Early Lessons From Launching an Innovative Community Health Household Model Across 3 Country Contexts

Abstract

Community health worker programs can contribute substantively to health systems working to implement universal health coverage, but there is no one-size-fits-all model. Program leaders should anticipate needing to adapt their plans as local realities demand, but lessons learned in other contexts can provide guidance on how to best proceed.

Abstract

Key Findings

• Assigning community health workers to households, as opposed to individuals, is a feasible and functional method for structuring how community health can contribute to implementing universal health coverage.

Key Implications

• Program managers should consider how to adapt international best practices for their unique contexts. The Partners In Health experience with implementing a new approach across 3 new program sites in 3 countries suggests that this is best done by both providing clarity on program architecture and also funding mechanisms for frontline program leadership to visit and learn from each other in situ.

• Policy makers should consider how community health programs can be structured as extensions of functioning health systems into households for all diseases and all age groups, as this provides a platform for working effectively toward universal health coverage.

ABSTRACT

Community health workers (CHWs) are integrated into health systems through a variety of designs. Partners In Health (PIH), a nongovernmental organization with more than 30 years of experience in over 10 countries, initially followed a vertical approach by assigning CHWs to individual patients with specific conditions, such as HIV, multidrug resistant-TB, diabetes, and other noncommunicable diseases, to provide one-on-one psychosocial and treatment support. Starting in 2015, PIH-Malawi redesigned their CHW assignments to focus on entire households, thereby offering the opportunity to address a wider variety of conditions in any age group, all with a focus on working toward effective universal health coverage. Inspired by this example, PIH-Liberia and then PIH-Mexico engaged in a robust cross-site dialogue on how to adapt these plans for their unique nongovernmental organization-led CHW programs. We describe the structure of this “household model,” how these structures were changed to adapt to different country contexts, and early impressions on the effects of these adaptations. Overall, the household model is proving to be a feasible and functional method for organizing CHW programs so that they can contribute toward achieving universal health coverage, but there is no “one-size-fits-all” approach. Other countries planning on adopting this model should plan to analyze and adapt as needed.