Integrated Primary Care Program Profile: Community Health Workers

Jan 17, 2020
Community Health Workers from Bangeli. Names (left to right): TAGARBE Thantal, GMANWE Ńtikime, N’GUIMBE N’limbiba, KPATIKA Oyanga. 

Salimatou, an Integrate Health Community Health Worker, begins each day by checking her backpack full of supplies. This backpack contains everything Salimatou needs to conduct a full consultation in a patient’s home. She throws her pack on over her bright blue Community Health Worker vest and steps out of her house. Salimatou spends each day walking door to door, checking on her neighbors in the community where she grew up. As Salimatou walks through the bustling market and down winding dirt paths, community members call out her name as they wave and smile. Eventually, she makes it to her first house of the day to check on a mother and her two-week-old baby. 

Salimatou’s eyes light up as the mother uncovers the tiny baby who is sleeping in her arms. She sits down next to the pair and pulls out her binder. The mother watches as Salimatou points to each photo and explains the different danger signs for newborns and postpartum women. After each photo and explanation, she makes sure to pause and wait for confirmation from the mother that neither she nor the baby are experiencing any symptoms of these danger signs.

Community Health Worker Salimatou sitting with a mother and her newborn, showing photos of the danger signs for newborn children and postpartum women. 

Midway through the visit, the rain begins, and the mother quickly invites Salimatou inside to finish up the consultation. With no cause for concern, Salimatou reminds the mother to visit the clinic for her next postpartum consultation, and the mother thanks her for stopping by. Salimatou takes one last look at the tiny baby before leaving the compound to visit her next family. By providing not only healthcare services but also education, support, and encouragement to her neighbors, Salimatou has become one of the most trusted sources of healthcare in the community. As the day progresses, Salimatou is greeted by community members at every turn as she makes her way through the neighborhood to visit other women and children. With a celebrity-like level of recognition, Salimatou is a true heroine in her community. 

Community Health Workers are the backbone of an effective primary healthcare system, especially in remote areas such as northern Togo. This month, we want to shine some light on an important component of the Integrated Primary Care Program, our Community Health Workers. 

What are Community Health Workers?

Community Health Workers are a cadre of non-physician healthcare providers who receive training and provide care in their own communities. At Integrate Health, the majority of Community Health Workers are female and work in their communities providing basic care and referrals for women and children under five. 

What does it take to become a Community Health Worker?

Community Health Workers are required to have at least a primary school education, and many have not held formal employment before being nominated and selected to work as Community Health Workers. Integrate Health works with local community members who nominate candidates following community meetings organized by Integrate Health. Nominated candidates are interviewed and evaluated by Integrate Health staff, and candidates are selected to participate in initial training. 

Practical group exercise among the Community Health Workers, supervised by the trainers 

The training modules include:

Integrated Management of Childhood Illnesses at the Community Level

Maternal Health 

Proactive Case-Finding

Programming and Activity Reporting Tools

Following the training, the highest performing candidates are hired to work full-time as Community Health Workers and receive four weeks of intensive coaching and supervision. Community Health Workers receive a minimum of one supervision visit per month from a dedicated nurse Community Health Worker Supervisor.

After six months of work, the Community Health Workers complete training on family planning and reproductive health. After the training, they complete a month-long practical internship at their local health center. 

A Community Health Worker counseling a woman about the different family planning methods available while being supervised by a trainer in a practical exercise

What services do Community Health Workers provide? 

Community Health Workers conduct proactive case-finding for common illnesses and provide care and counseling in the home for pregnant women, women of reproductive age, and children under five. They refer complicated cases to the health center. 

The package of services delivered by the Community Health Workers includes:

Integrated Management of Childhood Illnesses

Maternal Health including HIV/AIDS referral and follow-up  

Reproductive Health and Family Planning

Referral of Cases

Census-taking and Reporting 

Educational Talks with Community Members

A Community Health Worker visits a mother and her baby at their home to conduct a routine check-up.

How much does a Community Health Worker program cost?

In August of 2019, Integrate Health conducted a costing analysis of the Integrated Primary Care Program (IPCP). The IPCP includes four components in total, one being Community Health Workers. The analysis found that the entire Community Health Worker component of the IPCP, including salaries, costs less than $3 per capita, making it an affordable and cost-effective investment for the Ministry of Health.

What are the benefits of Community Health Workers? 

In addition to the direct healthcare services provided by Community Health Workers to their neighbors, Community Health Worker programs also have larger benefits for the community. As salaried, full-time employees, Community Health Workers often receive a reliable source of income for the first time, producing significant benefits for themselves and their families. Integrate Health Community Health Workers report being able to send their children, including their daughters, to school, and many independently form savings and loans groups to pool and invest their incomes. Having a reliable source of income also changes the power dynamics for women in the home and serves as a valuable injection of capital into local rural economies. The multiple benefits of Community Health Workers make them a tremendously valuable innovation in the movement to achieve universal health coverage.