Jaipur, India: Eleven South-East Asian countries committed to strengthen their community health workers (CHWs) and volunteers who work as key change agents for promoting healthy behaviour. In Jaipur today, health ministers and experts attending the Sixty-fourth session of the Regional Committee for South-East Asia recognized that a well-trained, well-equipped and well-supported community-based health workforce is the backbone of the primary health care-based health system. They also committed to re-align the role and functioning, and to strengthen their health systems to deliver public health interventions.
Most health systems in the Region focus on providing medical care with little emphasis on prevention of disease through health promotion and empowerment of the community. The rapid demographic and epidemiological changes in South-East Asia combined with rising life expectancy means that more elderly persons are likely to suffer and die from noncommunicable and chronic diseases. In addition to the unfinished agenda of controlling communicable diseases like malaria, tuberculosis, dengue and the high numbers of maternal and child deaths, the Region also faces health issues related to emergencies and disasters, ranging from disease outbreaks to natural disasters.
Community health workers are a precious resource deployed successfully by countries in South-East Asia to address their emerging health needs and existing inequities. “These health workers also provide a vital service as frontline health workers during outbreaks and emergencies,” said Dr Samlee Plianbangchang, WHO’s Regional Director for South-East Asia. “Effective deployment of the community-based health workforce will assist the countries in achieving the health-related Millennium Development Goals,” he added.
In order to make an effective contribution the community-based health workforce needs to be carefully selected, appropriately trained and continuously supported by the health system. They must be recognized as an integral part of the health system and of the referral chain within the health system.
Community health workers and volunteers are already contributing significantly towards the community’s health care needs in several countries in South-East Asia.
Thailand has 800 000 community health volunteers (CHVs) who educate the community and help the health staff in immunization, nutrition and child health campaigns as well as selfcare for patients with chronic ailments. Health professionals were alarmed at the rising graph of diabetes (6.9% of the community) with 8 out of 10 patients living in rural areas unable to control their sugar levels. In a six-month project, CHVs were brought in to help control diabetes. They monitored the progress of each patient every two weeks and maintained an individual patient folder. The volunteers created a network of people with diabetes to help patients keep and maintain a healthy lifestyle. They undertook group exercises and cooked and ate together. After six months for most diabetics, the body weight as well as the body mass index reduced significantly and 40% of the patients could keep their blood sugar within the acceptable range.
In Timor-Leste, the health challenge was to reach more than one million population living in the difficult to reach mountain terrains, with 41% people below the poverty line. To strengthen the preventive health needs and to integrate these with the basic health care package, the Servisu Integrado du Saude Comunidade (SISCa) was set up to provide health care at the community level. The community health workers are part of the health unit that goes to the village communities. The health workers there undertake family registration; promote nutrition and child health; ensure immunization coverage; promote maternal health and family spacing; hygiene, sanitation and malaria prevention; and provide ambulatory primary care and health promotion.
Over 800 000 Accredited Social Health Activists (ASHAs) in India are helping to rejuvenate the rural health care system under the National Rural Health Mission. The ASHAs work closely with the auxiliary nurse midwives (ANMs) and the health system focusing on the safe delivery of pregnant women in rural areas. The ASHAs are the interface between the community and the health system. They mobilize the community and help push up the demand for health services.
In Bangladesh in a BRAC project, over 90 000 Shashthya Kormis and the Shasthya Shebikas provide services to improve maternal health, neonatal health and child survival. They are tasked with improving maternal, neonatal and child health.
Indonesia’s 26 682 Posyandus, or health care centres, cater to the community. The Posyandu volunteers, mainly women, called “cadres” are assigned by the village. They have provided much needed health services at the community level for several decades.
Nepal’s female community health workers (FCHV) deliver primary health care to women and families in 75 rural districts and support the government health services to make them responsive to the community.