Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #109545

Kate E. Gilroy, ScM¹, Amy E. Patterson, MHS², Eric A. Swedberg, MPH³, Zana Daou⁴, Seydou Doumbia, MD, PhD⁵, and Peter Winch, MD MPH². (1) Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, 443-255-3875, kgilroy@jhsph.edu, (2) Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, (3) Office of Health, Save the Children, US, 54 Wilton Rd, Westport, CT 06880, (4) Bougouni Office, Health Sector, Save the Children, U.S., B.P. 84, Bougouni, Mali, (5) Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, BP 1805, Bamako, Mali

Background: Community health workers (CHWs) are being called upon to manage a wider range of childhood illnesses. This requires longer periods of training, more hours devoted to work and greater supervision, necessitating more effective operational strategies, especially those aimed to motivate CHWs and decrease attrition. Methods: Findings of a comprehensive review of CHW programs are combined with an in-depth case study of a Save the Children supported CHW program operating in southern Mali. The Mali study included in-depth interviews with CHWs and community members as well as review of CHW notebooks during a pilot introduction of zinc treatment for diarrhea in Bougouni, Mali. Results: A conceptual framework is presented which takes into consideration 1) contextual factors of the program and program area, 2) programmatic inputs, and 3) operational outcomes necessary to have a sustained impact on child health. In Mali, CHWs often missed planned activities due to seasonally-occurring agricultural commitments. Perceived inadequate financial remuneration and incentives were obstacles in implementation and affected coverage of services. Community recognition was commonly mentioned by CHWs as their primary reason for participation, although families often exerted pressure on CHWs to limit their time in program activities. Weaknesses associated with cost recovery mechanisms impacted availability of essential medicines at the community level. Conclusions: Program managers may use the framework to describe and evaluate the adequacy of implementation of CHW programs. Recommendations are made for strategies to promote community recognition of CHWs, and maintain motivation in the face of increased demands on their time.

Learning Objectives: At the conclusion of this session, the participant will be able to

• Describe a framework which can be used in the development and evaluation of CHW programs that treat sick children
• Discuss operational obstacles to implementing a CHW program that treats sick children
• Identify a number of possible solutions that can be used to overcome operational obstacles in CHW programs

Keywords: International MCH, Community Health Programs

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.