Challenges facing successful scaling up of effective screening for cardiovascular disease by community health workers in Mexico and South Africa: Policy implications
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Date
2016
Journal Title
Journal ISSN
Volume Title
Publisher
iMED
Abstract
The integration of community health workers (CHWs) into primary and secondary
prevention functions in health programs and services delivery in Mexico and South
Africa has been demonstrated to be effective. Task-sharing related to adherence
and treatment, from nurses to CHWs, has also been effectively demonstrated in
these areas. HIV/AIDS and TB programs in South Africa have seen similar successes
in task-sharing with CHWs in the areas of screening for risk and adherence to
treatment. In the area of non-communicable diseases (NCDs), there is a policy
commitment to integrating CHWs into primary health care programs at public
health facilities in both Mexico and South Africa in the areas of reproductive
health and infant health. Yet current programs utilizing CHWs are not integrated
into existing primary health care services in a comprehensive manner for primary
and secondary prevention of NCDs. In a recently completed study, CHWs were
trained to perform the basic diagnostic function of primary screening to assess the
risk of suffering a CVD-related event in the community using a non-laboratory risk
assessment tool and referring persons at moderate to high risk to local government
clinics, for further assessment and management by a nurse or physician. In this
paper we compare the experience with this CVD screening study to successful
programs in vaccination, reproductive health, HIV/AIDS, and TB specifically to
identify the barriers we identified as limitations to replicating these programs in
the area of CVD diagnosis and management. We review barriers impacting the
effective translation of policy into practice, including scale up issues; training and
certification issues; integrating CHW to existing primary care teams and health
system; funding and resource gaps. Finally, we suggest policy recommendations to
replicate the demonstrated success of programs utilizing task-sharing with CHWs
in infectious diseases and reproductive health, to integrated programs in NCD.
Description
Keywords
Cardiovascular disease, Community health workers (CHWs), Community health, Mexico, South Africa, HIV/AIDS, Tuberculosis
Citation
Abrahams-Gessel, S. et al. (2016). Challenges facing successful scaling up of effective screening for cardiovascular disease by community health workers in Mexico and South Africa: Policy implications. Health Systems and Policy Research, 3(1): 26