PHM-Exch> Lay or community health workers can improve the health of children

[Claudio Schuftan]

 from  <Leslie.London at uct.ac.za>,


Lay health workers may have a significant impact on people’s health, a new
Cochrane systematic review shows. Lay or community health workers are
members of the community who have received some training to promote health
or to carry out some health care services but are not healthcare
professionals. The new review concludes that lay health workers probably
have an impact on breastfeeding, immunisation uptake and tuberculosis
treatment results, and may reduce child illness and death. There is now
evidence from a wide range of settings to suggest that lay health workers
may have beneficial impacts on a range of common health issues in primary
and community care.



After searching for all relevant studies, authors found 82 studies from a
number of different settings. In the included studies, lay health workers
worked among people in low income areas in wealthy countries, as well as
among people living in poor countries. These lay health workers undertook a
range of tasks including giving help and advice about issues such as child
health, child illnesses, and medicine taking. In some studies, lay health
workers also treated people for particular health problems.



The review shows significant results in areas that could potentially have
important impacts on child health and on the achievement of key Millennium
Development Goals. In particular, the use of lay health workers, compared to
usual healthcare services, probably leads to an increase in the number of
women who breastfeed their child and the number of children who have their
immunization schedule up to date. The review also indicates that lay health
worker programmes may decrease the number of children who suffer from fever,
diarrhoea and pneumonia and the number of deaths among children under five.
Lay health workers may also increase the number of parents who seek help for
their sick child.



In addition to child health, the review also considers the use of lay health
workers to support people receiving treatment for tuberculosis. The review
concludes that the use of lay health workers, compared to people helping
themselves or going to a clinic, probably leads to an increase in the number
of people with tuberculosis who are cured. However, such programmes probably
make little or no difference in the number of people who complete preventive
treatment for tuberculosis.



This review is highly relevant to current policy debates internationally,
given the growing interest in lay health workers as a way of addressing the
human resource crisis in health care in many low- and middle-income
countries. It also has implications for strategies to extend services to
'hard to reach' groups and areas in both wealthy and poor countries. Task
shifting to lower levels of providers is currently much discussed. The
review suggests that lay health workers could be used to deliver a range of
maternal and child health services usually delivered by professionals.



This work was funded by the Research Council of Norway.

 Contact persons for more information:

SusanMunabi.Babigumira at nokc.no   karen.daniels at mrc.ac.za

For a summary of the review see:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004015/frame.html



For further information on this programme of work on lay health workers,
see: www.sintef.no/layvac



Full reference for the review:

Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van
Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M, Scheel IB. Lay
health workers in primary and community health care for maternal and child
health and the management of infectious diseases. Cochrane Database of
Systematic Reviews. 2010.



 *Plain language summary for the review:*

The effect of lay health workers on mother and child health and infectious
diseases

A review of the effect of using lay health workers to improve mother and
child health and to help people with infectious diseases was carried out by
researchers in The Cochrane Collaboration. After searching for all relevant
studies, they found 82 studies. Their findings are summarised below.



What is a lay health worker?

A lay health worker is a member of the community who has received some
training to promote health or to carry out some healthcare services, but is
not a healthcare professional. In the studies in this review, lay health
workers carried out different tasks. These included giving help and advice
about issues such as child health, child illnesses, and medicine taking. In
some studies, lay health workers also treated people for particular health
problems.



The studies took place in different settings. In many of the studies, lay
health workers worked among people on low incomes in wealthy countries, or
among people living in poor countries.



What the research says

The use of lay health workers, compared to usual healthcare services:

- probably leads to an increase in the number of women who start to
breastfeed their child; who breastfeed their child at all; and who feed
their child with breastmilk only;

- probably leads to an increase in the number of children who have their
immunization schedule up to date;

- may lead to slightly fewer children who suffer from fever, diarrhoea and
pneumonia;

- may lead to fewer deaths among children under five;

- may increase the number of parents who seek help for their sick child.



The use of lay health workers, compared to people helping themselves or
going to a clinic:

- probably leads to an increase in the number of people with tuberculosis
who are cured;

- probably makes little or no difference in the number of people who
complete preventive treatment for

tuberculosis.
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