International Journal of Health Policy and Management

International Journal of Health Policy and Management

Community Health Worker Programs to Improve Healthcare Access and Equity: Are They Only Relevant to Low- and Middle-Income Countries?

Document Type : Original Article

Authors
Sara Javanparast
Alice Windle
Toby Freeman
Fran Baum
Southgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia
10.15171/ijhpm.2018.53
Abstract
Background
Community Health Workers (CHWs) are proven to be highly effective in low- and middle-income countries with many examples of successful large-scale programs. There is growing interest in deploying CHW programs in high-income countries to address inequity in healthcare access and outcomes amongst population groups facing disadvantage. This study is the first that examines the scope and potential value of CHW programs in Australia and the challenges involved in integrating CHWs into the health system. The potential for CHWs to improve health equity is explored.

 
Methods
Academic and grey literature was searched to examine existing CHW roles in the Australian primary healthcare system. Semi-structured telephone interviews were conducted with a purposive sample of 11 people including policymakers, program managers and practitioners, to develop an understanding of policy and practice.

 
Results
Literature on CHWs in Australia is sparse, yet combined with interview data indicates CHWs conduct a broad range of roles, including education, advocacy and basic clinical services, and work with a variety of communities experiencing disadvantage. Many, and to some extent inconsistent, terms are used for CHWs, reflecting the various strategies employed by CHWs, the characteristics of the communities they serve, and the health issues they address. The role of aboriginal health workers (AHWs) is comparatively well recognised, understood and documented in Australia with evidence on their contribution to overcoming cultural barriers and improving access to health services. Ethnic health workers assist with language barriers and increase the cultural appropriateness of services. CHWs are widely seen to be well accepted and valuable, facilitating access to health services as a trusted ‘bridge’ to communities. They work best where ‘health’ is conceived to include action on social determinants and service models are less hierarchical. Short term funding models and the lack of professional qualifications and recognition are challenges CHWs encounter.

 
Conclusion
CHWs serve a range of functions in various contexts in Australian primary healthcare (PHC) with a common, valued purpose of facilitating access to services and information for marginalised communities. CHWs offer a promising opportunity to enhance equity of access to PHC for communities facing disadvantage, especially in the face of rising chronic disease.

Highlights

 

Watch the Video Summary here.

Keywords
Community Health Workers
Primary Healthcare
Health Equity
Healthcare Access
High-Income Countries
Subjects

 

 

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International Journal of Health Policy and Management
Volume 7, Issue 10
2018
Pages 943-954

  • Received Date 03 October 2017
  • Revised Date 01 June 2018
  • Accepted Date 02 June 2018
  • First Published Date 01 October 2018
  • Published Date 01 October 2018