Community health worker
[9] This means that they are trained and legally permitted to provide healthcare in fewer situations than physicians but more than other health professionals.
[14][15][16][17] It is unclear where the usage of community health workers began, although China and Bangladesh have been cited as possible origins.
"[18] Catherine Lovell writes that BRAC's decision to train locally recruited paramedics was "based on the Chinese barefoot doctor model then becoming known worldwide."
The rise of university-based medical schools, the increased numbers of trained physicians, the professional organizations they created, and the income and attendant political power they generated resulted in license regulations.
This further increased the fees doctors could charge and encouraged them to concentrate in larger towns and cities where the population was denser, hospitals were more available, and professional and social relationships more convenient.
Hundreds of thousands of rural peasants, chosen by their colleagues, were given rudimentary training and assigned medical and sanitation duties in addition to the collective labor they owed the commune.
Though there are many elements to the program (including classes for those who marry and the ending of tax incentives for large families), behvarz are extensively involved in providing birth control advice and methods.
[23] Liberia's program seeks to transform an existing cadre of unpaid and poorly coordinated community health workers into a more effective workforce by enhancing recruitment, supervision and compensation.
[24] The health ministry has organized a coalition of funding and implementation partners to support this new program, which aims to train, supervise, equip and pay 4000 Community Health Assistants, supported by 400 clinical supervisors, to extend primary care services to 1.2 million people living in remote rural communities.
In India, 600,000 community health workers are paid through a fee-for-service system to deliver a specific set of primary care functions, such as immunization.
All of the women were married, came from a good social standing, displayed a keen interest in the program, and were encouraged by their family to participate.
The women chosen were then trained in identification and referral of patients with mental illnesses, the common myths and misconceptions prevalent in the area and in conducting community surveys.
The training lasted 3 days and included lectures, role plays and observation of patient interviews at the psychiatry outpatient department at St. John's Medical College Hospital.
Also in India, The MINDS Foundation has developed a grassroots program targeted at providing mental health services to rural citizens.
They leave the responsibility in the hands of local rural citizens who are trained as Community Mental Healthcare Workers (CMHWs).
[30] The VHWs assisted pregnant women with birth planning, which included timely identification of danger signs, preparation, and accumulation of two or more essential supplies such as soap, razors, gloves for clean delivery, and mobilizing household resources, people and money to manage a possible emergency.
Approximately one year after the CBRHP's major interventions ceased in these communities, most of the VHWs continued to do health promotion by visiting pregnant women, teaching them about birth planning and danger signs, and assisting them in obtaining both prenatal and obstetric services.
They are seen to play an important role in assisting patients with navigating a complex, uncoordinated health care system.
[32] In Philadelphia, a standardized intervention was used by community health workers across multiple systems provided evidence of increased patient-perceived quality of care and hospitalization reduction among low-income populations.
[33] A randomized controlled intervention on the U.S.-Mexico border, used promotoras or "female promoters" to increase the number of women utilizing routine preventive examinations.
The Samastha project developed a network in which trained workers, village health committees, government facilities, people living with HIV (PLHIV) networks, and participating NGOs collaborated to improve recruitment and retention of PLHIV while strengthening and supporting their adherence to treatment.
Link workers were PLHIV who were selected by Samastha from a small number of HIV-positive candidates proposed by their community; they received an allowance for their work.
Ultimately, the link workers' coordinating role became a hallmark of Samastha's interventions in high prevalence rural areas.
Martin et al. found that the Latin-American population in the United States frequently does not benefit from health programs due to language barriers, distrust of the government, and unique health beliefs and practices, and specifically that providing effective asthma care to the Latino population is an enormous challenge.
[43] Though many countries have increased their spending on health care and foreign money has been injected, much of it has been on specific disease-oriented programs.
With training, monitoring, supervision, and support such workers have been shown to be able to achieve outcomes far better than baseline and in some studies, better than physicians.
Much remains to be learned about the recruitment, training, functions, incentives, retention and professional development of community health workers.
