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PubMed1995

Community health workers: integral members of the health care work force.

As the US health care system strives to function efficiently, encourage preventive and primary care, improve quality, and overcome nonfinancial barriers to care, the potential exists for community health workers to further these goals. Community health workers can increase access to care and facilitate appropriate use of health resources by providing outreach and cultural linkages between communities and delivery systems; reduce costs by providing health education, screening, detection, and basic emergency care; and improve quality by contributing to patient-provider communication, continuity of care, and consumer protection. Information sharing, program support, program evaluation, and continuing education are needed to expand the use of community health workers and better integrate them into the health care delivery system.

Community Health Workers↗
PubMedDate not supplied

Outcome effectiveness of community health workers: an integrative literature review.

Community health workers (CHWs) are promoted as a mechanism to increase community involvement in health promotion efforts, despite little consensus about the role and its effectiveness. This article reviews the databased literature on CHW effectiveness, which indicates preliminary support for CHWs in increasing access to care, particularly in underserved populations. There are a smaller number of studies documenting outcomes in the areas of increased health knowledge, improved health status outcomes, and behavioral changes, with inconclusive results. Although CHWs show some promise as an intervention, the role can be doomed by overly high expectations, lack of a clear focus, and lack of documentation. Further research is required with an emphasis on stronger study design, documentation of CHW activities, and carefully defined target populations.

Behavior Therapy↗
PubMed1985

Local politicization of Primary Health Care as an instrument for development: a case study of community health workers in Zambia.

The integrated approach of the Primary Health Care Concept has obvious implications for development. In view of Zambia's commitment to Primary Health Care it is important to evaluate the effectiveness of present institutional frameworks and the problems that may arise in shifting towards community responsibility for the provision of health. It is often assumed that the Primary Health Care approach of working through the community should be free of serious implementation problems. However, experience from community participation projects in a wide variety fields carried out in many countries, including Zambia has shown that failure to account for local institutional arrangements and political interests has hindered success. This article presents the theoretical issues involved in community participation research, reviews relevant literature and presents a case study of a community health worker in Western Province, Zambia. The case study derives from an on-going UNICEF/Government of Zambia sponsored project which is monitoring and evaluating the impact of child health and nutrition services in rural areas. The study illustrates some of the problems encountered by a CHW because of clashes with local political interests. An alternative model is proposed which if implemented can help alleviate and/or avoid these types of conflicts.

Child↗
PubMed1996

Enhancing the role of community-health workers in research.

With recognition of the importance of meeting the needs of underserved communities and the shift to more primary care-community-health workers need to be part of health teams. Community-health workers, in voluntary and salaried positions, augment the roles of professionals through outreach and community-based work and serve as liaisons between communities and institutions. This article describes the rationale for inclusion of community-health workers in research; their roles and responsibilities; and issues in their selection, training, and supervision. Examples are given from the authors' experience with interventions by nurse and community teams. Inclusion of community-health workers enriches the comprehensiveness of a holistic scientific approach to understanding health in a community.

Career Mobility↗
PubMed2003

Poor performance of community health workers in Kalabo District, Zambia.

OBJECTIVE: To determine the factors contributing to low performance of community health workers in Kalabo District, Zambia. METHODS: In a cross-sectional descriptive study, 86 community members, 27 community health workers and nine rural health centre staff were interviewed using semi-structured questionnaires. Other methods were focus group discussions and checklists. Data analysis was done manually. RESULTS: The low performance of community health workers is a real problem for Kalabo District. The two most important factors are the irregular and unreliable supply of drugs and selection of the wrong people to be trained for community health workers. CONCLUSION: Though initially implemented as such, the comprehensive approach of the primary health care project is no longer functioning in Kalabo. Community health workers are mainly valued because of their curative services. Communities do not properly follow the official criteria for selection of people to be trained, but have other considerations. Strategies will have to be formulated to rehabilitate the programme, mainly focussing on these two findings. Other factors, like inadequate community support and inadequate supervision, were mentioned by many contributors.

Adolescent↗
PubMed1999

Impact of community health workers on access, use of services, and patient knowledge and behavior.

Community health workers have been used in health centers for several decades. Known by various names (e.g., community health advisors, outreach workers, promotoras), they are trusted community members providing informal community-based health-related services and establishing vital links between health providers and the community. They perform many functions, including outreach and case finding, health education, translation, patient transportation, and case management (under the supervision of a nurse or social worker). This article, based on a study of community health worker programs at seven sites, is intended to share the lessons learned that could be helpful to other program managers and to examine the outcomes of such programs.

Community Health Centers↗
PubMed1987

Characteristics and functions of community health workers in Saradidi, Kenya.

