Human Resources for Health in Maternal, Neonatal and - HRH ...

functions, the latter involving mobilising the community to improve their social and
economic as well as health status.
CHWs have also been described as a ―bridge between the community and the health service‖
(Kuhn 1990), and cultural brokers (Willis 1999) however their role goes beyond this.
According to Bender and Pitkin CHWs are the cornerstone of PHC work (1987). CHWs often
reside in the community and therefore have an intimate understanding of community needs,
issues and the socio-cultural context. Community members have a degree of trust and
confidence in them and therefore CHWs ―can become rallying points for the positive social
transformation of communities‖(Were 2008). However, they are also vulnerable and their
recruitment and ability to function can be constrained or dictated by power relations or sociocultural
beliefs (Werner 1977; WHO/SEARO 2007).
Coverage
A conference in Beijing (AAAH 2007) and in Chiang Mai (WHO/SEARO 2007) indicated
that CHWs are a ubiquitous cadre. However little data is available on the numbers and
distribution of community health workers in the Asia Pacific region (AAAH 2008; WHO
2009). National data do not reveal coverage within countries. Density is purportedly low due
to geographic constraints in some countries (PHFI 2008). Prasad (2007) states that there is
diversity in coverage and asks what the optimal coverage might be bearing in mind the
different care and services that CHWs provide. In Sri Lanka for example a CHW covers as
little as 10 households offering a set of MCH related services (UNICEF, 2004). On the other
hand, there are countries such as India, where a CHW is responsible for about 1000
households providing family planning advice.
Contribution of CHWs to improving MNRH
Systematic reviews of the evidence from randomized controlled trials on the effects of lay
health worker (LHW) interventions in improving MCH in LMICs (Flottorp 2008; Lewin,
Dick et al. 2009) found evidence of their contribution to child health. There was evidence of
moderate to high quality of the effectiveness of LHWs in improving immunisation uptake in
children and in reducing childhood morbidity and mortality from common illnesses,
compared with usual care. This however is also the result of the successful implementation of
largely vertical immunisation and IMCI programmes. LHWs are also effective in promoting
exclusive breastfeeding up to six months of age.
Specific program evaluations such as the Lady Health workers program in Pakistan have also
found positive benefits of CHWs. Lady Health workers substantially reduced infant, child
and maternal mortality within a year. They also generated positive perceptions of family
planning in the communities (Barzgar 1997) and increased the use of oral contraceptive pills
condoms use among rural women (Douthwaite 2005). Other studies show that contraceptives
including injectable Depo Provera (depot-medroxyprogesterone acetate (DMPA)) can be
safely provided by CHWs (Ministry of Health Kenya 2007; Stanback, Mbonye et al. 2007).
CHWs have also been shown to have an impact upon preventing neonatal deaths (Bari,
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