State of the Planet

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Basic Health Care Doesn’t Have to Be of Basic Quality

While coordinating a Community Health Worker (CHW)-based asthma management program in New York City, I learned of the Millennium Villages Project (MVP), its CHW program, and of the opportunity to help build community health systems in sub-Saharan Africa. My diverse experience in healthcare gave me a unique understanding of the need for highly performing CHW programs to provide basic healthcare in Africa. Access to basic healthcare is usually taken for granted in Manhattan and is seen as a matter of luck in Mali. Little did I know, however, of the challenges to build scalable health systems for such basic care in sub-Saharan Africa.

When I first arrived as the Regional CHW Program Advisor, I traveled to the MVP sites in Potou, Senegal and Pampaida, Nigeria to help assess the health needs of the communities.  I realized that there needed to be better systems in place, more training of health workers, and stronger budgetary management. At the time, we were in the process of developing ChildCount+, an mHealth platform developed by the MVP, which aimed to empower communities by improving child survival and maternal health. It was clear that this innovative technology solution could greatly enhance the existing CHW program. In its paper-based form, this package would help standardize CHW case management competencies with key algorithms, streamline household health data transmission in a more targeted way through ChildCount+ forms, and cap the whole process under the immediate responsibility of a dedicated and well-trained CHW manager. With its technological benefits, ChildCount+ would allow village health workers (VHW’s) in Pampaida to send all of the newly identified pregnancies in real-time and with more individualized identifiers to a database. All of these improvements would create efficiencies to free up CHWs time to see more households, and provide targeted information that they could better tailor their services to meet patient needs.

With this innovative and service quality-oriented core in the MVP in West Africa, we have been able to systematically inscribe strong supervision of the Community Health Workers. This inscription of strong supervision along with assisted routine household visits has resulted in greater performance among the CHWs. The Millenium Villages Project Community Health Worker program is thus redefining supervision away from just “monthly or weekly meetings” and squarely as a household-based, on-the-job testament of high quality. That is how Community Health Extension Workers (CHEWs), the supervisors to VHWs in Pampaida, are now scheduling household visits with their VHWs to observe how the tasks relevant to the visit are being performed. Thus far, valuable lessons have been learned across sites, particularly in Pampaida, and this will help continue to strengthen the supervision-training package for the Senior Community Health Workers, the direct supervisors to the CHWs.

Basic health care does not have to be of basic quality. For this we are going to need ‘coaches’ a lot more often than ‘supervisors’ for our community health systems.
Yombo Tankoano is Regional CHW Project Advisor for West & Central Africa, Millennium Villages Project.
The Center for Global Health and Economic Development (CGHED) mobilizes health research and programs that enable low-resource countries to develop quality health systems for the poor, promote sustainable economic development and achieve the Millennium Development Goals (MDGs) – global targets for reducing extreme poverty and hunger and improving education, health, gender equality and environmental sustainability.  For more information about CGHED’s work, please visit our website.

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13 years ago

Basic healthcare should not mean basic health quality. The main idea is still to make health care accessible to rural communities especially to the poor. There are many organizations I knew that pursue access to it but the fact still remain that poverty continues to contribute to poor health, and poor health anchors large populations in poverty and at the end putting the lives, livelihoods and health of many people at stake. One solution I see is that the government and international organizations should take the lead in providing health services to the people in rural areas and do a lot of effort to provide higher level of health education especially to those area with lack of communications like telephones and public transport.

12 years ago

You mentioned that access to basic healthcare is usually taken for granted in the U.S. but is seen as a matter of luck in Africa. I am certainly not trying to discourage what you advocate regarding health care in other parts of the world. Question: should “basic” health care in Africa and in other underdeveloped countries be patterned after the “basic” health care in the U.S.? Where am I going with this? I have a friend who spent just over three hours in the emergency room at a small suburban hospital for a urinary infection. Other than a series of x-rays and an intravenous antibiotic, very little was done for my friend at the hospital. In my opinion, this was “basic” medical care. Her bill was $4,600.00. Is this an example of what will happen in other countries as they become more industrialized and more technologically advanced?

12 years ago

BYENUME-UGANDA. Health issues are also affected by the attitude of the implementers/ health workers. What is seen as minor, can be complicated by their delay / laxity of the so called technical staff.

Adeyinka Dawodu
Adeyinka Dawodu
11 years ago

Thanks for sharing this! I just cited you in one of my papers where I mentioned the benefits of taking “learning journeys”.