A community-based health development programme in Saradidi, Kenya had 126 village health helpers (VHH's) for the 56 villages. These volunteer health workers lived in the community and served a total population of about 43,000 in an area of 225 km2. Each VHH served a maximum of 100 households averaging 4.0 persons. Conditions imposed by the community were that the VHH be perceived to be a mature person, to be compassionate and to have a desire to help people and to live in the village. Literacy or formal education were not requirements. VHH's were chosen and supported by the people who lived in their village. Characteristics of the 126 VHH's were that 96.8% were women, 99.2% were married, 75.4% were between 25 and 39 years of age, and 80.2% had at least five years of formal education (only 7.1% had none). The VHH's spent an average five to ten days each month on programme activities in addition to their other responsibilities which included preparing meals, cleaning their homes, carrying water and firewood from long distances, caring for their children and cultivating food for their family. Each VHH visited about 15 households per month, spending one to two hours on a visit. Problems experienced by a random sample of 36 VHH's included difficulties due to lack of transport, lack of medicines, slowness of the community to accept new ideas, distance from project clinic, lack of food in the village, weak village health committees, and no payment for services. The main support for the VHH's came from village women individually, women's groups, and the central programme committee. Village Health Committees did not provide effective support. Nevertheless, in four years only four of the 126 VHH's dropped out of the programme. The main reasons that 36 VHH's reported for continuing to volunteer were as follows: the continuous training they were given was beneficial (mentioned by all); they agreed to serve the villages and did not want to go back on their word (36.1%); they liked the work (19.4%); they felt they have an impact on the health of people in the village (16.7%); the allowances they sometimes receive (22.2%); and personal development (13.9%). The characteristics and responsibilities of community health workers in Saradidi were similar to those elsewhere. The ingredients for a successful volunteer programme such as this one are present in many areas.(ABSTRACT TRUNCATED AT 400 WORDS)

Activities of Daily Living↗
PubMedDate not supplied

Community health workers and primary health care in Honduras.

Community participation and utilization of community health workers (CHWs) are essential components of the primary health care model. The success of CHWs is dependent on their training and subsequent community support. Community-prepared nurses are ideal CHW educators. A training program for CHWs was implemented in Honduras emphasizing the principles of adult learning and problem-based learning. Following a 4-month program of training a primary health care clinic was opened and managed by CHWs for a population over 10,000. Approximately 80% of local health problems were managed by the CHWs proving that well-trained CHWs can have a significant impact on the delivery of health care.

Community Health Services↗
PubMed2006

The influence of observation and setting on community health workers' practices.

OBJECTIVE: To determine whether results from an evaluation that involved observation of community health workers while they performed patient consultations in a hospital reflected normal everyday practices. DESIGN: Comparison of two samples of ill-child consultations: (i) consultations performed during an evaluation in which we observed community health workers in a hospital in-patient and outpatient department from February to March 2001 and (ii) consultations performed under no observation in villages and documented in clinical registers within the 90 days before the hospital evaluation. SETTING: Siaya District Hospital and villages in Kenya. STUDY PARTICIPANTS: Community health workers. MAIN OUTCOME MEASURE: Treatment error indicator, defined as the percentage of consultations where at least one recommended treatment (where recommended treatments were those that were indicated based on community health worker assessments of the child's condition) was not prescribed. RESULTS: We analyzed data on 1132 consultations (372 from the hospital evaluation and 760 from the community) performed by 103 community health workers. For all types of consultations combined, the difference between treatment error indicators (hospital minus community) was -16.4 [95% confidence interval (CI): -25.6, -7.1]. CONCLUSIONS: We found that community health workers made treatment errors less frequently when they were observed in a hospital in-patient or outpatient department than when they were not observed in the community. Evaluations that involve the observation of community health workers in a hospital setting might overestimate the quality of care that they normally give in their villages.

Clinical Competence↗
PubMed1990

Community health workers in Bolivia: adapting to traditional roles in the Andean community.

Community health workers (CHW) constitute an outreach program where community members become involved in their health concerns and elect someone to be trained and administer primary health care. A major problem is that CHWs do not fit into leadership roles of either modern or traditional medicine. CHWs of Oruro, Bolivia, are discussed to examine the success of this program in which CHWs adapted to political, economic, and cultural patterns of Andean communities.

Bolivia↗
PubMed2004

Community health workers and home-based care programs for HIV clients.

In Nyanza Province, Kenya, estimated HIV prevalence is 22%. Given that more than 80% of the population resides in rural areas, the majority of individuals in Nyanza Province do not have access to medical facilities on a regular basis. In response to the growing demands the HIV epidemic has placed on the people and communities in this region, hundreds of lay individuals have been trained as community health workers to provide home-based care to sick or dying HIV/AIDS clients in rural areas. This paper discusses the role and impact of these community health workers in Nyanza Province, Kenya. It outlines the collaborative relationship between community health workers and the Ministry of Health, examining community health workers' use of extant biomedical structures at the district level to provide services that government-run health facilities lack the monetary resources or personnel to provide. Finally, it explores the role played by community health workers in providing HIV/AIDS education to individuals in an attempt to prevent further infections.

