Essay on "Community Health Aides Around the World"

Essay 10 pages (3204 words) Sources: 5 Style: MLA

[EXCERPT] . . . .

Funds that could be used to hire more registered nurses and physicians are being diverted to the community health aide positions, which no longer fulfill the intentional purpose according to the program design (Cumper and Vaughan 365).

The professionalization of community health aides in Jamaica illustrates the potential for a co-optation of the program in the interest of the aides themselves, and presumably for the convenience of health center staff (Cumper and Vaughan 365). As discussed below, the community health aide program in Jamaica provided the strongest insight -- albeit, a negative insight that illustrates a potential problem for other nations that are less far along in the development of community health aide programs.

Rwanda

The rural population of Rwanda has about one physician for roughly every 20,000 people in a healthcare system that still struggles in a post-genocide environment (Kraemer). Partners in Health (PIH), a non-governmental (NGO) organization, the Clinton Foundation, and the Rwandan Ministry of Health (MOH) have partnered in an initiative to bring to Rwanda the community-based care model that was developed in rural Haiti (Kraemer). The model is based on community health workers (CHWs) who are trained, employed, and compensated by Partners in Health and the Rwandan MOW (Kraemer). Prior to the arrival of PIH in Rwanda in 2005, a system of community-based care was provided by three kinds of health workers: The Animateurs de Sante (Health Facilitators), the traditional birth attendants (TBAs), and the workers of the Home-Based Malaria (HBM) program (Kraemer). Most of these community health workers were not compensated, nor did they receive any formal, organized training (Kraemer). The community health workers receive training in primary care, childhood illnesses, family planning, hygiene, malnutrition, and reproductive health. There is also a training component focused on the treatment of HIV, TB, malaria; the CHWs emphasize the regular and dose-appropriate administration of medications, and educating patients about completing their medication regimens in order to avoid drug resistance and ensure maximally effective treatments (Kraemer).

The first two years of work by Partners in Health was a catalyst for the Ten Principles of Rwanda Scale-Up and the Rwandan District Health System Strengthening Framework (Kraemer; "Partners in Health"). By 2014, the comprehensive implementation plan achieves full scale up in the 27 districts responding to the ten goals, and will include universal healthcare services, socioeconomic aid to take down barriers to treatment, and access to nutrition services and medications (Kraemer; "Partners in Health"). The work will fall primarily to the Rwandan community health workers, who are elected to their positions by community members and receive support from local leaders in the districts (Kraemer; "Partners in Health"). Since the community health members are place-bound by their chosen obligation to their umudugudu (village), the rural Rwandans will not be dependent on foreign healthcare workers or doctors, but instead will be self-sufficient and positioned to benefit from medical innovations through their established collaboration with PIH and the Rwandan MOW (Kraemer; "Partners in Health").

The accompagnateurs, modeled after the community health workers who originated in Haiti due to the work that Partners in Health conducted, provide medical and socioeconomic aid to Rwandan villagers, actions that have contributed to the harmonization of the national system of health workers.

4. Results

The Mississippi Delta scores at the bottom of the health indices and it has for decades. The rural Delta -- known as the birthplace of the blues -- has good reason to lament the resistance to improved healthcare that is so pervasive in the region. The population suffers from the highest morbidity and mortality rates in the nation, with diabetes, hypertension, infant mortality, and obesity plaguing the residents of the Delta (Hansen).

The first federally qualified health center was built in 1967 in Mound Bayou in the Mississippi Delta region (Hansen). The objective, according to the health center founder, Dr. H. Jack Geiger, was to address the conflating problems in the lives of poor residents that contributed to their ill health (Hansen). Dr. Geiger said:

We built wells and privies and housing and started a 500-acre vegetable farm, and that probably had a bigger impact on the health of the population than what we were doing as doctors. The indigenous people we trained were among the most useful people on staff. (9)

Dr. Aaron Shirley is a civil rights-era hero who was for years the only black pediatrician in the state of Mississippi and, at the University of Mississippi Medical Center, was the first black resident (Hansen). Shirley worked at the first community health center in Mississippi, doing unorthodox things like helping poor black people to build wells for clean drinking water, and traveling the countryside to treat malnourished babies (Hansen). In the mid-1990s, he converted a dilapidated shopping mall into a health center -- known now as the Jackson Medical Mall -- that provided services to the poor residents of the town (Hansen).

Dr. Shirley started HealthConnect -- putting health houses in the schools in Jackson, Mississippi -- to demonstrate that community health workers could help save money and resources for hospitals. From this start, Dr. Shirley hopes to establish the Mississippi Community Health House Network pilot project based on the Iranian model that he learned about from Mohammad Shahbazi, a professor at Jackson State University, and a long time proponent of the health house model in his homeland, Iran -- and a student of the health care problems in the United States, his adopted country. Dr. Shirley asserts that, "the hospitals need a third party trained to discern what exactly will help a patient, and that party must come from the patient's world: talk the same, share similar fears and frustrations and life experiences" (Hansen 8).

Program Location

Lessons Learned

Alaska

The maintenance of reliable, highly trained, locally respected, and indigenous community health care workers, who remain in their villages.

Iran

The integration of services across the structural tiers supports robust, well articulated delivery of services.

Jamaica

The professionalization of community health aides allowed the program to be co-opted in a manner that benefited health center staff and aides over patients.

Rwanda

The accompagnateurs provide medical and socioeconomic aid to Rwandan villagers, helping to stabilize and harmonize the national system of health workers.

5. Conclusion

Through a review of four programs implementing community health workers in diverse regions, a number of key considerations emerged. All of the programs found that recruiting community health workers from indigenous people living in the rural areas to receive services is critical to implementation success.

In Alaska, the community health workers had little opportunity to serve in the regional hospitals for two primary reasons: 1) Since the regional hospitals were sufficiently staffed by highly qualified, licensed and certified staff, there were no openings to which community health workers could be recruited; and 2) the far distances between the villages, between the villages and the regional hospitals, and the harsh climate discouraged unnecessary travel, and underscored the need to keep indigenous community health workers in place as vital members of the rural healthcare teams.

Responsibility for the well being of their fellow villagers is a substantive stabilizing factor in the Iranian house health system. Moreover, articulation and coordination of services in the Iranian system resulted in a finely tuned system, in which patients are referred up a chain of hospitals as needed, and that is highly intrusive and personal by American standards.

The Rwandan model demonstrates the importance of a smoothed system that does not compartmentalize workers by function, but instead contributes to the development of a nationalized system for delivery of healthcare services that begins at the community health care worker level. Achieving a balanced program that fairly compensates community health care workers, and that seeks collaboration and integration with formal health care system, are goals of the Rwandan model, with the intention of securing stability for the community health worker program.

The Jamaican community health aide program provides the most salient lesson in the importance of achieving a balanced implementation design and a system of staffing that maintains fidelity to the original model, and integrity in the provision of healthcare services to the targeted populations. As the position of the community health aides, became more lucrative and conveyed higher status, it drew more candidates, some of whom were self-selected. The influence of organized labor effectively tipped the fragile balance that had developed in the Jamaican community health aide system, to the detriment of the rural populations.

6. Recommendations

When considering the kind of changes that can be accomplished in the healthcare systems in the United States, the emerging model in the Mississippi Delta is perhaps the best example. And as it is based on the Iranian health house model, it is a clear demonstration of what can be learned from community health aide programs in other countries. The Unites States has… READ MORE

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