child health field. 

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