The relative influence of the community and the health system on work performance: A case study of community health workers in Colombia

Robinson, Sheila; Larsen, Donald E.

doi:10.1016/0277-9536(90)90290-9

Cited by 34 publications

(22 citation statements)

References 7 publications

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“…Issues of training [11,12], supervision [13,14] and incentives facing these providers ( [14]; Korte et al, 1990) are frequent topics in this literature. However, there is limited evidence of their effectiveness except where limitations in some aspect of the CHW program are identified (e.g., training or community participation).…”

Section: Literature Review Of Phcmentioning

confidence: 99%

“…The guidelines state that the promoter is responsible for promotion, prevention, treatment and environmental sanitation in seven areas: child health, reproductive health, dental health, basic health assistance, first aid, basic sanitation, and, health education. 11 Health promoters are expected to be community leaders and to hold periodic meetings with the community. MSPAS workers are expected to visit low-risk 11 The manual designates the following activities to the promoter: (1) prevention, assistance and referral in cases of ADI (acute diarrhea infection); (2) prevention, assistance and referral of ARI (acute respiratory infection); (3) promotion, detection and referral of pregnancies; (4) promotion of post-natal care and newborn care; (5) promotion and assistance in family planning; (6) promotion of child growth and development; and (7) promotion and assistance in basic sanitation programs.…”

Section: Characteristics Of Mspas and Ngo Promotersmentioning

confidence: 99%

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Primary health care in practice: is it effective?

2004

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Primary health care is accepted as the model for delivering basic health care to low income populations in developing countries. Using El Salvador as a case study, the paper draws on three data sets and a qualitative survey to assess health care access and utilization across public and private sector options (including NGOs). Multivariate analysis is used to estimate the quantitative determinants of health seeking behavior. Physical and financial access is generally good. Households do not value the community health workers, and prefer high cost private care, even the poorest families, because of the lower waiting times and higher probability of successful treatment. Similarly, higher level public facilities--health centers and hospitals--are preferred because they are less costly in terms of time as they offer "one stop shopping" and do not require multiple visits, and treatment success is higher than among health posts, health units or community health workers. These results combined with the small size of El Salvador suggest that alternative strategies to community health workers may be a more cost effective approach. While prevention is desirable, community health workers do not have the skills or services that the communities value, which makes them less effective in promoting prevention. Alternative modes of reaching the community could reduce costs and raise the effectiveness of public health spending.

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Section: Literature Review Of Phcmentioning

confidence: 99%

Section: Characteristics Of Mspas and Ngo Promotersmentioning

confidence: 99%

Primary health care in practice: is it effective?

2004

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“…CHWs must be people who are already trusted members of the community (Nemcek and Sabatier 2003), who plan to stay in the community (Robinson & Larsen 1990) and who reflect the linguistic and cultural diversity of the population served (Witmer et al1995). Selecting workers who are not trusted and respected by the community, who misunderstand their role or have unrealistic expectations leads to high attrition rates, poor worker performance, and low community engagement with the program (Bhattacharyya et al 2001;Nemcek and Sabatier 2003;Witmer et al 1995).…”

Section: Appropriate Selectionmentioning

confidence: 99%

Retreat from Alma Ata? The WHO's report on Task Shifting to community health workers for AIDS care in poor countries

Campbell

Scott

2009

Global Public Health

108

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This paper examines the potential of community health worker (CHW) programmes, as proposed by the WHO's 2008 Task shifting to tackle health worker shortages -Global recommendation and guidelines, to contribute to HIV/AIDS prevention, care and treatment and the achievement of various Millennium Development Goals in low income countries. It examines the WHO proposal through the lens of a literature review of factors that have facilitated the success of previous experiences of shifting tasks from health workers to trained lay people. The WHO has taken account of five key lessons learned from past CHW programmes (the need for strong management, appropriate CHW selection, suitable training, adequate retention and incentive structures, and good relationships with other healthcare workers). It has, however, neglected to emphasise the importance of the 'community embeddedness' of health volunteers, found to be of critical importance to the success of many past CHW programs. We have no doubt that the WHO Plans will increase the number of workers able to perform medically oriented tasks. However, we argue that without community embeddedness CHWs will be unable to perform the socially oriented tasks assigned to them by the WHO, such as health education and counseling. We locate the WHO's neglect of community-embeddedness within the context of a broader global public health trend away from community-focused primary health care towards biomedically-focused selective health care.

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“…The literature is filled with descriptions of health projects that rely upon com munity participation (Reid, 1984;Berman, Gwatkin & Burger, 1987;Antia, 1988;Robinson & Larson;Shoo, 1991;Purdey, Adhikari, Robinson & Cox, 1994), and often community selection of health workers is described, but it is frequently difficult to establish both the means by which health messages are conveyed to the community at large, and in particular, how barriers to community participation are overcome. It has been said that health project initiators are too busy doing, and therefore have insufficient time to report their techniques (Stone, 1992).…”

Section: Community Participation In Cbrmentioning

confidence: 99%