Task-shifting impact of introducing a pilot community health worker cadre into Zambia’s public sector health workforce

Abstract

BackgroundThe Zambia Ministry of Health (MOH) recruited and trained a new cadre of Community Health Assistants (CHAs) as part of its National Community Health Strategy. The inaugural class of 307 CHAs completed one year of training in July 2012 and deployed to their communities.MethodsThe impact of the CHA program on the volume and type of health services provided at health posts and their respective referral health centers was measured with a non-randomized difference-in-differences design. Monthly health service provision data was collected for 12 months before and after CHA deployment at 8 health posts along with 8 referral health centers. The analysis controlled for seasonality, changes in non-CHA staffing, and periodic regional child health campaigns, and used facility-level fixed effects.ResultsDeploying two CHAs to a health post did not lead to a statistically-discernible increase in services at the intervention facilities. Health services provided at referral health centers increased by 697.9 services per month (95% CI: 131.4 to 1,264.3, p = .016), and combined services (at health posts and referral health centers) increased by 848.6 services per month (95% CI: 178.2 to 1,519.1, p = .013).ConclusionIn this pilot, the addition of CHAs in rural areas increased health service provision at referral health facilities and at facilities overall, shifting the burden of basic health services away from more highly trained health workers. Shifting tasks to lesser-trained, less-expensive cadres like the CHAs, policymakers can rapidly improve access to care with constrained budgets. Evaluations measuring the direct impact of lower level cadres without accounting for task-shifting may underestimate their contribution to the health workforce.

Surgical symptomatic knowledge among medical staff and community health workers in rural Cambodia: a descriptive study for workforce improvement

“…The median score for knowledge of surgical symptoms was 8 (7)(8) [median (interquartile range)] among the medical staff, 8 (7-8.5) among CHWs, and 8.5 (8-9) among the villagers. Tukey's test for knowledge of surgical symptoms among each of the three occupations showed no significant difference between medical staff and CHWs, medical staff and villagers, CHWs and villagers (P = 0.974, P = 0.057, P = 0.134) The score did not differ significantly across different occupations, indicating that the medical staff and CHWs did not have sufficient knowledge of surgical symptoms even in comparison with villagers.…”

“…The median score for knowledge of surgical symptoms was 8 (7)(8) [median (interquartile range)] among the medical staff, 8 (7-8.5) among CHWs, and 8.5 (8-9) among the villagers. The score did not differ significantly across different occupations.…”

“…However, there are fewer surgeons in rural areas compared to urban areas 5,6) . Additionally, training surgeons requires considerable time and effort compared to training non-physician medical staff or CHWs 7,8) . Thus, the role of non-physician medical staff and CHWs in rural areas is potentially significant.…”

Moving to a strong(er) community health system: analysing the role of community health volunteers in the new national community health strategy in Malawi

“…These are issues which, in the 1990s and early 2000s, led countries (e.g. Ethiopia, Kenya, Rwanda, South Africa, Zambia) to establish national community health policies and strategies 20 22–26. In some cases, additional guidelines were developed and scaled up to facilitate collaboration and task-shifting processes between professional and non-professional health workforce 3 23.…”

“…Ethiopia, Kenya, Rwanda, South Africa, Zambia) to establish national community health policies and strategies 20 22–26. In some cases, additional guidelines were developed and scaled up to facilitate collaboration and task-shifting processes between professional and non-professional health workforce 3 23. The challenges encountered in this historical process have been considered in a number of studies 2 26–29.…”