By Lilian Otiso and Kate Hawkins
Surely it is high time to "go to the community and just listen. Shut up your mouth, and then unlearn the bad habits that medical school taught you, like your elitism." These are the wise words of Penina Ocholla of the Great Lakes University of Kisumu at the USAID SQALE Symposium.
As the Fourth Global Symposium for Health Systems Research in Vancouver aims to understand how to build resilient and responsive health systems, there is no doubt that the voice of community health workers should be central to that discussion. But where are they?
Part of the solution
The Ebola crisis in West Africa was not tackled solely by humanitarian agencies, NGOs and governments. In fact, it was the integral role of community health workers (CHWs) that bridged the very large gap between the national health systems and the community in tackling the rapidity and aggressiveness of the epidemic. This is testament enough that the role of CHWs is significant, if not momentous, in preparing and responding to future global health challenges. If the global community is going to get anywhere near achieving the Sustainable Development Goals by 2030, we had better quieten down and listen to CHWs.
The importance of the role of CHWs is by no means a new phenomenon. CHW programs have been implemented in many countries since the Alma Ata declaration on primary health care in 1978. While many of the programs declined in the 1990s, they started picking up again in the 2000s. Now they are once again in the spotlight, as governments look for new ways to tackle the crisis of too few health workers and the importance of community engagement in health systems is acknowledged.
At the Prince Mahidol Award Conference earlier in the year, policymakers, donors, practitioners and researchers highlighted the integration of CHW views into health system policy and decision making as an area that would benefit from further attention and focus in the upcoming WHO guidelines on community health.
Challenges remain
The perceptions of CHWs about the facilitators and barriers to their work have been documented to some degree but their needs differ depending on the context in which they work. Some issues seem to be recurring:
•Recognition and involvement in planning and decision making about their programs would be a simple step, but is often overlooked.
•Training and continuous professional development are seen as paths towards career progression for all health workers but too few programs adequately focus on this. International conferences are often out of reach.
•The provision of supportive supervision aimed at improving their work and helping them gain recognition from supervisors and their community has been widely recognized as a motivator.
•Paying CHWs for their work is essential. How are they to find time and resources for generating their own incomes if they are overworked, under-supported, full time volunteers?
•Lack of basic medical supplies such as painkillers and mosquito nets make communities suspicious of CHWs and in some cases hostile. REACHOUT context analysis reports in six countries in Africa and south East Asia all pointed out that a lack of supplies and commodities affected their work.
The global health community needs to put in place improved mechanisms within our programs to ensure that priorities are set by CHWs as partners with their counterparts in service provision, government and academia. To do this will require us to "go to the community and just listen," leave our elitist attitudes at the door and do more to tackle the power imbalances that too often place the community at the bottom of the pile.
Dr Lilian Otiso is a medical doctor with experience in HIV program management working with government and NGOs. She is the co-chair of the Health Systems Global Thematic Working Group on Community Health Workers.
Kate Hawkins is the communications manager of the REACHOUT Consortium--a research program working in 6 countries to analyse close-to-community health programs. She is the Secretary of the Health Systems Global Thematic Working Group on Community Health Workers.
This blog is part of the series: "Resilient and Responsive Health Systems for a Changing World" by the Canadian Society for International Health and Health Systems Global, to share the central issues that will be explored at the 4th Global Symposium on Health Systems Research in Vancouver, 14-18 November 2016.
The views expressed are those of the authors and do not necessarily reflect the views of CCIC or its members.
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