Community Health Workers?

In Zambia, CHWs are typically in their mid-forties, farmers, average nine years of education, and are married.  In two recent Rotary CHW training projects in the Copperbelt, women and men were roughly equal in number.  CHWs are given formal training for six days + one field day, in classes of 30 to 40.  The training applies a standard curriculum of Integrated Community Case Management Plus (iCCM+) developed by the Ministry of Health and delivered by experienced National, Provincial and District Health trainers. 

The CHWs are trained in how to conduct a pin prick, draw a drop of blood and dispense it onto a Rapid Diagnostic Malaria Test (RDT) plate. They learn how to read the result, if positive, negative or invalid and how to record the result.  For the RDT positive cases without clinical complications, they provide treatment medicines.  For positive cases with clinical complications, the CHWs stabilize and refer the patient to the closest rural health centre/health post  or to a hospital if  intensive treatment is required.  The “+” in iCCM+ means that a positive test result requires the testing of family members and neighbors within a defined radius–to eliminate the human reservoir of the malaria parasite within that immediate area.

On completion of their formal training, CHW candidates are then attached to health facilities closest to their home communities for a six-week practicum and mentorship with an assigned supervisor.  Their core competences are assessed and those that meet the standard are deployed to their respective communities to offer community case management services, whereas those that do not meet the basic competences stay attached to facility until they achieve the necessary capabilities. 

Equipment

Deployed CHWs are equipped with backpacks, rapid diagnostic test kits, medicines, health education materials, rain gear, shirts and hats, PPE, cell phone time, and robust bicycles. Routine assessment and mentorship then continue at resupply and during health facility staff’s outreach visits to the communities.  After two years, CHWs receive four – five days of refresher training and equipment resupply.

During their monthly meetings with their supervisors, CHWs’ surveillance and test data is reviewed and edited.  The consensus regarding the data is submitted by a selected ”Data CHW” using a smart phone to the District Health Information System (DHIS). These monthly meetings are also a time to discuss their work and address any issues.  Another point of technical support and supervision are data review meetings. These now take place at the community level, i.e., they involve both facility staff and the CHWs they supervise. These meetings also provide an opportunity for the CHWs to see visualized data to improve understanding of how their individual work and reporting feeds into the bigger picture of Zambia’s pursuit of malaria.

The deployment of volunteer CHWs is a very cost-effective way to bring health care to rural communities.  At a ratio of one CHW per 500 residents, the training, equipping, and sustaining of a CHW costs less than $2.00 per person per year.