Can the deployment of community health workers for the delivery of HIV services represent an effective and sustainable response to health workforce shortages? Results of a multicountry study

Abstract

In countries severely affected by HIV/AIDS, shortages of health workers present a major obstacle to scaling up HIV services. Adopting a task shifting approach for the deployment of community health workers (CHWs) represents one strategy for rapid expansion of the health workforce. This study aimed to evaluate the contribution of CHWs with a focus on identifying the critical elements of an enabling environment that can ensure they provide quality services in a manner that is sustainable. The method of work included a collection of primary data in five countries: Brazil, Ethiopia, Malawi, Namibia, and Uganda. The findings show that delegation of specific tasks to cadres of CHWs with limited training can increase access to HIV services, particularly in rural areas and among underserved communities, and can improve the quality of care for HIV. There is also evidence that CHWs can make a significant contribution to the delivery of a wide range of other health services. The findings also show that certain conditions must be observed if CHWs are to contribute to well-functioning and sustainable service delivery. These conditions involve adequate systems integration with significant attention to: political will and commitment; collaborative planning; definition of scope of practice; selection and educational requirements; registration, licensure and certification; recruitment and deployment; adequate and sustainable remuneration; mentoring and supervision including referral system; career path and continuous education; performance evaluation; supply of equipment and commodities. The study concludes that, where there is the necessary support, the potential contribution of CHWs can be optimized and represents a valuable addition to the urgent expansion of human resources for health, and to universal coverage of HIV services.

Client and Provider Perspectives of the Efficiency and Quality of Care in the Context of Rapid Scale-Up of Antiretroviral Therapy

“…To address the shortage of manpower needed to meet the ever-increasing workload associated with scaling up of HIV care, ART programs are increasingly incorporating HIV clients into the clinic's work force, assisting with adherence education and support, and nontechnical tasks such as clerical support. [15][16][17] Unlike Mulago and MMC, ROM places a strong emphasis on utilizing volunteers, most of whom are HIV clients, and has documented that their community-based approach to providing care results in similar quality of care and clinical outcomes as more conventional models. 12 We observed glaring bottlenecks in management of medical records across all the three clinics.…”

Attitudes of medical school deans toward interprofessional education in Western Pacific Region countries

“…Several initiatives have been taken at the working level to respond to the worldwide crisis, including task shifting (Celletti et al, 2010), interprofessional collaboration, skill-mixing and so on. In the Framework for Action on Interprofessional Education & Collaborative Practice issued by the World Health Organization in 2010, interprofessional education (IPE) will play an important role in mitigating the global health workforce crisis on the basis of findings indicating that effective IPE enables effective collaborative practice (CP).…”

Staff attrition among community health workers in home-based care programmes for people living with HIV and AIDS in western Kenya

“…The HBC programme draws upon actors ranging from well-trained health care professionals to community health workers (CHWs) who work with family members [5]. The CHWs contribute significantly to HIV services delivery [6], particularly because they help to expand primary health care services to underserved and remote areas [7]. The CHWs are trained in the hope that they can improve prevention and provide support to families affected by HIV and AIDS in their communities and refer patients with complications to specialists for further treatment [8].…”