Half of the world’s population lacks access to essential primary healthcare, including treatment for common childhood illnesses like diarrhea or malaria, family planning, or prenatal care. This gap is particularly acute in remote communities, where an estimated two billion people live outside of the reach of healthcare. Compounding this crisis is a massive health worker shortage, as we need at least 18 million more health workers by 2030 to deliver primary healthcare globally.
These issues are often addressed by Community Health Care Workers (CHWs); trained professionals providing services where they are most needed especially in remote and rural areas. However, CHWs are chronically low in numbers and are frequently overworked. CHWs are underpaid, undervalued by communities/health professionals, work in unsafe conditions with limited access to resources. Their ability to deliver services is often impacted by limited skills due to redundant/non-existent training programs and limited organizational support.
To address the problems at hand, a CHW system is needed that has accessible training programs that appeal to the populations in need, utilizes the available technology and data management systems and is connected to government and private health services. Organizations that seek to meet this health care gap using CHWs often face challenges regarding funding and scaling. These issues can be addressed via a results-based financing model and CARE Social Ventures’ program for building sustainable social businesses.
At CSV I was tasking with evaluating the NGO sector for CHWs and identifying the areas that organizations most often fell short when providing health care solutions. After evaluating the organizations, I came up with a recommendation for a Community Health Care application that would help meet each criteria. The criteria for a successful CHW model are listed below.
Improving CHW Agency and Wellbeing by motivating them through training, mentoring, equipping, incentivizing, data driven decision making, supportive supervision, continuous quality improvement performance-based cycles and collective performance targets.
Transforming Community Norms by supporting actively engaged communities who monitor the quality of primary health care services they receive through utilization of the Community Score Card, the Social Analysis and Action (SAA), as well as the gender-focused transformative approaches.
Strengthening primary health care systems by enabling inclusive and responsive services through improved service provision, integration and linkages. Inclusive governance through participatory decision making and ensuring the availability of resources are also key components under this criteria.
Creating sustainable payment systems for CHW workers and organizations by decreasing reliance on philanthropic donations.
Many organizations meet a couple of the criteria but no one organization provides access to all four. These criteria could be met by creating a smart phone application with a CHW training program and platform for service delivery that is free to use globally. CHWs complete digital training, pass assessments and are hired by members of their community on an ad hoc basis.
Availability of Trained Health Care Workers
Training programs and assessments ensure high-quality training without supervision
Reviews for CHWs incentivize high-quality service delivery
Example: Training program piloted by Last Mile Health
Availability of Health Care Services, Products and Facilities
CHWs are given the option to sell health care products, promoting entrepreneurship and increased accessibility for remote communities
Partnerships with government and private health care facilities to provide expert care as needed
Example: Door-to-door healthcare products by Live Well Zambia
Technology, Data Collection and Performance Management
Data collection is built into the CARE CHW platform and performance is monitored remotely
Application-based training programs allow basic health care to reach any place that a smart phone can reach
Examples: Using technology to increase access to health services and reduce the service delivery time per CARE Bihar’s CAS Application and streamlined programs with technical expertise in service delivery such as Dimagi’s ICT4D programs
Sustainable Payment Systems
By creating diverse avenues for CHW salaries, the CHW model can be flexible for the financial circumstances in each country and will help ensure that remote communities are more accessible. This can be accomplished through results-based financing and the adaptation of humanitarian projects into social ventures.
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