Community Health Workers at the Millennium Villages Project increase access to the health workforce

Author: The Millennium Villages Project (MVP)
Countries:

A successful project which focuses on community health workers delivering basic healthcare services to strengthen health systems. With around 90% of community health workers staying in these rural areas, this had led to a dramatic reduction in conditions such as malaria prevalence, malnutrition, and improvements in infant vaccination programs.

CHW checks on child to ensure that they are ok
© Millenium Villages Project
CHW checks on child to ensure that they are ok

Challenges

Three of the eight MDGs set by world leaders in 2000 at the World Millennium Summit are directly related to health. Two important targets include reducing child and maternal mortality. The Millennium Villages Project (MVP)’s main aim is to achieve the MDGs in showcase village clusters through proven interventions in 10 countries across 14 sites in different agro-ecological regions.

Policy description

Within the health sector the MVP emphasizes the delivery of a free minimum package of primary healthcare services at the village level. The project has built infrastructure such as primary health care clinics and provided inputs to referral clinics with an aim of strengthening health systems. A major component of the project involved the use of approximately 800 professional and paid Community Health Workers (CHWs) in all its 14 sites.

CHWs provide a variety of health care services to underserved communities who usually do not have access due to a lack of transport, long distances from health facilities and lack of finances. CHWs focus on key issues affecting these areas, such as child and maternal health as well as the prevention and treatment of diseases such as malaria, diarrhea, child malnutrition, TB and HIV/AIDs.

CHWs are chosen by the community through Village Health Committees. They are given initial training in key areas such as community health, child and maternal health, malaria, HIV/AIDs and TB, and are given refresher training throughout the year. Clear task profiles are created and all are given the necessary resources to fulfill their roles (including mobile phones, airtime credit, bicycles, back pack with medical supplies etc). A clear management structure is in place, remuneration is paid on a regular basis and a system of financial and non-financial incentives has been put in place to ensure CHWs remain motivated. Multiple levels of assessments are conducted on a regular basis to assess CHWs, as well the project itself, and these are used to proactively address problems as they arise. CHWs have also started making use of an innovative mobile telephony platform whereby text messages containing real time health information are sent as part of the project’s data collection activities.

Outcomes

It is in the innovative approaches to the management of CHWs within the project that MVP has achieved many of its health-related goals. The MVP CHW project has created a structure that provides adequate support, resources, incentives and management for CHWs. This ensures that they have both the capacity and motivation to provide quality health services to communities.

The project currently has a retention rate of around 90% for CHWs. This has led to a dramatic improvement in essential health outcomes, such as reduction in malaria prevalence, malnutrition and large increases in the number of children immunized in the communities served by the MVP. The project has also facilitated the collection of timely health care data in areas where previously no such data existed.

Conclusions

Governments should rethink existing Human Resources for Health plans and reform them to cost for and scale up CHWs programs as a paid and professional part of their national health systems. The MVP experience provides proof that if CHWs are well motivated, supervised, and remunerated; they can accomplish great results and strengthen existing country health systems.

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