Towards a Community Health Worker Gender Action Framework
09 November 2017
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It is estimated that only 30% to 50% of the population have access to healthcare services in Mozambique. Mozambique first introduced the community health worker programme in 1977 as a strategic attempt to reduce poor access to healthcare services in the rural population. The programme faced challenges as a result of the civil war, but with the emergence of HIV, new types of community health workers appeared. The Ministry of Health decided to revitalise the community health programme in 2007 and introduced a new training curriculum, terms of reference, and payment of a monthly subsidy. This programme, including the new curriculum, was developed and approved by the Ministry of Health but because of financial and other constraints implementation only began in 2011 when training of the first groups of community health workers in each province of the country began. The current programme pays particular attention to maternal and child health. The first trained community health workers are soon expected to start providing services related to promotion of healthy lifestyles, prevention of diseases, and curative care for diarrheal disease, malaria, and respiratory infections afflicting children less than five years of age.
The revitalised community health programme is a new programme with new priorities. While expectations and levels of input are high, it is likely that there will be many challenges, and approaches to support and supervision have not yet been worked out. In the past the focus has been on fault-finding. This has lead to a demoralised workforce and opportunities to develop its capacity have been missed. With the support of Eduardo Mondlane University and Liverpool School of Tropical Medicine the Ministry of Health has developed a costed operational plan including a framework for monitoring and evaluating the effectiveness of the current community health programme. The utility and appropriateness of the indicators in this framework have not yet been tested.
At provider level the Ministry of Health is highly committed to implementing the revitalised national community health worker programme. However other key governmental institutions, such as the Ministry of Finance and the Ministry of Public Administration, also need to commit to the programme. As the current policy is a decentralised one, there is also a need to gain commitment from provincial and district governments. Finally, there is a need for country-wide standardised approaches to monitoring and evaluation of services offered by community health workers, including appropriate supervision, support, and training for community health workers and their trainers.
At policy level there are currently mechanisms of interaction between policy makers, practitioners and researchers in the form of the Human Resources for Health Observatory. Mozambique is regarded as being exemplary within Lusophone countries for having and implementing a Human Resources for Health Development Plan and also for having a very proactive task group made of partners supporting the ministry of health on human resource and health system related issues. At the government level there is already a commitment to community development and the district level is now becoming the main focus for development, although there is not yet equal technical capacity to interpret and use research findings at the different levels of government. There are also issues related to coordination between different policy making sectors at the ministry of health that result in duplication.
In Mozambique REACHOUT will explore how best to support and supervise community health workers to deliver their child health functions, and to test the relevance of performance indicators that have been developed for monitoring and evaluation. REACHOUT is focusing on supervision, training, motivation, satisfaction, and retention within the community health worker programme, and on the impact these have on maternal and child health in the communities they serve. REACHOUT will assess the structures in place for community health workers at district level. Factors affecting delivery of services will be measured in terms of equity, effectiveness, and efficiency. In addition REACHOUT will strive to build on existing good practices in monitoring and evaluation mechanisms at district, provincial, and ministerial levels. REACHOUT will also respond to the gaps in the national health research agenda specifically related to community health workers and maternal and child health issues. REACHOUT work will strengthen the technical capacity of policy makers to understand and use research results for evidence based policy making by running short courses.
This project is funded by the European Union.