Community Health Workers↗
PubMed1989

Emergency department detection and follow-up of high blood pressure: use and effectiveness of community health workers.

This study introduced trained paraprofessionals, community health workers (CHWs), into the emergency department (ED) to supplement providers' routine efforts in high blood pressure (HBP) detection, treatment, and follow-up among high-risk black men. In a demonstration project over a 2-year period, CHWs provided (1) BP and pulse measurements, and educational counseling regarding HBP and cardiovascular risk factors; (2) telephone preappointment reminders to improve ED follow-up visit rates; and (3) recontact of patients failing to show for their ED follow-up visits to improve return rates even after missed BP appointments. Results of preappointment reminders by CHWs showed a 19% improvement in appointment keeping (P less than .001). With a sample of patients who had failed to return for a follow-up visit, CHW contact was also effective, showing an overall improvement rate of 7% (P less than .001). The results reported support the idea that individuals from the community, trained as paraprofessionals, can improve appointment keeping as well as be useful in assisting in screening and counseling for chronic conditions within the ED. These CHWs are seen as having the additional advantage of enhancing the integration of the ED, the community, and continuing care sites. The approaches used in this study should be applicable and may serve as a model for the approach to other chronic conditions experienced in urban high-risk communities.

Adult↗
PubMed1998

Urban community health workers: selection, training, practice and outcomes.

The role, desirability and success of community health workers is debated. Conflicting reports have highlighted important concerns and provided guidelines. Particular issues identified are the necessity for both community and health professional input to determine needs and to ensure an acceptable selection process, training, support and accountability. Such steps were followed in the Greater Soweto Maternal Child Project. These are described together with the results achieved. Eight trained Soweto community health workers centered at Chiawelo Clinic and providing home based and neighbourhood health care undertake supervised Tuberculosis treatment, tracing of immunisation defaulters, and health education based on GOBI FFF (Grant JP, UNICEF:1985;94) and "Facts for Life" (UNICEF 1989-1993). They form a link between the community and government health care services and also other available resources. Over a period of 26 months, working from their own homes, they provided 14,254 health related services and in addition undertook 14,501 neighbourhood home visits. They were responsible for 8,710 referrals to the clinic or other relevant agencies for assistance. Incremental training has included HIV/AIDS counselling, advice on family planning with regular report back sessions and discussions. Participatory management involves all major role players. The community health workers have the approval and support of the Local Soweto Health Authority, the Civic Association and the communities they serve. On completion of the project, all were redeployed into local health service posts where it is intended that they form the nucleus of an expanding service. Delegation of selected tasks allows for cost effective functioning of more highly trained staff, an improved service and better use of available resources.

Adult↗
PubMed1996

Community health workers' response to violence against women.

This paper reports on a qualitative study of community health workers from a predominantly rural based region in Queensland. The purpose of this study was to determine the community health worker barriers to identification, assessment and intervention on the issue of violence against women. The qualitative research method comprised five structured focus group interviews with 28 community health workers using open-ended questions to explore their perceptions. Analysis of the focus group data revealed that community health workers expressed reluctance to become involved in cases of violence against women. The reasons they provided are grouped under three main themes: barriers to identification; barriers to assessment; and barriers to intervention. Training programs offered to rural community health workers need to be aware of the barriers to identifying, assessing and intervening in cases of violence against women that are highlighted by this study. Further studies are needed to assess the wider relevance of these findings to other groups of community health workers in rural and non-rural settings.

Attitude of Health Personnel↗
PubMed2006

People Improving the Community's Health: community health workers as agents of change.

People Improving the Community's Health (PITCH) uses teams of community health workers to provide targeted outreach, to enroll those eligible in health coverage plans, to provide information and linkages to health and social support services, and to engage community members in community improvement activities. The initiative is based on the assumption that communities must work on the determinants of health and effectively mobilize all their assets to improve not only individual health, but also community health. Developed with support from the Kellogg Foundation's Community Voices Initiative, PITCH addresses intertwined public health concerns about access to health care and community health improvement. Outcomes of PITCH include increased enrollment in health coverage plans as well as increased participation in community improvement activities. The PITCH initiative helps community members work together to unleash the enormous power for change that emerges when people connect to one another, thereby tapping the knowledge, skills, and resources of community members and institutions alike.

Community Health Planning↗
PubMed2005

Improving asthma research in an inner-city Latino neighborhood with community health workers.

This study tests the feasibility of a partnership between an academic medical center and community health workers to perform mutually beneficial research investigating asthma in an urban Latino neighborhood. Community heath workers participated in the study design, instrument development, implementation, and analysis. The 103 participants recruited by the community health workers were primarily Mexican with very low education and acculturation levels. After the 1-year enrollment period, the community health workers described the challenges of data collection and gave explanations for the access to care outcomes. This academic-community partnership showed that community health workers can be effective research partners.

Academic Medical Centers↗