Community health workers as a cornerstone for integrating HIV and primary healthcare

Abstract

Haiti is the poorest and most heavily HIV-burdened country in the Western hemisphere, with even less health infrastructure than many countries of sub-Saharan Africa. Since the early 1980s the HIV epidemic has affected the poorest communities in Haiti, who lack access to even basic healthcare. Large-scale HIV treatment requires that basic healthcare services be built and scaled up simultaneously with HIV-prevention and -care programmes. Such improvement in access to general healthcare will require substantial investments in health infrastructure, service delivery and human development. This study describes the contribution of the non-governmental organization, Zanmi Lasante (ZL) to the HIV prevention and treatment scale-up and to the ongoing efforts to improve primary healthcare (PHC) services in the public health system in Haiti. The model depends on community health workers (CHWs) who supervise antiretroviral therapy (ART) and provide community outreach, including active case finding and outreach to marginalized populations. Zanmi Lasante has recruited, trained and financed a large cadre of CHWs to provide such linkages between communities and health centres in rural Haiti. The study analysed key components of their work--their self-perception, their role in enhancing community uptake of services and their role in targeting vulnerable groups. We found that most patients at risk were properly identified at a community level. The CHWs are facilitating the uptake of PHC services, including by the most vulnerable households. The general training of CHWs has created a positive self-definition in these cadres of their medical, patient support and health service roles; although with some variability across different groups. The results of this study will be used to emphasize, standardized and strengthen the biosocial training of CHWs.

The future of health in Zimbabwe

“…Some innovative ways to strengthen the health workforce would be: (1) to encourage retention and motivation of current workers through better, safer work environments; (2) to build leadership capacity in the workforce, potentially by mobilizing the Zimbabwean health diaspora to engage in training and skill-building among the current workforce [3]; and (3) to place a greater reliance on mid-level and non-specialist providers [32] and on community members including community health workers (CHWs) [33–36] and traditional healers [37–40]. …”

“…This will mean hiring Zimbabweans, building capacity, and listening carefully to local priorities. Community health models, often using community health workers, have been successful in many areas of global health including HIV/AIDS, child health, malaria, and tuberculosis [33,35,36]. Although a village health worker program was installed in the 1980s via the Health Transition Fund, this effort was limited by a lack of true community participation and a bureaucratic top-down approach where decisions were still made by the Ministry of Health [2].…”

The relationship between knowledge of HIV, self-perceived vulnerability and sexual risk behavior among community clinic workers in Chile

“…However, the criteria for defining suitable knowledge and the instruments used for measuring knowledge level have varied between studies and research findings have been contradictory. Some studies have suggested that health workers have a "sufficient level" of knowledge (7,8) but others have reported deficient knowledge in several areas like prevention, transmission, diagnosis and treatment (9,10). A few studies in Chile have analyzed secondary and tertiary level health workers' HIV knowledge and found their knowledge to be deficient regarding transmission (11).…”

Learning from diverse contexts: Equity and inclusion in the responses to AIDS

“…The voluntary work that people, often women, do in community organisations takes them away from their own homes and draws heavily on personal resources. While the Haiti study shows that community health workers improve the outreach and effectiveness of health services, not S86 R. Loewenson all services finance this contribution as the Haiti services do (Mukherjee & Eustache, 2007). The studies also signal that the withdrawal or weakening of the state has left communities disadvantaged and, conversely, that strong public and community institutions are critical for an equitable response.…”

“…There are some contrasting positive examples as well: the international resource support to the provision of integrated primary healthcare in Haiti in ways that seek to reinforce the public sector infrastructure, linking communities to services through community health workers, provides one example of such vertical connections (Mukherjee & Eustache, 2007). The support by KENWA to provide treatment to women in the Nairobi informal settlements is another.…”