Community Engagement: Training and Working with Community Health Workers.

Transcription

1 Community Engagement: Training and Working with Community Health Workers. Marco A. Celada, MD Medical Director CHD Trifinio, Guatemala Assistant Clinical Professor of Pediatrics University of Colorado Denver School of Medicine

2 Community Health A three legged stool according to the late Dr Carl Taylor (Johns Hopkins Univ): Needs input from the community Needs input from a change agent (could be an NGO, university, or dev. Project) Needs input/collaboration and evaluation from the local govt or ministry of health

3 Who are the Community Health Workers? Where do they reside What level of education Men or Women Should they be paid or volunteers What other specific skills or qualifications

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5 Community listening: Homework: Prelim. Info needed on: community locale,structure (demography) and function (sociology); (use focus groups as well as research info) Consider with community (democratic representation from all corners, all ages) Problems identified by community Problems identified by health service

6 Whose voice is heard? Priorities? What kind of resources; personnel? Best community health workers are resident home visitors (not outreach workers ) Therefore:Ask and document: who is already doing what in this community? Home visits, with community members at exploratory stage, are necessary

7 Step 1 Defining Norms: many meetings Identifying current feeding, caring and practices in the community Focus groups: caretakers, decision makers

8 Community health workers and HEALTH FOR ALL Resident home visitors; accessible; able to work with women s groups Accountable: to community; to funder Info syst. begins with mapping and house numbering; door to door registration; reporting/following unimmunized on pregnancies, deaths, births; Able to communicate results, not just give messages

9 CHW s and Adult education Identify with community behaviours that want changing. Focus on the positive: Example: positive deviant poor families with well nourished children; make home visits; identify/use their child feeding practices, caring behaviours; create practice fields

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11 Adult participatory education: Adult cycle of learning How many times to get a new idea across? (seven?) How many times to repeat a behavior before it becomes habit? 21 times? APPRENTICESHIPS ARE NECESSARY

12 What do CHW s do? (Peru) Community helped decide to: Conduct community registration, census Carry out monthly check list monitoring women/children; no child left out Home visits for orientation, ed, referral Conduct or help with demonstration sessions Fill out monthly reports; attend training

13 Training for CHW s Not your banking method, instead Skill by Skill on the job. Meet compentency stds: Can he/she do this? Yes/no; if no, repeat training

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15 Challenges Retention of CHW s Avoiding burnout Keeping the engaged and empowering them Find a balance between needs of Physicians and Organizations involved and needs of the community and the CHW

16 Recruit volunteers and help provide motivation for these volunteers (madres monitoras) Provide support group Provide longterm supervision Provide longterm mentorship

17 Supervision Biggest problem; this is what fails often. Must be direct and indirect. Not punitive but formative (examples) Use of guest register left in house works best ; CHW signs that s/he visited, date name signature, task accomplished). Examples: Malaria eradication prog in Haiti; bed net distribution in Phillippines

18 Supervision; Training Everyone deserves Supervision Rex Fendall, London School Top Med and Hygiene Skill by skill on-the-job training is best What are tasks and why What is the skill? Teach first the knowledge What are th evaluation indicators? Who evaluates? (Is community included?)

19 Summary Many approaches to recruiting CHW but they all should include: Local people from within the community In general should be paid a just salary Should work with goals Should have longterm supervision Should have longterm mentorship Most important should take into account specific geographical location and culture.

20 I want to leave you with a challenge, and That is to think about how CHW s can improve the efforts that you will hear about in the various presentations this week. Thank you.