Home Careers Community Health Nurse. Community health nurses work to improve the health and well-being of communities they serve by educating them about illness and disease prevention, safe health practices, nutrition, and wellness. They often provide treatment for poor, culturally diverse, and uninsured populations. One of the primary functions of a community health nurse is to identify health problems in the community and to provide health care to patients who may not have access to, or be able to afford, medical services. They develop intervention plans to address the health, safety, and nutritional issues they discover, and attempt to educate their patients about healthy choices that assist with disease and illness prevention.
How to Become a Community Health Nurse
Community health workers CHWs are used increasingly in the world to address shortages of health workers and the lack of a pervasive national health system. However, while their role is often described at a policy level, it is not clear how these ideals are instantiated in practice, how best to support this work, or how the work is interpreted by local actors. This paper addresses this issue. A case study approach was undertaken in a series of four steps.
Firstly, groups of CHWs from two communities met and reported what their daily work consisted of. Secondly, individual CHWs were interviewed so that they could provide fuller, more detailed accounts of their work and experiences; in addition, community health extension workers and community health committee members were interviewed, to provide alternative perspectives. Thirdly, notes and observations were taken in community meetings and monthly meetings.
The data were then analysed thematically, creating an account of how CHWs describe their own work, and the tensions and challenges that they face. The thematic analysis of the interview data explored the structure of CHW s work, in terms of the frequency and range of visits, activities undertaken during visits monitoring, referral, etc. The importance of these findings as a contribution to the field is evidenced by the depth and detail of their descriptive power.
The way that these CHWs described their work was as healthcare generalists, working to serve their community and to integrate it with the official health system. Their work involves referrals, monitoring, reporting and educational interactions. Their work is widely appreciated, although some households do resist their interventions, and figures of authority sometimes question their manner and expertise. The material challenges that they face have both practical and community aspects, since coping with scarcity brings community members together.
The implication of this is that programmes co-designed with CHWs will be easier to implement because of their relevance to their practices and experiences, whereas those that assume a deficit model or seek to use CHWs as an instrument to implement external priorities are likely to disrupt their work. Community health workers CHWs represent a widespread strategy in the majority world to address shortages of health workers and the lack of a pervasive national health system, particularly in rural areas.
Recently, research interest in this group has grown, both because of the need to accomplish the health-related Millennium Development Goals combined with the lack of human resources available for health work in the majority of the world. Community engagement in health systems has been seen as both a practical response to the challenging conditions of health provision in low-income settings [e. However, a substantive account of CHW s own view of their own practice has been lacking up until now, hindering the integration or alignment of CHWs to the formal health care system at the community level.
The concept of CHWs was universally adopted at the Alma Ata conference in , as a means for achieving the goal of health for all. Although CHWs operate under a variety of names, there is evidence that the role has existed in one form or another for more than 50 years 5. However, this variety of terminology signals inconsistencies in what CHWs do, as well as how they are identified. Reflecting this, many definitions of their role have remained vague.
For example, in , The World Health Organization proposed that:. Community Health Workers should be members of the communities where they work, should be selected by communities, should be answerable to the communities for their activities, should be supported by health system but not necessarily a part of its organisation, and have shorter training than professional workers.
Whilst this outlined relationships, it did not specify in any detail what CHWs might be expected to know or do. Examples of this include Kenyan CHWs who promote behaviour change through health education, earlier case identification and timely referral to trained health care providers 1 ; and the ASHAs in India, who identify and register new pregnancies, births and deaths; mobilise, counsel and support the community in demanding entitled health services; identify, manage, or refer diseased cases; support health service delivery through home visits, first aid, immunisation sessions and camps; maintain data; and participate in community-level health planning 7.
The community-facing role of CHWs means that these duties are typically carried out within households, rather than in formal medical settings. Importantly, however, generalists also act as a link between community households and the nearest health facility. They may also organise community development activities and collect data from the households 8 , 4.
Kahssay et al. Interestingly, these are primarily deficit-based interventions, assuming that CHWs themselves are the issue, although influences such as the attitudes of health personnel or community members may also be problems. Moreover, such interventions have not resolved matters; although training and supervision have been recognised as being important for over 20 years 9 , there remains considerable variation in what is available.
This body of prior research provides a useful high-level overview of CHWs practices. It outlines broad areas of responsibility, for example. Braun et al. Whilst this review identified common practices such as home visits, assessment and treatment of disease, data collection, education and counselling and referrals, it did at a high level of generality, signalling categories of work but providing few details about the processes involved. Moreover, the projects reviewed were exceptional, typically undertaken through funded initiatives, with no guarantee of the sustainability of these new practices.
