An integrated approach of community health worker support for HIV/AIDS and TB care in Angónia district, Mozambique

Abstract

BackgroundThe need to scale up treatment for HIV/AIDS has led to a revival in community health workers to help alleviate the health human resource crisis in sub-Saharan Africa. Community health workers have been employed in Mozambique since the 1970s, performing disparate and fragmented activities, with mixed results.MethodsA participant-observer description of the evolution of community health worker support to the health services in Angónia district, Mozambique.ResultsAn integrated community health team approach, established jointly by the Ministry of Health and Médecins Sans Frontières in 2007, has improved accountability, relevance, and geographical access for basic health services.ConclusionThe community health team has several advantages over 'disease-specific' community health worker approaches in terms of accountability, acceptability, and expanded access to care.

Community Health Workers in Low- and Middle-Income Countries: What Do We Know About Scaling Up and Sustainability?

“…32 Integration with the health system was also vital to the scale-up of vitamin A distribution by CHWs in Mozambique and Nepal; in each case, the country's Ministry of Health managed CHW training and involved district or local Ministry of Health staff in oversight and supervision. 25,28 Other enabling factors in this category were Ministry of Health or other government support manifested in financing or advocacy (n = 7) and coordination with nonhealth development programs (n = 1).…”

‘All they do is pray’: Community labour and the narrowing of ‘care’ during Mozambique's HIV scale-up

“…An externally funded civil conflict and structural adjustment-imposed austerity measures decimated much of this infrastructure. Though APEs survived in some regions and have been revitalised in recent years (Simon et al, 2009), the role of post-structural adjustment CHWs has shifted from 'change agent' to 'extension worker,' oriented towards technical and community management functions (Lehmann & Sanders, 2007, p. 6). Structural adjustment measures introduced in 1987 initiated privatisation of public services and industries, cuts in education and health, removal of price subsidies for food and fuel and reduction of other social services and safety nets (Hanlon, 1996;Pitcher, 2002).…”

Unacceptable attrition among WHO stages 1 and 2 patients in a hospital-based setting in rural Malawi: can we retain such patients within the general health system?

“…WHO stages 1 and 2 patients are mainly being seen at the community level, where a specific care, follow-up and tracing system could operate through associations of people living with HIV/AIDS, PLWA support groups and home-based care volunteers. 10,12,[16][17][18][19][20] This would open greater opportunities for community counselling, awareness-raising and patient empowerment. Thyolo has launched an initiative called 'improved health posts', which in brief are sites at community level managed by community associations, patient support groups and a full-time community nurse trained in HIV/AIDS care and care of other chronic illnesses.…”

“…Finally, existing patient tracing systems, including community-based mechanisms using PLWA groups, volunteers and home-based care programmes, 10,12,[16][17][18][19][20] are not activated to trace and encourage these pre-ART patients to attend their follow-up visits. Community involvement in Thyolo has previously been shown to reduce loss to followup rates and has made reliable ascertainment of deaths possible.…”