Community health worker

A community health worker (CHW) is a member of a community who provides basic health and medical care within their community, and is capable of providing preventive, promotional and rehabilitation care to that community, typically without formal education equal to that of a nurse, CHO, or doctor. They are chosen within the community to assist a train personnel community health extension worker who is train in college or schools of health. A community health extension worker (CHEW) is a specially trained professional who provides similar preventive, curative and rehabilitative health care and services to people where they live and work, the CHEW Are well trained for three years And they graduate with diploma While the JCHEW are trained for two years and graduate with certificate Other terms for this type of health care provider include lay health worker, village health worker, community health aide, community health promoter, and health advisor.^[1][2]

Community health officers contribute to community development and can help communities improve access to basic health services. They are most effective when they are properly trained to provide information and services to the community.^[3] Community health officers are the most promising form of delivering health services to resource-constrained areas. They are seen as secondary health services in most low-income countries are available as a service to the community.^[4]

In many developing countries, especially in Sub-Saharan Africa, there are critical shortages of doctors .

Community Health Officer (CHO), also called Mid Level Health Provider (MLHP) and non-physician practitioner, are trained health care providers who have a defined scope of practice.[8] In India, only Nursing and AYUSH Practitioner are eligible for this cadre.^[9] This means that they are trained and legally permitted to provide healthcare in fewer situations than physicians but more than other health professionals.^[10][11] In India, Community Health Officer is another name of Mid-Level Practitioner.

Recently in India, Community Health Officers at Ayushman Bharat Health and Wellness Centres are now allowed to supply certain medicines to the patients, as they have been included in Section 23 of Schedule K of Drugs and Cosmetics Rules, 1945.^[12] In India, Community Health Officer (CHO) is another name of mid-level practitioner.^[13]

Ministry of Health and family welfare, Government of India published guidelines for prevention and controlling of COVID-19 cases in rural area of India. According to guidelines Symptomatic cases can be triaged at village level by tele-consultation with Community Health Officer (CHO), and cases with comorbidity or low oxygen saturation should be sent to higher centres.^{[14][15][16][17]}

History

It is unclear where the usage of community health workers began, although China and Bangladesh have been cited as possible origins.

Brazil undertook a medical plan named the Family Health Program in the 1990s that made use of large numbers of community health agents. Between 1990 and 2002, the infant mortality rate dropped from about 50 per 1000 live births to 29.2.^[20] During that period the Family Health Program increased its coverage of the population from 0 to 36%. The largest impact appeared to be a reduction of deaths from diarrhea. Though the program utilized teams of physicians, nurses and community health workers, it could not have covered the population it did without the community health worker. Additionally, there is evidence in Brazil that the shorter period of training does not reduce the quality of care. In one study workers with a shorter length of training complied with child treatment guidelines 84% of the time whereas those with longer training had 58% compliance.^[21]

Iran utilizes large numbers of para-professionals called behvarz. These workers are from the community and are based in 14,000 "health houses" nationwide. They visit the homes of the underserved providing vaccinations and monitoring

The Government of Liberia launched the National Community Health Assistant Program in 2016 to accelerate progress towards universal health coverage for the most vulnerable populations, especially those in remote communities.[23] Liberia's program seeks to transform an existing cadre of unpaid and poorly coordinated community health workers into a more effective workforce by enhancing recruitment, supervision and compensation.^[24] The health ministry has organized a coalition of funding and implementation partners to support this new program, which aims to train, supervise, equip and pay 4000 Community Health Assistants, supported by 400 clinical supervisors, to extend primary care services to 1.2 million people living in remote rural communities.

Scope of programs

The World Health Organization estimates there are over 1.3 million community health workers worldwide.^[25] In addition to the large-scale implementation by countries such as China, India, Brazil, and Iran, many countries have implemented community health worker programs in small-scale levels for a variety of health issues.

