Enhancing Community Health Worker Training with Effective Management in DRC

Enhancing Community Health Worker Training with Effective Management in DRC

A community-based distribution agent discusses family planning options with a family in the DRC health zone of Ndekesha. {Photo credit: MSH.}Photo credit: MSH.

Cross-posted from Frontline Health Workers Coalition.

Evidence of the need to scale up the number of frontline health workers in developing countries abounds throughout sub-Saharan Africa, as described in a recent post on the Frontline Health Workers Coalition blog by Avril Ogrodnick of Abt Associates. Yet training new health workers is not sufficient, in itself, to sustainably address the crisis: governments must also invest in providing management support to harvest the full value of these trainings.

In the Democratic Republic of the Congo (DRC) --- where almost half of the total deaths among children under age 5 are caused by malaria, diarrhea and pneumonia --- the Ministry of Health and its partners are addressing this situation systematically to reduce the child mortality rate. To do so, they must face the reality that there are only 0.09 doctors and one nurse per every 1,000 people in the country. The ministry is working with partners to train community health workers (CHWs) to provide access to basic health services that have the potential to save lives.

To provide such access, the training program needs effective management support. Management Sciences for Health (MSH), the International Rescue Committee and Overseas Strategic Consulting, LTD are supporting the DRC’s Integrated Health Project (DRC-IHP), funded by the US Agency for International Development (USAID). Among other objectives, this project works to increase access to and availability of the government’s Minimum Package of Activities, which are designed so people across the country will take more charge of their own health needs by having greater access to quality, comprehensive care.

The program must address several challenges. There is low ownership of the approach at the intermediate level resulting in weak linkages between the community and the greater health system. Retention of trained CHWs is difficult due to a lack of incentives. Drugs are often not available, and supervision is irregular and inadequate.

To address these challenges, the project is utilizing a method called the “Integrated Case Management of Childhood Illnesses (iCCM)” approach. The iCCM goal is to ensure increased access to effective care services of children under age 5 living in the most underserved rural areas who suffering from the three main causes of child mortality: malaria, diarrhea and pneumonia. The program includes training and supportive supervision of CHWs chosen by each community, as well as provision and collection of essential drugs, job aids and reporting tools.

The CHWs are volunteers trained in iCCM, including training in behavior change communication. Head nurses from health centers in the DRC transfer some of their lengthy list of tasks to the CHWs by training with the volunteers at the ICCM sites and providing monthly supportive supervision. The CHWs are tasked to perform basic diagnosis and follow standard treatment protocol for uncomplicated malaria, diarrhea and pneumonia, and refer severe cases to health centers. They also provide counseling to mothers of sick children so that they understand key messages including medicines prescribed and dosage instructions.

Although a full evaluation of this program has not yet taken place, we know that community health workers, as a vital part of the health workforce, will improve their performance with basic management support in place.

Mary O’Neil, EdD, is principal program associate for human resources for health at MSH.


Laura Bahena
Very interesting article. I wish you all the best with this initiative. It sounds that in order to make this work all working in this project need to be sold on it. The community as you say may not be invested on it maybe because it may not resonate as important as other factors such as food, etc. Also, there seems to be a need for clear job descriptions of what a CHW should be doing. That is not to say that they may not do what they are trained by the nurses to do such as the diagnostic test BUT that they are not overburden and obligated to do the nurses duties just because the nurses themselves are overburden. Lastly, some type of recognition of the value of CHWs has to be done. Perhaps a paid job. If this is not possible then some type of campaign so community can understand the importance of the CHWs and how important their role is in saving the lives of the community members. Perhaps having CHWs from other sites or countries to visit these communities may help. If they have access to the internet expose them(the community members, the Community Health Workers) to different online examples of what CHWs, Outreach workers etc.. are doing throughout the world which is exciting! CHWs be Proud because you are worth more than the gold of this world and millions times more than the diamonds of this world! So move forward and continue to do your work because others see the great work that you do. Do not ever forget that! Salutations to all of you who make this great project help people ! You are saving lives! With Much Appreciation, Laura Bahena Certified Community Health Worker Network Coordinator Chicago CHW Local Network Office of Minority Health Steering Committee for Promotores de Salud Initiative American Public Health-CHW Section Section Coucelor

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