Discussion of global health efforts often focuses on the newest medicine or latest advanced device. However, Dalberg Global Development Advisors recently designed a framework for the MDG Health Alliance to analyze an approach that has been around for decades – Community Health Worker (CHW) programs. This framework was incorporated into a new study by the Johns Hopkins School of Public Health (JHU), which found that expanding access to existing health interventions via CHW programs could save more than 3.6 million lives a year.
Community health workers are called by different names in different countries: they are “lady health workers” in Pakistan and “health extension workers” in Ethiopia. Regardless, CHW programs share essential similarities: they employ local members of communities, usually women, to provide access to basic family planning, maternity, neonatal and early childhood care. For instance, for decades CHWs have been at the forefront of efforts in Bangladesh to deliver oral rehydration salts to children with diarrhea and, more recently, to distribute misoprostol to prevent postpartum hemorrhaging in new mothers.
CHW programs are especially important given the limited human resources in existing health systems. In Africa and Asia there is an estimated shortage of 4 million doctors, nurses and midwives. Thus, though CHWs generally receive no professional or paraprofessional certification, they are often the first and only point of care for the communities they serve.
However, despite their lack of formal degrees, the community-based nature of CHWs can drive stunning results. Take the case of pneumonia, the leading cause of under-five mortality: Until recently, the global consensus was that severe pneumonia should be referred to a hospital or formal health center to be treated only by trained professionals. Yet a recent study found that CHW intervention could produce a 70 percent reduction in mortality. In fact, the study found CHWs were just as effective overall as formal facilities – in part simply because they are present and able to reach the patient.
Because CHWs are diffused throughout populations, they are also able to reach a tremendous breadth of individuals. In Bangladesh, the NGO BRAC used CHWs as part of a campaign to reduce diarrhea mortality in the 1980s. Treating diarrhea with oral rehydration salts can reduce mortality by up to 93 percent, but in developing countries, only 32 percent of children under five receive them. CHWs from the BRAC program visited households and trained women on how to make and administer homemade oral rehydration salts. Following this intervention, use of oral rehydration salts in Bangladesh skyrocketed, going from 1 percent in the 1980s to 81 percent in 2011. Bangladesh now has the highest percentage in the developing world of childhood diarrhea cases treated with oral rehydration salts.
In addition to these logistical advantages, available information suggests CHW programs deliver excellent value. During a trial in Ethiopia to compare CHWs and traditional health facility workers in treating TB, the CHWs had a cost per patient that was 62 percent less than the traditional facility model – and they maintained a higher treatment success rate. While there is a need to collect more data, evidence like this indicates that CHWs are quite cost-effective.
Overall, the JHU and MDGHA analysis revealed that CHW programs can reduce the main drivers of child mortality (Millennium Development Goal Four) by at least 25 percent. That figure alone makes a convincing case for involving a CHW component in future global public health programs, and Dalberg has worked with the MDG Health Alliance to find ways to strengthen CHW impact even more.
In an ideal world, all people would have access to top-quality health care and health care professionals. Until that day comes, the data demonstrates that CHWs are a promising, high-potential way to bridge the gap.
Editor's note: this article originally appeared on Dalberg Global Development Advisors' D-Blog. It is cross-posted with permission.
Click here to learn more about the ambitious campaign to train and deploy 1 million community health workers in sub-Saharan Africa.
Ya’ir Aizenman is a senior consultant with Dalberg Global Development Advisors, where he focuses on the firm’s health care practice.