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Community Health Workers: Bridging the Healthcare Accessibility Gap

Photo by Rebecca E. Rollins Partners In Health – Malineo Sethobane
Malineo Sethobane, a community health worker in Lipeneng, Lesotho. Photo credit: Rebecca E. Rollins/Partners In Health
January 14, 2020

For many of us when it comes to healthcare, our primary concern is receiving professional and specialized care, but for many others, it is simply access. Accessibility can be an issue in areas with limited healthcare professionals, long distances to healthcare facilities, and poor transportation systems or rough terrain. Beyond physical accessibility, there can be a lack of knowledge of treatment options and their benefits, or misconceptions about costs. 

The accessibility problem in global healthcare is clear when examining statistics on maternal, newborn, and child health. The WHO recommends women receive antenatal care to detect possible complications early, but in 2013, 40% of pregnant women globally received no such care

Partners in Health’s long-standing Maternal Mortality Reduction Program in Lesotho exemplifies how community health workers (CHWs) can bridge the gap between communities and healthcare. As part of the program, CHWs actively find expectant mothers in rural mountain villages and refer them to clinical care (if necessary), they inform women of the benefits of facility-based care versus home delivery, and they perform regular home visits and escort the women to the hospital for their delivery. The CHWs are recruited from the villages they work in—many having been traditional birth attendants—further deepening the link between formalized healthcare and the community. 

Another key component of the program was the construction of housing near the clinic to accommodate women waiting to give birth, eliminating the need to make a difficult journey while undergoing labour. This has proved highly effective, with no deaths in the first two years of the program even with deliveries increasing by 350% by the second year. Beyond this, CHWs provide first response to a broad range of health issues—from administering simple medications and vaccines to performing preliminary assessments and referring patients to facilities for specialized treatment. CHWs also help advocate for the healthcare needs of their communities by gathering health metrics that provide insight into local conditions. 

An illustration of the accessibility problems faced by poor rural communities. From the World Health Statistics 2018, Section 3: Broad Spectrum of Health Challenges – Selected Issues.

Community health workers take on roles that benefit the community beyond access to healthcare by ensuring that not only the medical needs, but also the social and mental needs of patients are met. In Partners in Health’s rural health program in Chiapas (one of the most marginalized regions of Mexico), CHWs, called acompañantes in Spanish, participate in case finding campaigns for chronic diseases and offer emotional and instrumental support (e.g., organizing pills) to patients in dealing with conditions such as diabetes and hypertension through weekly home visits. Acompañantes build social connections with patients by providing advice and counselling in addition to medication and information. These connections have a positive impact on the mental health of individuals who face an increased risk of social isolation due to their ailing health. The work of acompañantes have yielded measurable results, with twice the odds of clinical control in diabetes and hypertension beyond two years, despite isolated, and often, poor environments. 

If you would like to learn more about the impact CHWs can have, you can explore this visual documentation, by Partners in Health Canada, of the conditions acompañantes work in and the lives they lead. You can also learn more about the benefits of community health workers through the Community Health Impact Coalition.