As mentioned in my first series of updates, I attended an interesting side session to the WHA on CHWs and UHC organized by World Vision International (WVI). CORE's old friend, Tom Davis, facilitated the session. I'm too lazy to write all my notes about it, but I thought that one introductory presentation, in addition to being short [I'm a believer, but I'm not practicing] hit a lot of key points through the experience of WVI in different countries.
I'll try to have one more update on my time at WHA after that. But for now, I'm ceding the floor to Dan Irvine, Sr Director, Sustainable Health, WVI - here is his text with slides.
Now let’s
talk a bit more about the next generation of CHWs… In 2015 I directed a census of CHWs being
supported by World Vision in 48 countries around the world. One of the outcomes of our census that I found
particularly intriguing was this analysis of the diverse activities they were
engaging in – 25 activities in all. As
you consider the proportion of engagement in each activity, bear in mind that
this is based on 220,000 CHWs we supported at the time.
Last year we
were thrilled to see publication of the Nurturing Care Framework for Early
Childhood Development, which calls for an integrated approach towards the young
child cohort inclusive of health, nutrition, water and sanitation, early
stimulation, child protection and caregiving.
The framework suggests a critical role for the frontline health
workforce in these objectives as this cadre most typically engages families in
regards the well-being of young children.
In our experience, once again it is CHWs that present one of the best
opportunities to support this multi-sector approach.
pkins and Al Quds universities to evaluate impact of the approach in a
number of countries. In this example in
Palestine we found that inclusion of psychosocial first aid and early
stimulation components resulted in significant gains across three standardized
ECD scales, with positive effects for mothers as well as the children.
I'll try to have one more update on my time at WHA after that. But for now, I'm ceding the floor to Dan Irvine, Sr Director, Sustainable Health, WVI - here is his text with slides.
*****
The
Universal Health Coverage goal today is presenting us a seemingly
insurmountable challenge: 50% of the world’s population does not have access to
health services; there is a current gap of 18 million healthcare workers.
Additionally,
the UHC agenda is opening up a realm of health and well-being issues that
historically have not been prioritized - issues like mental health, early child
development, violence, sexual and reproductive health, non-communicable
disease, and nutrition. Our colleagues
in the health system, and particularly at the front lines, are increasingly
straining to effectively address these needs.
So who
better to ensure that all people, everywhere, are reached with diverse health
services than community health workers? CHWs
have always been at the heart of the Primary Health Care movement. Since Alma Ata they have represented one of
our strongest links between formal health systems and communities.
We know
today that CHWs are successful health agents when they are appropriately
supported. The WHO CHW guidance
published last year, and the CHW resolution that will be passed in this 72nd
world health assembly, are testaments to a new global confidence in the
potential of CHWs, supported by an ample evidence base. WHO notes that CHW platform support has been
“uneven”, and in my experience that is certainly true. World Vision frequently employs the CHW
Assessment and Improvement Matrix to assess CHW program functionality, and we
often identify sub-optimal support, for example in supportive supervision and
incentive structures.
This has to
change. I believe one of the key
messages of this session today is to advocate utilization of excellent
available global CHW guidance, including the most recent WHO guidance, as well
as many other important tools, some of which are listed on your handouts. We should not be seeing today gaps in CHW
platforms that have been identified consistently over the past years as
marginalizing CHW results. We have
identified these challenges, we have developed guidance for implementers to
address them – we all need to use the guidance, and shame on us if we don’t.
Now let’s
talk a bit more about the next generation of CHWs… In 2015 I directed a census of CHWs being
supported by World Vision in 48 countries around the world. One of the outcomes of our census that I found
particularly intriguing was this analysis of the diverse activities they were
engaging in – 25 activities in all. As
you consider the proportion of engagement in each activity, bear in mind that
this is based on 220,000 CHWs we supported at the time.
You will
note that amongst the activities many are closely aligned with core reproductive
maternal, newborn child health and nutrition interventions. But note also that nearly half of the
programs state addressing early child development, 37% addressed adolescent
health, and over half supported parenting groups.
Over the
last few years we have been exploring somewhat non-traditional roles for
CHWs. This month we are just concluding
a study in four countries: Kenya, Tanzania, Myanmar and Bangladesh, on CHW
address of violence against children.
This follows a study we published last year examining national policy
alignment with the WHO Action Plan to Combat Violence, wherein we found some
positive trends, but little policy implication for CHWs.
In the
current study we interviewed 412 CHWs across these countries and have frankly
been somewhat surprised to find that the majority already consider addressing
violence against children as part of their role, they observe situations of
violence in the household, and are actively intervening. They also state a desire for capacity
building to better address this violence.
With 1.7 billion children facing situations of interpersonal violence
each year globally, World Vision will be testing how to best support CHWs to
help them.
Last year we
were thrilled to see publication of the Nurturing Care Framework for Early
Childhood Development, which calls for an integrated approach towards the young
child cohort inclusive of health, nutrition, water and sanitation, early
stimulation, child protection and caregiving.
The framework suggests a critical role for the frontline health
workforce in these objectives as this cadre most typically engages families in
regards the well-being of young children.
In our experience, once again it is CHWs that present one of the best
opportunities to support this multi-sector approach.
World Vision
began integrating early child development interventions into core health CHW
platforms many years back, and have worked with partners at Harvard, Aga Khan,
Johns Ho
Time after
time, whether it be diagnosis and treatment of infectious disease, treatment of
severe acute malnutrition, or addressing violence and caregiving, we have seen
that properly supported lay health workers can effectively extend service
coverage. In this case World Vision
worked with WHO and the University of South Wales to test CHW delivery of a
mental health intervention addressing distressed victims of gender-based
violence in Kenya.
The Problem
Management Plus intervention involves facilitation of five behavioral treatment
sessions with distressed women on an individual basis. Our trial in Kenya demonstrated that the CHW
facilitated approach outperformed the standard enhanced usual care approach.
Once again,
Universal Health Coverage means that all people, everywhere, have affordable
access to support for all issues affecting their physical and mental health and
well-being. If we are to realize this
goal we must have a strong primary health care system, and I believe that CHWs
are at the heart of that system.
Dan Irvine. 5/21/2019 [Dan_Irvine at WVI dot Org]
