TAILIEUCHUNG - Community Health Workers: a review of concepts, practice and policy concerns

Therapeutic patient education* has brought about a significant de- crease in the number of hospital admissions of patients with bronchial asthma or diabetic coma. In addition to a decrease of lower limb am- putations it has resulted in a better quality of life by delaying amputa- tions in 75% of cases 6 . There is a need to emphasize the role of patients’ families and significant others in long-term care. Therapeutic patient education* of quality must include the educational and psychological-support roles of the families and significant others of patients receiving long-term care. It is essential to the long-term well-being of patients that. | Community Health Workers a review of concepts practice and policy concerns1 Prasad BM VR Muraleedharan August 2007 Prasad BM BDS MPH Project Officer CREHS IIT Madras Chennai India VR Muraleedharan PhD Professor of Economics Department of Humanities and Social Sciences IIT Madras Chennai India 1 This review is a part of ongoing research of International Consortium for Research on Equitable Health Systems CREHS funded by UK Government Department for International Development DFID lead by London School of Hygiene Tropical Medicine LSHTM UK. For more details please visit http 1 1. Introduction The global policy of providing primary level care was initiated with the declaration of Alma-Ata in 1978s. The countries signatory to Alma Ata declaration considered the establishment of CHW program as synonym with Primary Health Care approach Mburu 1994 Sringernyuang Hongvivatana Pradabmuk 1995 . Thus in many developing countries PHC approach was seen as a mass production activity for training CHWs in 1980s Matomora 1989 . During these processes the voluntary health workers or CHWs were identified as the third workforce of Human resource for Health 1 Sein 2006 . Following this approach CHWs introduced to provide PHC in 1980s are still providing care in the remote and inaccessible parts of the world WHO 2006a . In this paper we attempt to a provide an overview of the concepts and practice of Community Health Workers CHWs from across a range of developing and developed countries and b draw some insights into policy challenges that remain in designing effective CHW schemes particularly in the Indian context. In the subsequent sections we provide a review of the various ways in which community health workers have been deployed in different settings. To arrive at this we adopted a systematic search of literature on CHWs using key words such as community health worker primary health care worker community based health care worker lay health worker we also used the

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