As we all know and recognise that community health workers (CHW) are the part of the community and have a significant role to play for our health improvement. There is plenty of scientific evidence wherein community involvement has increased the reach and impact of health systems. This works for communicable and non-communicable disease programmes as well as health promotion and prevention (TB, malaria and HIV care and prevention). I strongly believe that the success of pulse-Polio programme, was immensely contributed to CHW and similarly we could say that the TB-DOT programme has its success attributed to CHW. It has become clear that their support have unique advantages including their closeness with the community, their ability to communicate through people’s own culture and language and also to understand the needs of the communities and their ability to mobilize the community members.
Based on my experience with the CHW, I feel following are some of the objectives for their involvement into any programme:
1. They have access to the target community, as they are from the community and have acceptability within the community.
2. Bridges the gap between the community and programme
3. Increases outreach for the programme
4. Community empowerment
5. Prompt response for any emergency need of the community
6. Facilitate improvement in surveillance and monitoring of any programme.
7. Facilitates in community mobilization for any activity.
Our government has acknowledged their contribution to the improvement of health status. I could easy quote an example from India, like ASHA (Accredited Social Health Associate) are local volunteers who are recruited through panchayat system and Village Health Committee
Under National Health Mission Programme (NRHM) with specific selection criteria. Following their recruitment, they are imparted training on regular basis for various programmes. For eg. in malaria programme, they are responsible for mobilizing community to accept the Indoor Residual Spray (IRS) and Long Lasting Insecticide Nets (LLINs) and also how to diagnose the case by using Rapid Diagnostic Treatment (RDT) kit, preparation of blood smear/slide for further investigation etc. They are also involved in collecting data from the villages for further assessment by the programme managers. Their performance is assessed from time to time by the state/district team and accordingly they are paid their incentives.
However, I have experienced that it was difficult to sustain them for a longer duration and we came across the following few challenges in the programme:
● Lack of supportive supervision and motivational activities.
● Overloaded with activities of multiple programmes;
● Logistic and supply management for various programmes;
● Acceptance by the community;
● Dependency of community on volunteers;
● Timely payment of performance linked incentive through single window system;
We felt that these challenges be addressed jointly by the community and the government authorities to sustain them for the benefit of the programme. Few suggestions include; a CHW should be assigned to manageable number of households instead of villages to avoid overburden of work; to provide integrated training; community could also contribute in supporting CHW through motivational programmes including honouring them and acknowledging their work from time-to-time. Having said this, we still cannot see a programme without their involvement and it would not be out of place to mention that the success of any health programme primarily depends on the these community volunteer.
Jatinder Chhatwal was a student of e-learning course in Public Health Management(ePHM) conducted by Institute of Public Health, Bangalore, India.
Disclaimer: IPH blogs provide a platform for ePHM students to share their reflections on different public health topics. The views expressed here are solely those of the authors and not necessarily represent the views of IPH.