Achieving impact: supporting and motivating frontline health workers
Malaria Consortium renews its commitment during World Health Workers Week to supporting those health workers to bring care to those in need, and in particular some of the world’s most vulnerable children.
This year’s theme focuses on human resources for universal health coverage; defined as everyone having access to a skilled, motivated, supplied and supported health workers within a robust health system. Achieving universal health coverage with the support of motivated and supported community health workers is crucial to meeting the Millennium Development Goals and should remain a key focus of the post-2015 agenda.
“World Health Workers Week is an opportunity for national and international policy makers to take notice of the impressive and life-saving work community health workers do,” says Dr James Tibenderana, Malaria Consortium’s Africa Technical Director. “Since 2009, Malaria Consortium has trained over 15,000 community health workers to diagnose and treat children suffering from malaria, pneumonia and diarrhoea. We are passionate about showing our appreciation to these community health workers who are saving the lives of children across sub-Saharan Africa.”
Malaria Consortium has trained community health workers (CHWs) in Mozambique, South Sudan, Uganda and Zambia in integrated community case management (ICCM). Under this programme, CHWs are trained to conduct health promotion activities and to diagnose and treat three of the leading causes of death in children under five – malaria, pneumonia and diarrhoea. This training enables CHWs to recognise danger signs in newborns and under-fives so that they can be referred to the nearest health facility.
Access to healthcare remains challenging for communities living in remote regions, due to a lack of transport as well as poverty. This strategy aims to reduce mortality among under-five children by up to 35 percent, bringing diagnosis and treatment closer to home. It is estimated that over 1.5 million children have received treatment as a result of Ministry of Health led and Malaria Consortium supported ICCM programmes in these four countries.
CHWs are usually members of the village or community in which they are working and are given a formal training in order to perform the tasks they are expected to. Depending on the country and health system, this training from several days to up to six months. CHWs also have very different tasks and responsibilities and can be volunteers or paid a small salary for their commitment.
Highlighted by World Health Workers Week, some of the key challenges facing CHWs around the world are a lack of supplies, supervision and the retention of trained and motivated community health workers.
A recent report published by the Johns Hopkins Bloomberg School of Public Health on the effectiveness of community health workers and their ability to accelerate progress in achieving the health-related Millennium Development Goals highlighted the importance of effective linkages between CHWs and the formal health system for supervision, continuing education, receipt of supplies and medicines, and referral of patients.
Supportive supervision is often seen as the most challenging part of any CHW programme, and impacts greatly on motivation and retention; new and effective strategies are needed to address this challenge. For this reason, the inSCALE project supported by the Bill & Melinda Gates Foundation is conducting research on innovative strategies to improve CHW motivation, performance and retention in Mozambique and Uganda. Results from a randomised control trial have the potential to influence policy around CHW retention in these countries and more widely.
Mozambique and Uganda are implementing technology based interventions as part of the trial. In both countries CHWs and their supervisors are given mobile phones which have access to a closed user group on their phones in order to increase communication and support. CHWs are able to report on their weekly patients through the mobile phone, providing the district biostatistician with important data on number of patients seen, number of referrals and supply of medicines. In addition, CHWs’ phones contain innovative tools such as respiratory timers to support their work in pneumonia diagnosis.
In Uganda, a community based intervention is also being implemented, focusing on the set-up and running of Village Health Clubs. These are designed to be highly participatory with the CHWs in the role of facilitator, aimed at increasing awareness about the CHW role and improving motivation through the support of the community.
“There are still challenges, like the work itself and that the medicines are not always enough,” says Julius Barakuraha, who has been a CHW in the mid-western region of Uganda since 2010. “But being in contact with my supervisor on a regular basis is very exciting.”
Dr Tibenderana concludes “The ICCM strategy has the potential to reduce childhood mortality from, malaria, pneumonia and diarrhoea by 40%; we should continue to support and retain community health workers to achieve this.”
 HOW EFFECTIVE ARE COMMUNITY HEALTH WORKERS? An Overview of Current Evidence with Recommendations for Strengthening Community Health Worker Programs to Accelerate Progress in Achieving the Health-related Millennium Development Goals. Perry, H; Zulliger, R; 2012
Malaria Consortium is an international public health NGO working in Africa and Asia to control malaria and other common childhood diseases like pneumonia and diarrhoea. The organisation uses innovative strategies and approaches to work with partners and governments to improve the health of individuals and communities.
The main causes of death in children under five are malaria, pneumonia, diarrhoea, neonatal conditions and HIV.
Malaria Consortium conducts several programmes in ICCM of pneumonia, diarrhoea and malaria in Mozambique, South Sudan, Uganda and Zambia.
Eleni Capsaskis Regional Communications Specialist-inSCALE
Malaria Consortium Uganda Plot 25, Upper Naguru East Road P.O Box 8045, Kampala
Tel: +256 (0) 312 300420 Mob: +256 (0) 772744358 Skype: leniuli