The best single resource for learning and understanding Community Based Health Care (CBHC) programs is a book entitled Setting Up Community Health Programmes: A Practical Manual for Use in Developing Countries by Dr. Ted Lankester. It is available in the US through the Hesperian Foundation (see www.hesperian.org). In Chapter 1 of this book, Dr. Lankester describes CBHC as a convergence of vertical medical programs and horizontal community-operated programs in ways that support each other.
Combining Horizontal and Vertical Approaches
CBHC is not opposed to vertical hospital-based healthcare programs. In fact, the idea is to create synergy, partnership, and integration of vertical and horizontal initiatives. There is always a need for advanced healthcare services. Of course, it would be an understatement to say that surgery needs to be a global health priority. The idea behind creating effective CBHC is to develop strategies where vertical hospital-based programs are integrated with horizontal community-based programs to facilitate the achievement of health and wholeness in communities.
The Stages of Health Development
According to Lankester (2009), health development often occurs in three stages.
Stage 1 is traditional healthcare, which uses traditional healers. He explains that at this stage, development healthcare takes place in the community according to the wishes and convenience of the people. However, is not usually effective.
Stage 2 is the acceptance and use of vertical western healthcare programs in which the healthcare is provided by outsiders with specialized scientific knowledge. Healthcare takes place in this second stage of development in hospitals and clinics. In this situation, the care is dominated and directed by a physician or practitioner often outside the community. The challenge is that this form of healthcare is not sustainable at the community level without an external financial-support mechanism. In order to be sustainable, services and medications are often charged for, excluding many in need of care.
In Stage 3 of the health-development process, healthcare returns to the community. It integrates the best of health system-based vertical programs and community-based horizontal programs.
Community health workers are chosen by community leaders and are trained (usually by healthcare professionals) in disease prevention and basic curative care. Disease prevention and affordable healthcare then becomes available in the community from a resident of the community. Also, they have referral ability to area clinics and a regional health system. Even short-term global health programs can go a long way toward launching and or collaborating with such programs.
The Impact of Community Health Workers (CHW)
According to the Department of Human Resources for Health at WHO (2007), CHW-entered programs are not a panacea for a weak health system, nor are they a cheap option to allow affordable access to healthcare in underserved regions. Many CHW programs have failed because of poor planning and underestimating the time and effort required to establish and sustain them. In some areas, this has unnecessarily undermined and damaged the credibility of the CHW concept. This being said, it is achievable for short-term health initiatives to start, develop, and sustain such programs as long as the organization is willing to return to that community a couple of times per year to monitor, evaluate, and provide ongoing support.
Utilizing Medications in CHW Programs
There are even organizations that will provide essential lifesaving child medications free of charge to CHW programs. This is providing there is an organization willing to provide continued training to workers and supervision of the project. The upside to this is that healthcare workers are allowed to charge for the medications, and they receive 50% of the funds. The other 50% goes to purchase the medications from the supervising organization or health system.
These funds are used by the organization to offset customs and transport charges. Medications are donated and shipped to countries free of charge, but port, customs, and transport charges are the responsibility of the receiving organization. For information on this medication program, contact the Christian Health Service Corps at [email protected]. Medications are usually supplied to area health centers for distribution to the CHWs, and they return with them to outlying communities.
Even if CHWs are not trained only in education and immunizations and not to dispense medications, there are many ways to arm them to fight disease. One example is artemisinin-based suppositories. Putting them in the hands of community-health workers to give to families with proper education has saved the lives of many children in developing countries. It buys enough time for them to get to a clinic or medical facility.
Department of Human Resources for Health at the WHO. (2007). Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. Geneva: Department of Human Resources for Health.
Lankester, T. (2009). Setting up community health programmes. Berkeley, CA: Hesperian. https://store.hesperian.org/prod/Setting_up_Community_Health_Programmes.html
Seager, G. (2012). When healthcare hurts: An evidence based guide for best practices in global health initiatives. Bloomington IN: Authorhouse.
Blog Editing by: Lynley Hatcher