International Journal of Health Policy and Management

International Journal of Health Policy and Management

The Governance of National Community Health Worker Programmes in Low- and Middle-Income Countries: An Empirically Based Framework of Governance Principles, Purposes and Tasks

Document Type : Original Article

Author
Helen Schneider
School of Public Health and SAMRC/UWC Health Service to Systems Unit, University of the Western Cape, Cape Town, South Africa
10.15171/ijhpm.2018.92
Abstract
Background
National community health worker (CHW) programmes are increasingly regarded as an integral component of primary healthcare (PHC) in low- and middle-income countries (LMICs). At the interface of the formal health system and communities, CHW programmes evolve in context specific ways, with unique cadres and a variety of vertical and horizontal relationships. These programmes need to be appropriately governed if they are to succeed, yet there is little evidence or guidance on what this entails in practice. Based on empirical observations of South Africa’s community-based health sector and informed by theoretical insights on governance, this paper proposes a practical framework for the design and strengthening of CHW programme governance at scale.
 
Methods
Conceptually, the framework is based on multi-level governance thinking, that is, the distributed, negotiated and iterative nature of decision-making, and the rules, processes and relationships that support this in health systems. The specific purposes and tasks of CHW programme governance outlined in the framework draw from observations and published case study research on the formulation and early implementation of the Ward Based Outreach Team strategy in South Africa.
 
Results
The framework is presented as a set of principles and a matrix of five key governance purposes (or outputs). These purposes are: a negotiated fit between policy mandates and evidence, histories and strategies of community-based services; local organisational and accountability relationships that provide community-based actors with sufficient autonomy and power to act; aligned and integrated programme management systems; processes that enable system learning, adaptation and change; and sustained political support. These purposes are further elaborated into 17 specific tasks, distributed across levels of the health system (national, regional, and local).
 
Conclusion
In systematising the governance functions in CHW programmes, the paper seeks to shed light on how best to support and strengthen these functions at scale.

Highlights

 

Watch the Video Summary here.

Keywords
Community Health Workers
Governance
Leadership
South Africa
LMIC
Subjects

 

 

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International Journal of Health Policy and Management
Volume 8, Issue 1
January 2019
Pages 18-27

  • Received Date 10 April 2018
  • Revised Date 09 September 2018
  • Accepted Date 10 September 2018
  • First Published Date 01 January 2019
  • Published Date 01 January 2019