In India, 600,000 community health workers are paid through a fee-for-service system to deliver a specific set of primary care functions, such as immunization.^[26] They have also been found to be effective in delivering care for chronic conditions such as hypertension and diabetes, though there has been limited utilization of community health workers for these conditions.^[27] In addition, community health workers have been utilized to increase mental health service utilization and decrease stigma associated with mental illness.^[28] In this program respected female members of the community were chosen to participate. All of the women were married, came from a good social standing, displayed a keen interest in the program, and were encouraged by their family to participate. The women chosen were then trained in identification and referral of patients with mental illnesses, the common myths and misconceptions prevalent in the area and in conducting community surveys. The training lasted 3 days and included lectures, role plays and observation of patient interviews at the psychiatry outpatient department at St. John's Medical College Hospital. A population of 12,886 were surveyed using a brief questionnaire. Out of this population, 574 were suspected patients. Out of this 242 suspected patients visited the clinic after follow up from the community health worker. Also in India, The MINDS Foundation has developed a grassroots program targeted at providing mental health services to rural citizens. They leave the responsibility in the hands of local rural citizens who are trained as Community Mental Healthcare Workers (CMHWs).^[29]

In Tanzania, village health workers were part of a community-based safe-motherhood approach.^[30] The VHWs assisted pregnant women with birth planning, which included timely identification of danger signs, preparation, and accumulation of two or more essential supplies such as soap, razors, gloves for clean delivery, and mobilizing household resources, people and money to manage a possible emergency. Approximately one year after the CBRHP's major interventions ceased in these communities, most of the VHWs continued to do health promotion by visiting pregnant women, teaching them about birth planning and danger signs, and assisting them in obtaining both prenatal and obstetric services. Local VHW associations are forming with support from local political leaders, the Ministry of Health, and the non-governmental organization CARE to sustain the work of the VHWs. The community development officers, some of whom were also the master trainers, are involved in spearheading the formation of VHW organizations.

In

Community health workers have also been utilized to assist in research. Martin et al. found that the Latin-American population in the United States frequently does not benefit from health programs due to language barriers, distrust of the government, and unique health beliefs and practices, and specifically that providing effective asthma care to the Latino population is an enormous challenge.^[36] In addition, they found that Latinos are also often excluded from research due to a lack of validated research instruments in Spanish, unsuccessful study recruitment, and a limited number of Latino researchers.^[37] Thus, Martin and colleagues decided to use community health workers to recruit participants. To gauge the effectiveness of their recruitment strategy to other more traditional recruitment models they looked at two studies. Both these studies offered significant monetary incentives for participation while the community health worker study offered nothing for the initial participation. Martin et al. found that individuals who chose not to participate in the study went on to receive other services in the areas of diabetes and cancer prevention, which was not the case for the other studies.

In the Philippines, community health workers are known as

Community health workers play a variety of critical roles in pandemic response.[39]

Current status

Cost and access to medical care remain problems of worldwide scope. They are particularly severe in the developing world and it is estimated one million more health care workers are needed in Africa to meet the health-related

Important attributes of community health workers are to be a member of and chosen by the community they serve.[50] This means they are easily accepted by their fellows and have natural cultural awareness. This is crucial because many communities are disengaged from the formal health system. In Sub-Saharan Africa, 53% of the poorest households do not seek care outside the home.^[44] Barriers include clinic fees, distance, community beliefs and the perception of the skills and attitudes of medical clinic workers. Community health workers are unable to emigrate because they do not have internationally recognized qualifications.^[45] Finally, the variation in incentives between areas of the country tends to below. All these factors combined with strong community ties, tend to result in retention at the community level.

Much remains to be learned about the recruitment, training, functions, incentives, retention and professional development of community health workers. Learning developed in one country may not be applicable to another due to cultural differences. Health worker adaptability to local requirements and needs is key to improving medical outcomes.

See also

• Health care providers
• Health human resources
• Barangay Health Volunteers
• Community health agent
• Lady Health Worker
• Health Extension Worker
• Physician shortage
• 5-SPICE Framework

References