PHM-Exch> PHC success relies on CHWs being able to do more - learning from Thailand, Brazil, Rwanda

[Claudio Schuftan]

From: Bridget Lloyd <blloyd at phmovement.org>

http://www.health-e.org.za/news/article.php?uid=20033611

PHC success relies on CHWs being able to do more


 *CAPE TOWN - South Africa needs to urgently look to countries such as
Rwanda, Thailand and Brazil, where they have employed community health
workers (CHWs) to deliver a range of primary health care services that
dramatically reduced mortality, public health expert Professor David
Sanders told the National Health Assembly (NHA).*

Speaking during yesterday’s (THURS) plenary session, Sanders said by
extending the scope of what CHWs could do and by supporting properly
selected and trained individuals, the country could make a very real impact
on maternal and child mortality.

For many years the head of the School of Public Health at the University of
the Western Cape, Sanders is an iconic figure in the field of public health
internationally.

His work has contributed hugely to the understanding of primary health care
as a framework for health and development, and to improvements in child
health through research, teaching and training, and policy advocacy and
service development.

The appointment of part-time CHWs could create between 400 and 500 000
jobs, Sanders said.

He added that it was critical that these workers would among others be
allowed to do HIV tests, pregnancy tests, Vitamin A supplementation, the
distribution of family planning, oral rehydration therapy and zinc for
diarrhoea, deworming, malaria treatment and prescribe antibiotics for
pneumonia, one of the biggest killers of children.

The current proposed workload for CHWs was impossible and would lead to the
re-engineering of South Africa’s primary health care system failing, Sander
warned.

Sanders accused nurses and doctors of being the main forces opposing the
extension of the scope of practice of these CHWs.

“We need to reduce the power of conservative heath professional bodies such
as the Health Professions Council and the Nursing Council or we will be in
the same place in 10 years time,” he added.

“If we get the unions to agree and we appoint these part-time CHWs, we
could get the coverage attained in places like Thailand and Rwanda,” said
Sanders.

Sanders said it was also critical for South Africa to stand up to the
industries dominating the unhealthy food environment and in essence driving
the obesity epidemic.

He said local such as Tiger Brands and internationals such as Nestle and
Parmalat dominated with supermarkets supply up to 60% of food to households.

“And our government says Walmart is welcome,” he said.

A survey conducted by Sanders and fellow researchers revealed that between
2005 and 2010 the consumption of ready made meals went up by 43 percent in
South Africa and that of unhealthy snacks bars, also by 43 percent.

Sanders pointed out that South Africa had the lowest rate of exclusive
breastfeeding in the world (8% of infants under 6 months) with government
allowing infant formula feed companies to “get right inside our health
system”.

Health and social justice activists as well as health ministers and key
policy makers from across the world are meeting in Cape Town this week to
address the drivers of inequity which fundamentally impact on the health of
the poor.

The NHA, which focuses on South Africa, ends today (FRI) after which health
minister Dr Aaron Motsoaledi will open the international People’s Health
Assembly this afternoon (FRI).
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