How Do CHWs Work Around The World?

Researched and Written by Siddhi Camila Lama
Edited by Victoria Fine

There are many ways that CHWs are making communities healthier around the world. This map highlights a range of unique and impactful ways that CHWs have supported and improved the health of their communities. This small sampling of programs focuses on either large-scale programs, substantial community benefit, or programs that have the potential to have large-scale impact.

CHW programs are often funded by multiple institutions. Here, Orb Media has highlighted work funded by a diverse range of funding bodies. While many of the programs highlighted may have received later-stage funding from an international or non-community source, used to research or scale-up existing models elsewhere, we have made our best effort to highlight programs that are driven by the community, for the community.

 Why haven’t we featured more CHW programs in Europe and North America, Australia and New Zealand?

Community health workers have been around since the 1970s, yet studies that demonstrate their benefits and implementation in countries like the USA, Canada, New Zealand, and Australia have not been widely documented as compared with the rest of the world. CHW-related studies that are published in relation to the Global North generally focus on healthcare for minority populations or minority, low-income populations, or an even smaller subgroup, like pregnant women within these populations.

While CHWs in these countries are doing meaningful work, there is concern that health systems will not formally recognize them or the value of their roles. This issue is exacerbated as CHWs are rarely integrated into the greater healthcare system, limiting their effectiveness.

 Editor’s note: To make reporting easier, we’ve included the full text for the infographic above for you to adapt and use in your own reporting.

Micro-entrepreneurs support community health in Uganda

Country name: Uganda

Intervention run by: Living Goods, BRAC Uganda, and the Uganda Ministry of Health

Publication(s):https://www.poverty-action.org/sites/default/files/publications/Living%20Goods%20paper.pdf

Short Summary: CHWs were trained in entrepreneurship and nutrition, as well as antenatal, neonatal, and childhood healthcare education. These CHWs were able to visit homes to promote positive behavioral changes, provide medical advice and basic health services, refer severe cases to nearby health centers, and sell preventative and curative health products.

CHWs reduce depression in South African townships

Country name: South Africa (Khayelitsha, Cape Town)

Intervention run by: Philani Child Health and Nutrition Project & Intervention Program, along with the University of California at Los Angeles, Harvard Medical School, Stellenbosch University, the Medical Research Council of South Africa, Massachusetts General Hospital, and the United Nations Children's Fund

Publication(s): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167933/  

Summary: Depression is common among women living in South African township settings. Despite minimal mental health training, CHWs were able to detect potential cases of antenatal depression through the use of a mobile mental health app.

 A second, related study reports that CHWs could also teach cognitive-behavioral principles to depressed mothers. This strategy, along with CHW’s focus on improving maternal and child nutrition and health, helped improve child growth and development whether or not the mother’s depression was treated.    

 

CHWs screen for antepartum depression in eSwatini

Country name: eSwatini (Matsapha)

Intervention run by: Siphilile & Philani Maternal and Child Health and Nutrition

Publication(s): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5659190/

Summary: CHWs trained in maternal and child health received additional mental health training in order to screen for antepartum depression. CHWs from this study used this training to identify women with depression, as well as refer severe cases for further psychosocial support.

 

CHWs provide Pakistani mothers and children with physical and mental healthcare

Country name: Pakistan (Hala and Matiari subdistricts & rural Rawalpindi)

Intervention run by: Pakistan’s National Program for Family Planning and Primary Health Care, Wellcome Trust UK, WHO and the Saving Newborn Lives program (Bill & Melinda Gates Foundation)

Publication(s): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61400-2/fulltext and https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62274-X/fulltext

Summary: Pakistan’s Lady Health Workers (LHWs) have been deployed to provide maternal health education, support during childbirth, and newborn and antenatal care. They can also promote healthcare-seeking behaviors and refer patients to other healthcare providers. One study found that LHWs reduced neonatal and perinatal death rates when they were able to liaise with traditional birth attendants and establish village health communities. They were also able to promote maternal care and nutrition, after-birth care, and refer sick newborns who were in need of further medical treatment.

Another study found that adding cognitive behavior therapy to LHW training has greatly reduced the rate of depression among prenatally-depressed women. Mothers were also more likely to use contraception and play with their infants, while infants were less likely to suffer from diarrhea and stunting, and were more likely to be immunized.

 

CHWs join Ethiopia’s Health Extension Program

Country name: Ethiopia

Intervention run by Ethiopia’s Health Extension Program

Publication(s): https://openknowledge.worldbank.org/bitstream/handle/10986/24119/9781464808159.pdf?sequence=2

Summary: As civil service employees, Ethiopia’s CHWs work in both urban and rural areas to provide many services, including immunizations, injectable contraception and basic medical treatment like first aid, anti-malaria treatments, and medications for diarrheal diseases and intestinal parasites. They also provide health education and information on health-related services, like family planning, antenatal care, and general outpatient services, including fever and diarrhea treatments.

 

CHWs reduce infant mortality in India by improving newborn care practices

Country name: India (Haryana; Uttar Pradesh)

Intervention run by: Indian Integrated Management of Neonatal and Childhood Illness (IMNCI) program; Saksham program, USAID, and Save the Children-US (Bill & Melinda Gates Foundation)

Publication(s): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61483-X/fulltext

Summary: In India, CHWs helped reduce neonatal and infant mortality, as well as improved newborn care practices. An additional study found that CHWs were specifically able to increase breastfeeding, improve birth preparedness, ensure delivery hygiene, and promote healthy thermal, umbilical cord, and skin care practices post-birth.

