Early Lessons From Launching an Innovative Community Health Household Model Across 3 Country Contexts

Abstract

Assigning community health workers to households, as opposed to individuals, is a feasible and functional method for structuring how community health can contribute to implementing universal health coverage.

A household-based community health worker programme for non-communicable disease, malnutrition, tuberculosis, HIV and maternal health: a stepped-wedge cluster randomised controlled trial in Neno District, Malawi

“…Assigning CHWs to every household, called the HHM, is increasingly common. 30 Our results provide evidence that such a model can expand health coverage by reducing default rates from chronic care and improving uptake of ANC. Importantly, existing HIV programme success was not harmed by the expansion of the CHW role; we did not anticipate or observe changes in HIV retention in care, given long-term survival and retention rates above 90% in Neno district prior to the study.…”

Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All”

“… The Brazilian experience informs us that a comprehensive, life-course approach is entirely feasible providing that the number of households assigned to each CHW is reasonable (currently 150–200 in Brazil) [ 53 ]. Based on the available evidence on which interventions for NCDs (including mental health conditions) can be effectively delivered by CHWs [ 54 – 59 ], consider whether incorporating some or all of these functions into existing CHW programmes is feasible, acceptable, promotes equity, and is cost-effective. Support research into how to sustain at scale the role of generalist CHWs (not funded under vertical programmes) in: identifying those with conditions of public health importance (e.g., HIV, tuberculosis, hypertension, diabetes, obesity, mental illness, persons with surgically treatable conditions) as well as conditions of local need (e.g., readily preventable or treatable health problems of the elderly such as presbyopia, palliative care for those with terminal conditions, pain control, basic needs for improved water and sanitation, and so forth), linking them to treatment, and serving as first-line providers of treatment under controlled conditions, with appropriate supervision and support.…”

“…Based on the available evidence on which interventions for NCDs (including mental health conditions) can be effectively delivered by CHWs [ 54 – 59 ], consider whether incorporating some or all of these functions into existing CHW programmes is feasible, acceptable, promotes equity, and is cost-effective.…”

Strength in Diversity: Integrating Community in Primary Health Care to Advance Universal Health Coverage

“…Palazuelos et al describe adopting a community health model in 3 countries, broadening from a focus on individuals with HIV, multidrug resistant-TB, and noncommunicable diseases to a whole-household approach. 24 Napier et al look at the successes of reducing malaria in Lao People's Democratic Republic and Honduras and the need for expanding the roles and responsibilities of CHWs as community needs shift. 25 Downey et al stress the importance of orienting to policies that track CHW knowledge as a performance metric and that promote quality service delivery in CHW programs.…”

“…21 Palazuelos et al discuss a cross-country learning process and the experience of a near-facility CHW program building trust between communities and health care teams. 24 Two articles describe experiences from Kenya and include an in-depth discussion on the policy process over the last 15 years 23 and the use of human-centered design to address a specific issue regarding the commodity supply chain among nomadic communities. 28…”