Should community health workers (CHWs) be paid? Can they provide injectable contraceptives safely? Can they test people for HIV? How are CHW data incorporated into national information systems?
These are questions that policy and program designers and researchers ask as they endeavor to expand the health services to people who are underserved. Community health workers (CHWs) are an important part of efforts to extend access to health care in ‘last mile’ communities. Over time, their scopes have evolved to respond to global and national priorities, from the 1978 Alma Ata Declaration to focused investments in immunization and family planning programs in the 1980s–90s to broader agendas like the Millennium Development Goals, Universal Health Care, and the Sustainable Development Goals since the turn of the century.
Community health programs are often subject to the ebb and flow of donor investments and often operate on a limited and inconsistent scale, with tenuous links to the formal health system. Community health systems remain fragmented, with uncoordinated vertical programs, parallel information systems, and inequitable access to services. In response, at least 15 sub-Saharan African countries have, since 2014, overhauled their national community health strategies, emphasizing better coordination, stronger supply chains, and integrated, more robust information systems. Benin, Liberia, Tanzania, and Uganda have introduced CHW cadres to help achieve national targets, and numerous other countries have revised existing CHW programs.
What is the Community Health Systems Catalog?
In support of global efforts to strengthen, scale up, and harmonize community health programs, the Advancing Partners & Communities (APC) project launched the Community Health Systems Catalog (the ‘Catalog’) in March 2014. The Catalog aims to fill a knowledge gap about community health and family planning policies and programs in 25 countries. Previously, this information was scattered across policies, strategies, curricula, and other documents.
In 2017, APC updated the Catalog as part of its portfolio of tools and activities that support the role of policy in aligning and strengthening community health systems. The updated Catalog is based on the WHO Health Systems Framework and incorporates maternal and child health and nutrition data through partnerships with the SPRING and MCSP projects. It features 25 country profiles, cross-country slides and infographics, and the complete Catalog data set for public use (forthcoming).
How can you use the Catalog?
• To advance advocacy efforts. When designing and revising community health programs, policymakers look at regional and global best practices. For example, Sierra Leone’s Ministry of Health and Sanitation developed its 2017 Community Health Worker Policy by examining evidence and policies from other countries to inform decisions, such as how to remunerate CHWs and which interventions to include in their scope. Countries are also interested in experience with CHW provision of family planning methods, such as injectable contraceptives, implants, and emergency contraceptive pills. For example, in Malawi, health surveillance agents have been providing injectable contraceptives since 2008, and this experience serves as an example to other countries interested in family planning task sharing. The Catalog presents diverse community health approaches and trend data to support local, national, and global policymakers to make informed policy decisions about community health.
• To identify policy and implementation gaps. It is no secret that the programs and strategies described in policy do not always reflect reality. Often, policies are either designed without input from those who are responsible for implementing them or from those who the policies are meant to serve, which can lead to gaps in policy design and implementation. The Catalog country profiles highlight common gaps in policy guidance, including:
- Focusing on the ‘what’ more than the ‘how’ of program implementation. For instance, policies specify information about CHW incentives, supervisors, and training but fewer details about process.
- Assigning coordination roles to a multitude of health and administrative bodies at each level of the health system, which contributes to duplication of and miscommunication about responsibilities.
- Providing limited information on the current number of CHWs, how many the country needs, or the number it aims to have. This information gap stymies planning and implementation processes, including determining resources needed to support CHW incentives, estimating necessary commodities and materials, and determining supervision processes.
• As a “one-stop shop” for research and reference. Catalog users have largely comprised researchers interested in family planning and human resources for health. The Catalog has been referenced in journals and manuscripts on task sharing, family planning, and mobile health. It can answer specific questions, such as which community health providers in India provide emergency contraceptive pills? The Catalog also includes more than 400 community health policies and strategies for further reference.
As countries update their community health policies and strategies over the next five, ten, and twenty years, the Community Health Systems Catalog will continue to serve as a hub of information on community health systems and aid in policy and program development processes, thereby contributing to country efforts to advance and strengthen community health programming.