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The Value of Community Health Workers

Great article “Realigning Health with Care” in the Summer 2012 Stamford Social Innovation Review.  Among other things, the authors discuss the value of training community health workers.

This is of great interest to me because the correct use of Clean Birth Kits requires that  community health workers (CHW) are trained in their use and distribution.   Then the CHWs train the birth partners (mothers, sisters, friends) who will be present at the birth in birth hygiene and the use of the sterile kits.

Nontraditional medical workers are critical to health systems, especially those in resource-constrained environments. They are less encumbered by competing clinical care priorities, possess firsthand understanding of patient culture, community, and experience, and are often more aware of nonmedical local resources that may improve patient care. Acknowledging that licensed clinicians are not the only health care providers can help health systems become more efficient, effective, and equitable.

PIH, for example, relies on doctors and nurses to provide clinic-or hospital-level care and hires community health workers (CHWs) to distribute food, deliver medicine to patients in remote rural areas, and identify undiagnosed illnesses as well as social needs. CHWs can help health care systems overcome shortages of human and financial resources by providing high-quality, low-cost services to community members in their homes and by diagnosing diseases in their early stages, before they become more dangerous and expensive to treat.

Similarly, in sub-Saharan Africa, Mothers2Mothers trains and employs new mothers with HIV, who work side by side with doctors and nurses in health care facilities and are responsible for ensuring that patients understand and adhere to antiretroviral treatments and other prescribed interventions. These “Mentor Mothers” are a new tier of paid, professional, health care providers—drawn from, trained in, and working for local communities. Evaluations of the program have found that enrolled mothers are more likely to receive and take medications and to undergo tests to determine if they are eligible for antiretroviral treatment and if their babies are infected with HIV.

Training Workshop for Birth Attendants: Hygiene, Cord Care, Referrals

This is an informative article about a training held in Nigeria for traditional birth attendants.  The training focused on: hygience, cord care and referral to a health facility.  This training outline seems like it would be applicable to many countries in the developing world.

HYGIENE: Wherever labour and delivery are managed, cleanliness is the first and foremost requirement. Nails must be short as well as clean and hands must be carefully washed with soap and water. Attention should be paid to the personal hygiene of labouring women and TBAs. As well as to the cleanliness of the environment and all materials used during birth. Positive effect of three cleans – hands, perineal area, and umbilical area. The TBAs must make sure that there is clean water at hand. There is need for careful hand washing – clean hands, clean delivery surface, clean cord cutting and care prevents puerperal sepsis (infection after delivery). Some measures should be taken during all deliveries to prevent possible infection of the woman and / or the TBAs. These measures include the avoidance of direct blood /direct contact with blood and other body fluids by the use of gloves during vaginal examination, during delivery of the infant and handling the placenta. Surgical gloves are latex gloves there are sizes to fit the hand. Sterile surgical gloves should be worn for each vagina examination.

UMBILICAL CORD CARE: Minimal handling of the umbilical cord should be done. The cord if not handled properly, can be the portal of entry of bacteria and other infective organisms. Therefore, ensure good cord care: Cut with clean new freshly opened razor blade, tie tightly to avoid bleeding. Ensure that the tie is sterile and keep clean and dry until it falls off.

REFERRAL TO A HEALTH FACILITY: TBAs should refer a woman to a higher level of care if complications arise which requires interventions, which are beyond the competence of the TBAs… Some cases requiring referral to a health facility are prolonged labour, prolonged second stage of labour, retained placenta, cord presentation, cord prolapse, antepartum, and postpartum haemorrhage, scarred uterus such as a woman with previous caesarean section or previous myomectomy, eclampsia and obstructed labour16, 18.

Great post by Train Midwives Save Lives

I really like the conclusions (AHA! Moments) drawn by Carrie Blake at http://trainmidwivessavelives.org/.  Full text here:

AHA! Moment #1: Systematically provide training appropriate for anyone who might be attending a birth (family or community member) to enable them to make good decisions as to which women are low-risk.

AHA! Moment #2:  Provide training to those same people as to how to provide a clean birth environment, what to do when a baby doesn’t breathe at birth (and no resuscitation equipment is available), and a mom  bleeds excessively (and no pharmaceuticals are available).

I have also thought about the system that needs to be in place in areas like Laos where homebirths attended by trained personnel, let alone hospital births, are a (far in the) future goal.  Training for community/family members seems to be a practical goal for starters.   I’d love to hear from people on the ground, working to promote safe birth, on the subject.

Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India

Article from the Lancet 1999.  The findings may be relevant today:

Village health workers trained in neonatal care made home visits and managed birth asphyxia, premature birth or low birthweight, hypothermia, and breast-feeding problems. They diagnosed and treated neonatal sepsis. Assistance by trained traditional birth attendants, health education, and fortnightly supervisory visits were also provided. Other workers recorded all births and deaths in the intervention and the control area (1993-98) to estimate mortality rates.

….

Home-based neonatal care, including management of sepsis, is acceptable, feasible, and reduced neonatal and infant mortality by nearly 50% among our malnourished, illiterate, rural study population. Our approach could reduce neonatal mortality substantially in developing countries.

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