When I was a medical student I studied the novel Chinese experience of the “barefoot physicians”—community health workers in its vast countryside. With a basic training and a lot of enthusiasm they provided critically needed access to clinical and obstetrical services for its impoverished population. In the years that have passed by, the Chinese central government has made a big investment in economic and human resources for the medicalisation of maternal care, which now occurs usually in well-equipped care centers.

Community health workers now play a pivotal role in most health care initiatives around the globe as they provide preventive and curative care to underserved, poor communities in far away regions with difficult access. The scarcity of health care personnel has given new impetus to their training and deployment in order to complement and even spearhead care initiatives. They are responsible for the great strides in malaria control and eradication.

An editorial in “The Lancet Global Health” says, “a quick look at the CHW panorama shows great success as well as missed opportunities. Large-scale government-led programmes in countries like Brazil and Tanzania, where CHWs are part of the formal health system, trained, and remunerated, have led to increased health care coverage and improved health indicators. Conversely, man local smaller-scale programmes that lack the necessary support system—clear financial and administrative planning and coordination—have proven to be unsustainable or misaligned with local needs, and have fallen through attrition or lack of utilization.”

Even though they often shoulder the burden to provide access to basic health services to underserved communities, the CHWs dwell in a “grey area” of the formal care systems as their professional role is not properly formulated and they are not efficiently trained to obtain a final certificate or diploma. The World Health Organization (WHO) has promoted a labour strategy to streamline and rationalize their training to integrate them into the systems. These good Samaritans need resources, good pay and a clear career pathway.

What do you think? Please tell us.

Don’t leave me alone.

 

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