When community health worker (CHW) programs have focused on supporting patients with pre-defined conditions, the impact for these patients can be life-changing. Community-based accompaniment provided by Partners In Health CHWs in Haiti and Peru more than a decade ago, for example, resulted in game-changing outcomes in HIV and TB care that were felt around the world.
As it turns out, that’s just the start of what CHWs can do.
At PIH sites in Malawi and Liberia, a transition is underway to a new model that recognizes CHWs’ value extends far beyond the needs of any specific patient group. More than just a link to other levels of the health system, CHWs can be agents of social connection. When CHWs are able to work with all households in a community instead of only with patients known to be sick, it can have dramatic implications.
— Lassana Jabateh, Director of Community Health Programs for PIH Liberia
“PIH Liberia is one of PIH's newest sites and PIH-Malawi is 11 years old, yet when watching the two teams come together for the first time, it was like watching a family reunion,” said Dr. Dan Palazuelos, Senior Health and Policy Advisor for Community Health Systems at Partners In Health. “They understood each other immediately and had a working relationship almost instantaneously. It was heartening to watch.”
Basimenye Nhlema, Director of Community Health for PIH in Malawi, appreciated a discussion around the potential role of household CHWs in building a supportive plan to encourage pregnant women to choose facility-based deliveries. Facility-based deliveries allow for a better clinical response and lower maternal mortality especially in case of complicated pregnancies, but women in remote and rural areas face very real challenges when making that choice. Even when there are maternal waiting homes near health facilities, women may not have all the support they need either at the waiting homes or for other children back at home while they would be gone. As a result, some women in the PIH Malawi catchment area are still choosing to deliver at home.
“The Liberian team suggested that we try using a more comprehensive approach to accompanying pregnant women that includes helping them to come up with practical ways of preparing for delivery and possibly post-natal processes,” Nhlema said. “Our CHWs can help pregnant women to plan together with their families on how they will support the pregnant woman throughout pregnancy, delivery period and afterwards, and the CHW can monitor on a monthly basis how that plan is being ‘actionalized’ in preparation for delivery. We are excited with this proposition and look forward to trying it.”
From the Malawi team, Jabateh learned the importance of using a checklist to guide CHW responsibilities and use of time. Formalizing regular connections with clinical staff to understand a health center’s capacity to take new patients and identify gaps in interactions between CHWs and facility-based colleagues is also critical to providing strong patient care. For patients who need to be taking regular medications, these linkages can be the difference between treatment failure and increasing drug resistance and successful retention in care.
— Basimenye Nhlema, Director of Community Health for PIH in Malawi