 

CHWs reduce deaths of infants and mothers and improve family planning in Bangladesh

Country name: Bangladesh (Northern Bangladesh; Sylhet and Chittagong)

Intervention run by: BRAC Project for Improving Maternal, Neonatal, and Child Survival, UNICEF, Government of Bangladesh, and the Bangladesh Knowledge Management Initiative Project’s eHealth Pilot

Publication(s): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560389/

Summary: CHWs are trained to provide essential maternal, neonatal, and child health care services. Their work improved healthcare-seeking behaviors and the likelihood of women using a healthcare facility for their child’s birth. CHWs also helped create a birth plan and provided postnatal care, which helped reduce infant mortality.

A second study also found that CHWs successfully provided family planning services. Netbooks equipped with eLearning videos and audiovisual resources supported this component of their work.

 

CHWs use technology and in-person connections to prevent postpartum depression among mothers in the Gulf Coast

Country name: United States (Louisiana)

Intervention run by: Transdisciplinary Research Consortium for Gulf Resilience on Women’s Health

Publication(s): https://link.springer.com/article/10.1007/s10995-017-2419-4

Summary: CHWs used a mixture of mobile technology (texts and phone calls) and home visits to provide perinatal support and health information. This intervention reduced rates of postpartum depression among minority, low-income women living in Louisiana.

 

CHWs work to prevent and treat Malaria in Ghanian children

Country name: Ghana (Shime, in Keta)

Intervention run by: Keta District Health Administration, University of Ghana, Swiss Tropical Institute, UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases

Publication(s):https://malariajournal.biomedcentral.com/articles/10.1186/1475-2875-8-292

Summary: CHWs treated suspected cases of malaria and reduced future cases of malaria in children (from six months to five years) by providing intermittent preventive treatment and educating families about the benefits of using insecticide-treated bed nets. Anemia levels among children were also reduced as a result of this work. 

 

Reducing major causes of childhood mortality in Liberia

Country name: Liberia (Rivercress County)

Intervention run by: Last Mile Health and the Liberia Ministry of Health

Publication(s): https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304555

Summary: CHWs were trained in malnutrition identification as well as diagnosis, prevention, and treatment of malaria, diarrhea, and acute respiratory infections. They provided treatment for uncomplicated cases of childhood illness and referred complicated cases to nearby health facilities. CHWs improved access to healthcare and reduced rates of fever, diarrhea, and acute respiratory illnesses in children.

 

CHWs support family health goals across Brazil at scale

Country name: Brazil

Intervention run by: Brazil’s Family Health Strategy Program

Publication(s): https://pubmed.ncbi.nlm.nih.gov/21914989/ and https://pubmed.ncbi.nlm.nih.gov/26927450/

Summary: Brazil’s CHWs have been deployed across the country to provide promotive, preventive, curative, and rehabilitative services. The exact role of the CHW varies based on where they are located. They are particularly helpful in providing health education, promoting breastfeeding, increasing immunization rates, improving drinking water quality, and supporting adherence to medical treatments. They have even worked with the army to control the population of aedes aegypti mosquitoes in order to reduce the rates of Zika, dengue and Chikungunya virus infections.

 

CHW Volunteers support stroke survivors to strengthen their community support and quality of life

Country name: Thailand (Chiang Mai)

Intervention run by: Thailand’s Primary Health Care Division of the Department of Health Service Support and Chiang Mai University

Publication(s):https://www.tandfonline.com/doi/abs/10.1080/07380577.2020.1773010?journalCode=iohc20

Summary: Village health volunteers (VHVs) work throughout Thailand, where they assist seven to 15 households in their communities. VHVs provide support for public health problems such as malnutrition and infectious diseases, as well as chronic disease prevention and management. In this study, CHWs completed additional training specific to stroke rehabilitation. They then worked in rehabilitation centers to support people from their communities who had recently experienced strokes, improve community integration (both in and out of the home) and the quality of life among stroke survivors.

 

CHWs promote the breastfeeding of low birthweight infants in the Philippines

Country name: Philippines (metropolitan Manila)

Intervention run by: Philippine General Hospital (University of the Philippines) & Uppsala University

Publication(s): https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1651-2227.2005.tb02053.x

Summary: Volunteer CHWs, who typically provide first aid and maternal, neonatal, and child health, can be given additional training to support mothers with low birthweight infants. The CHWs in this study supported maternal and infant health through regular home visits. CHWs encouraged breastfeeding, helped mothers manage breastfeeding issues, and increased the likelihood of mothers breastfeeding until their infants were six months of age. Over 60% of infants who were exclusively breastfed had not experienced issues with diarrhea.  

 

CHWs Improve contact tracing of tuberculosis patients in Spain

Country name: Spain (Barcelona)

Intervention run by: Barcelona TB Control Program

Publication(s): https://link.springer.com/article/10.1186/1471-2458-12-158

Summary: Immigration affects the epidemiology and strategies needed to control tuberculosis in large cities. In Barcelona, the Barcelona TB Control Program has worked with CHWs to promote treatment adherence, control outbreaks, and improve contract tracing. CHWs in this study improved contact tracing by taking on a more interdisciplinary role by acting as interpreters, cultural mediators, facilitators, and community mobilizers.

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