By Kate Hawkins
We’re big fans of Health Systems Global and the symposium that they hold every couple of years. Their next conference is coming up in November in Vancouver and we hope you will join us there to find out more about the work we are doing on community health workers. Details of our poster presentations will be released shortly, but you can put the dates of our panel sessions in your diary right now!
We all want to improve the quality of health services – but how can we do it in practice? This session will explore the challenges to embedding quality improvement in close-to-community programmes in Bangladesh, Kenya, and Malawi and suggest some way they can be overcome.
Recent investments and support to community health workers (CHWs) and other close-to-community services are to be welcomed, not least because these programmes provide a valuable link between communities and the health system and can foster a more effective approach to the social determinants of health and universal health coverage. However, scale up of services without a simultaneous focus on addressing quality will have limited impact on population health and has the potential to further entrench inequality.
Multiple project-led quality improvement initiatives in community health programmes have been shown to be effective in temporarily increasing CHW performance and effectiveness. This is particularly the case for programmes that describe tasks in a single disease area, where proven effectiveness of narrowly focused interventions is not sustained after the end of donor or research funding.
The challenge now it is to transition knowledge from these individual quality improvement efforts to a district-led health systems approach to embedding quality that ensures the local ownership of data collection, analysis and use for quality efforts at community level and is able to negotiate and sustain this in a complex system.
Some health programmes which are technically sound fail to deliver the expected change or results; a lack of institutional and political capacity to deliver reform can help explain some of these problems. Understanding how political structures, power relations and historic legacies shape the motivations of different stakeholders and the behaviours within systems is therefore an important piece of the puzzle, alongside considering the financing gaps or technical understanding of what works for health reforms. This means looking at the incentives and norms that explain why and how heath systems operate as they do – in other words, the political economy of those systems.
The purpose of this session is to use case studies to explore the complexities of embedding quality improvement efforts in community health programmes in Africa and Asia and discuss how these efforts can be designed to ensure sustainability.
Community health workers (CHWs) play a central role in linking communities to health systems and thereby making health systems more people-centered. This panel session focuses on the need and strategies for strengthening the voices of CHWs, which are essential in building resilient and responsive health systems.
Over the last decade, the role of CHWs within health systems in low- and middle-income countries has gained interest. CHWs can connect communities to health facilities, increase access to health services for underserved populations and improve population health outcomes related to HIV/AIDS, maternal and child health. CHWs often work in a context of poor infrastructure and constrained resources. Even in highly fragile settings or during disasters, CHWs have demonstrated to be invaluable frontline health workers, playing a role in emergency response, health promotion, social mobilization and referral. The Ebola epidemic in West Africa has proven once again the important role that CHWs have for building resilient and responsive health systems. To be able to maintain and expand this role, there is a need to identify strategies for strengthening the voice and engagement of CHWs.
The purpose of this session is to explore what research, policy and practice can do to enhance the voice of community health workers in building resilient and responsive health systems. The session will highlight personal stories from CHWs in the field in various health system settings and experience of active engagement of CHWs in health system research.
The session falls under the thematic area of new partnerships and collaborations for health systems research and development. Recently, research has increasingly included voices of CHWs, to gain in-depth knowledge on how policies, programmes and interventions could be shaped to optimize CHW performance and enhance their role in building resilient and responsive health systems. Still, CHWs’ voices are often unheard. The session will discuss to what extent CHWs’ voices are taken on board in policy making, programme development and overall learning, and issues to take into account to ensure meaningful participation that supports the role of CHWs. The session will present various case studies in which CHWs take the floor, after which learning points will be discussed on strategies for strengthening the voices of CHWs in building resilient and responsive health systems.
This project is funded by the European Union.