Thanks to everyone for the valuable insights to the CHW discussion each day. I’d like to respond in one go – for which I apologize, but my thoughts are cross-cutting, stimulated every time I read another contribution.
There is clearly critical evidence that CHWs can provide missing care to people who often have no care at all. However, the care provided has to be consistent with the skills that CHWs have, and across countries and even within countries, there are different types and levels of training, hence different skills levels. We have also seen that CHWs can safely and effectively provide parts of care chains in specialist areas – the treatment of TB for example, or the prevention and early detection of Malaria. This is laudable and cost-efficient, as studies point out – because CHWs are cheap.
Now I begin to worry a bit: are we saying then that what the world needs is CHWs rather than other types of health workers – because the world can afford CHWs and not health workers? No-one has actually articulated this actual sentence, but no-one has articulated either what the overall plan is. Are CHWs envisaged as a temporary solution to the health workforce crisis- or a permanent one? If the solution is temporary then what may be required is a career path that enables the CHW to progress into well paid employment as a health worker. Even well qualified health workers have difficulties progressing up the career ladder in low income settings – where are the jobs and where is the money?
To really address the health workforce crisis, what is needed is investment in the health system and especially the health workforce. CHWs have a vital role as a member of a dynamic health team with a range of competencies to deal with the total disease burden of a community.
For CHWs to be really clinically successful they have to have a reliable referral system, that ensures that people get seen quickly, when needed, at each level of the health care system. Yet where CHWs are envisaged as the solution to health workforce shortages, the referral systems are the weakest also. CHWs are important as one cadre in the health worker team, but they are definitely not the panacea for what ails health systems. There is no panacea. What is needed is for governments to choose to invest in healthy populations by developing stronger health systems and well paid, highly valued health workers, no matter what title they have.
Barbara Stilwell | Senior Director of Health Workforce Solutions
IntraHealth International | Because Health Workers Save Lives.
t. +1 (919) 313-9161| firstname.lastname@example.org