Community Health Workers – an important resource towards achieving the MDGs
Author: AMREF Tanzania
Country: Tanzania
Challenges
The Tanzanian health system is faced by a number of important challenges, including the chronic shortage of well-trained, motivated and equitably deployed health workers at all levels. The problem is exacerbated in the rural areas where over 70% of the population resides, but where the human resources for health challenges are greatest. Although a government strategy on Human Resources for Health (HRH) (2008 – 2013) exists, shortages and inequalities in distribution prevail across all cadres, and health worker productivity, performance and retention are poor. At the district level, 40% of positions remain vacant. Many health workers lack the necessary qualifications and skills to deliver quality health services. At the national level, systems for re-tooling, task shifting and continuing professional development of health workers are weak. At both national and local government levels, support and supervision systems are ad hoc.
Policy description
AMREF Tanzania recognizes the important role played by Community Health Workers (CHWs) in meeting the health MDGs. For example, CHWS can sensitize community members on the importance of pre- and post-natal care, and of having a skilled health worker to attend births. In Kilindi district AMREF has trained CHWs to provide vital support through assisting in healthcare provision. These CHWs are mobilizing the community, raising awareness on sexual and reproductive health and rights (SRHR) and HIV/AIDS, by organizing meetings, forums, providing door-to-door advice, and through unstructured peer discussion. The CHWs also visit and advise pregnant mothers to attend MCH services, encourage them to deliver at the healthcare centre, and report harmful cultural practices, including female genital mutilation (FGM), to village leaders.
AMREF-trained Community-Own Resource Persons (CORPs) and Peer Educators on sexual and reproductive health and rights are well accepted by the communities of which they are a part. In Mtwara, AMREF has trained CHWs to provide house-to-house health education on safe motherhood, including on the importance of ante-natal care attendance, and the use of intermittent preventive treatment (IPT). CHWs have also been trained to provide counselling and nutrition education for pregnant women and their newborns, family planning education, the distribution of contraceptives, and the provision of technical support on the running and maintenance of the Community Referral Fund.
Outcomes
The presence of CORPS and Peer Educators in the community has increased the confidence of young people in speaking out about sexual and reproductive health issues. People served by the project express clearly that the project has improved access of people to quality SRH services and hence has played a significant role in reducing the diseases burden and improving their quality of life. Documented outcomes include:
- Increased awareness of HIV/AIDS within communities;
- Increased and correct usage of condoms in communities;
- More cases of severe convulsions and malaria are being referred to health facilities rather than traditional healers.
Conclusions
Based on the lessons learned from programming in Tanzania, AMREF advocates for the integration of CHWs into the revised HRH strategic framework, including the development of new strategies to enable CHWs to contribute more effectively to improved maternal and newborn health outcomes. CHWs must be expected to do a limited number of tasks, which complement the work of health professionals, and should receive continuing support and supervision by mid-level health workers in health facilities.