PHM-Exch> Lay or community health workers can improve the health of children (3)

[Claudio Schuftan]

>From Ted Lankester <tedlankester at hotmail.com>


> I can think of several examples of sustainability, eg, the Jamkhed Project
> in India. www.jamkhed.org
>
> From Khandker Hakue hakuekmr at gmail.com

> Other than the practitioner type, such as Traditional Birth Attendants or
> (Unqualified) Village Doctors, who are usually paid per case basis, I did
> not find communities supporting Health Workers on a long term basis.
> Non-accredited paramedical workers, when trained from a reputed
> organization, e.g., Gono Shasthaya Kendra (GK) in Bangladesh, are recruited
> by NGOs or Private Health Care Providers (bypassing the formal health care
> sector).
> Along with Massimo Serventi, I shall also appreciate (challenging experts)
> receiving LHW experiences being supported sustainably by the community on a
> long term basis.
> Reza Haque
> 37 years in Public Health
>
>
> From Camila Giugliani <giugli at hotmail.com>
>
>>
>> LHW can mean a wide variety of types of workers involved in
>> community-based interventions: small or large scale, volunteer or non
>> volunteer, etc. It's really hard to reach a conclusion considering such a
>> wide variety of modalities in terms of community health workers.
>> What I would like to contribute here is with the specific case of Brazil
>> in mind and a little bit about Angola.
>> In Brazil, the Community Health Workers Program was implemented on a
>> national basis since 1991. It first started in the poorer or most vulnerable
>> regions of the country, but it quickly expanded to the whole country. From
>> 1991 to 1994, it worked as a program consisting of CHWs working under the
>> supervision of a nurse. Since 1994, the CHWs were integrated in the Family
>> Health Team, and started working together with physicians and nurse
>> technicians, besides nurses. From the beginning, the CHWs have been
>> remunerated by the local governement, and were part of the public health
>> system. But only in 2002 was the CHW recognized as a "profession". Today,
>> there are more than 230 thousand CHW working in Brazil's National Health
>> System, most of them as part of a Family Health Team, which is the national
>> strategy for Primary Health Care. In a very summarized way, I just want to
>> say that, besides all the problems in really guaranteeing equitable access
>> and good quality health care, the CHWs in Brazil have played a very
>> important role in reviving PHC, and have been considered to have made an
>> important difference in the Family Health Strategy's achievements, such as
>> reduction of infant mortality and of hospital admissions nationally. What is
>> determinant of this large (enormous) scale experience is that it was a
>> public policy from the beginning, and that CHW are health professionals
>> integrated in the health system (still struggling for better remuneration
>> though, and better training).
>> In Angola, the Public Health Department of Luanda has launched a CHW
>> Program very much inspired in the Brazilian model. But it was launched with
>> provisional and limited funds, and not as a public health policy included in
>> the state's budget. So the program went quite well in the beginning and is
>> now facing the problem of where to go from now on, since the provisional
>> funds are over. Because of the provisional character of the program, CHW
>> were recruited as volunteers and payed with small incentives. The moment is
>> critical: either the governement will decide to invest in this as a public
>> policy, or the program will probably end.
>> So these are two short examples to contribute to the discussion.
>> If anyone's interested in more details about any of the cases, I'll be
>> happy to exchange more.
>>
>> from Porto Alegre, Brazil
>>
>
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