Much of the research to date reports on what CHWs do through such high-level categorisations; it does not reflect, for example, how CHWs themselves see their work. This is a particular issue for those wishing to understand CHW s work, since there is little evidence of participatory approaches, through which the CHWs would be able to explain what they do.
This is an issue: CHWs and other close-to-community CTC providers may originally have been introduced as a means of extending services, but in their operation have developed insights and expertise into the operation of initiatives that it not currently taken into account in policy or new initiatives 4. Qualitative studies have been undertaken to explore and understand implementation issues. For example, Mireku et al. They also found that their workload was not clearly defined; that supervisors often prioritised facility-based responsibilities over community work and had no clear guidelines for supervision; that there are few incentives beyond community recognition for their work; and that CHWs were sometimes forced to use their own resources to subsidise services.
Other studies have also identified some insights from CHWs, or from those who work closely with them. For example, Nyamhanga et al. Similarly, Buchner et al. Pitt et al. Although these studies recognising some of the expertise of CHWs, this is a secondary function, a by-product of the main purpose of the work. What CHWs have to say about their own practice remains largely unheard.
Although there is over two decades of literature addressing CHWs, much of this is policy-driven, taking a directive, normative tone. Other research involves CHWs as part of the health system, exploring for example their efficacy in delivering specific interventions. Accounts that explore the day-to-day realities of working as a CHW, and how the CHWs themselves understand and explain these, are rarer. Such accounts remain relatively fragmented, providing little detail about how their work is actually undertaken, or about how the perspective of their communities on their work.
This is a missed opportunity, given the expertise that CHWs have about building links between formal healthcare and the community, and about the successful implementation of new initiatives. This paper seeks to address this gap by presenting the findings of a study that explored the day-to-day practices of CHWs in two regions of Kenya although we believe that similar challenges arise in other contexts , through the generation of rich qualitative data with CHWs and key members of the communities they serve.
In doing so, it contributes to previous literature both by detailing what practice consists of in these regions, and by exploring what this work means to the CHWs. The findings reported in this paper are based on a structured, in-depth qualitative case study of two communities in Kenya — one urban and one rural. The study was part of a project exploring the development, implementation and evaluation of a practice-based mobile learning intervention.
The aim of the study reported here was to develop a thorough and systematic account of CHW s practices, providing a baseline to inform the development and evaluation of subsequent interventions. Given the gaps identified in the literature above, particular concerns included the patterns of communal engagement and support, and the training and supervision of CHWs. The emphasis here is on the identification and description of issues as identified and understood by the CHWs and other CTC actors, as a precursor to theory development, claims about prevalence or other generalisations.
Such cases can also contribute to theory refinement by generating interpretations, which can be useful in limiting other generalisations or identifying areas of complexity that warrant further study Used in such ways, case studies support better informed understandings of factors influencing complex interventions 19 , thus minimising the implementation variation 20 across sites when more generalisable methodologies such as randomised control trials need to be used.
The kinds of analytical generalisations that case studies support also. Specifically, the study invited them to reflect on the challenges they face, and the forms of support that might help them with these. A case study approach was required to explore these open-ended, practitioner-focused questions. Both sites are located within Kenya. Infant mortality nationally stands at 52 deaths per 1, live births, although mortality rates differ considerably by province.
Amref s own internal statistics provide a more detailed picture, and are used here to help characterise the study sites. The first study site is a semi-arid rural county in Eastern Kenya which experiences long droughts, resulting in high poverty levels. Health care services are delivered through an estimated health facilities. The second site is an urban informal settlement in Nairobi.
Health care provision is extremely limited, poorly resourced and difficult to access, making the extended reach of CHWs critically important. The community is characterised by high levels of poverty, insecurity and inadequate access to basic social services. There is little or no access to water, electricity, basic services and adequate sanitation. Most structures are let on a room-by-room basis with many families on average six people, compared to a national average household of 4.
These factors have serious health repercussions, demonstrated by the child mortality rate: Wide regional disparities in health services and shortages of human resources in the health sector make the availability and accessibility of health services in Kenya challenging. Prompted by these challenges in general and in response to deteriorating maternal and infant mortality rates specifically, in , the Ministry of Health decided to decentralise the provision of health services and to devise a new health strategy, the Kenyan Community Health Strategy A plan for the training and involvement of CTC providers on a regional level was designed and implemented in The administrative structure of this new community health strategy was divided into six levels: This administrative and managerial decentralisation of the country s health service provision allowed the communities to participate in health decision making on levels 1, 2 and 3, i.
