increase access to HIV services

Can the deployment of community health workers for the delivery of HIV services represent an effective and sustainable response to health workforce shortages? Results of a multicountry study.

Celletti F, Wright A, Palen J, Frehywot S, Markus A, Greenberg A, de Aguiar RA, Campos F, Buch E, Samb B. Celletti. AIDS. 2010;24 Suppl 1:S45-57.

In countries severely affected by HIV, shortages of health workers present a major obstacle to scaling up HIV services. Adopting a task shifting approach for the deployment of community health workers represents one strategy for rapid expansion of the health workforce. This study aimed to evaluate the contribution of community health workers with a focus on identifying the critical elements of an enabling environment that can ensure they provide quality services in a manner that is sustainable. The method of work included a collection of primary data in five countries: Brazil, Ethiopia, Malawi, Namibia, and Uganda. The findings show that delegation of specific tasks to cadres of community health workers with limited training can increase access to HIV services, particularly in rural areas and among underserved communities, and can improve the quality of care for HIV. There is also evidence that community health workers can make a significant contribution to the delivery of a wide range of other health services. The findings also show that certain conditions must be observed if community health workers are to contribute to well-functioning and sustainable service delivery. These conditions involve adequate systems integration with significant attention to: political will and commitment; collaborative planning; definition of scope of practice; selection and educational requirements; registration, licensure and certification; recruitment and deployment; adequate and sustainable remuneration; mentoring and supervision including referral system; career path and continuous education; performance evaluation; supply of equipment and commodities. The study concludes that, where there is the necessary support, the potential contribution of community health workers can be optimized and represents a valuable addition to the urgent expansion of human resources for health, and to universal

With the shortage of qualified medical staff in low- and middle-income countries constituting a major barrier to scaling up to universal access, this is a must read article. Learn how these five countries have reorganised their HIV clinical services under a task shifting model and what regulatory and policy frameworks were needed to support the model. Cross-country findings are presented for collaborative planning, education and training, recruitment procedures, employment conditions, sustainability of financing for services rendered, and the informal status of community health workers. Historical case studies for Ethiopia, Malawi, and Brazil set out in boxes provide promising examples of the creation of community health worker cadres. The regulatory framework in each country is analysed and a 2-page table lists the HIV clinical tasks performed by community health workers in the countries studied. High-level policy support and the existence of an enabling environment are both key to successful and sustainable deployment of community healthcare workers to increase access to quality HIV services.