According to these administrative levels, a district health management team now manages the committee of the health facilities, who in turn manages CHCs, and the CHCs manage their voluntary CHWs. These voluntary CHWs are linked to primary health facilities through trained health workers employed in the facilities — called community health extension workers CHEWs The purpose of the CHC is to represent issues affecting the provision of health services in the communities and direct resources and CHWs towards them.
According to the community health strategy implementation guide 22 , the CHC s roles include:. Members of the CHC are elected at the assistant chief s baraza a meeting with community elders and generally are elders or of respectable social status. Together, these administrative and managerial structures constitute the community health strategy and shape the roles of CTC providers.
Amref Health Africa is an African-based organisation that aims to strengthen the capacity and capability of health and health-related professionals and institutions in Africa through training, research, health care provision and advocacy. Through a variety of different projects and partnerships, including e-learning initiatives and tailored community health courses, Amref Health Africa is training health workers in close to 35 African countries.
It relies on an extended network of relations with governments, international donors and the private sector. In a report, Amref described itself as follows:. From its decades of engagement with Africa s most remote and impoverished populations, Amref has developed a specialised approach to its work in health. Much of its credibility with local communities and African governments stems from the relationship and trust that Amref has built over the past 54 years.
The study reported here was conducted with CTC providers working directly under the community health strategy, i. To address the gap in understanding CHW s practice identified above, a rich body of data was gathered through a series of four steps. Firstly, focus groups were held with groups of CHWs at which they were invited to talk through what they tended to do each day; these accounts were treated as data in their own right, but were also used to prompt mind-mapping activities that generated overviews of CHW practice.
Community Health Worker
In my experience in the rural reaches of Africa and Haiti, and among the urban poor too, the problem with so many funded health programs is that they never go the extra mile: Training and paying village health workers also creates jobs among the very poorest. They believe that not only could CHWs remove the problem of the last mile, but that they could also provide prevention, which is a significant yet overlooked aspect of healthcare. The vast majority of sickness in rural areas could be prevented with clean water, waste-disposal systems and more diverse farming. They need to end discrimination against women and Untouchables, and to learn about hand-washing, nutrition, breast-feeding and simple home remedies.
Community health workers CHWs are used increasingly in the world to address shortages of health workers and the lack of a pervasive national health system. However, while their role is often described at a policy level, it is not clear how these ideals are instantiated in practice, how best to support this work, or how the work is interpreted by local actors.
Within today s booming healthcare industry, a community health worker is a trained professional who offers a link between community members and health educators to develop strategies that will improve public health for enhanced well-being. As medical costs continue to escalate, the demand for community health workers will be very high to teach the public about healthy habits and behaviors to avoid costly chronic conditions or medical procedures. If you are interested in educating the public to reduce the occurrence of lung cancer, heart disease, skin cancer, diabetes, asthma, HIV, obesity, and much more, read on for a full job description for community health workers. Using their in-depth knowledge on the communities they serve, community health workers are given the responsibility of identifying health-related issues affecting the community, collecting data, and discussing health concerns with the public.
What Does a Community Health Worker Do?
Victorian government portal for older people, with information about government and community services and programs. Type a minimum of three characters then press UP or DOWN on the keyboard to navigate the autocompleted search results. The following content is displayed as Tabs. Once you have activated a link navigate to the end of the list to view its associated content. The activated link is defined as Active Tab. There is a range of subsidised and free health services, including services for mental health and dental health, available for children in Victoria
Module 1: Who Are Community Health Workers and What Do They Do?
Community health is a major field of study within the medical and clinical sciences which focuses on the maintenance, protection, and improvement of the health status of population groups and communities. It is a distinct field of study that may be taught within a separate school of [public health] or [environmental health]. The WHO defines community health as:. Community health tends to focus on a defined geographical community. The health characteristics of a community are often examined using geographic information system GIS software and public health datasets. Medical interventions that occur in communities can be classified as three categories: Each category focuses on a different level and approach towards the community or population group. In the United States , community health is rooted within primary healthcare achievements.
Rural Health Information Hub
Community health centres
.VIDEO ON THEME: Community Health, Population Health and Public Health: Understanding the Differences