IEEE Technology and Society Magazine - Spring 2013 - 46

offer health education including
nutrition and surveillance. CHWs
also support maternal and child
health, are involved in family planning activities, and contribute to the
treatment and care of tuberculosis,
HIV/AIDS, malaria and acute respiratory disease. Trained in providing
referrals, CHWs also spend time
recordkeeping and collecting data
on illnesses within the community.
CHW programs have been developed with the goals of improving
access to healthcare and decreasing
morbidity and mortality rates. These

lack of healthcare professionals. The
Global Health Workforce Alliance
completed in-depth case studies of
CHW programs around the world
to evaluate the impact of CHWs on
the Millennium Development goals.
They reviewed the training, supervision, standards deployment, performance, and impact of CHWs in the
areas of maternal and child health,
HIV/AIDS, TB, mental health,
and non-communicable diseases.
We have discussed case studies of
CHWs in Brazil, Ethiopia, Bangladesh, and pakistan, to review best

Approximately 530 000 women die
in pregnancy or childbirth each year.
programs aim to lower the costs in
seeking medical advice, and create
self-reliance and local participation
in community healthcare. Increasing access to resources and community participation in turn improves
coverage and equity across the country. It has been shown that CHW
programs improve health indicators,
behaviors and utilization of services.
Such programs also improve the cultural appropriateness of health and
education campaigns. The community empowerment model of CHW
programs promotes the sustainability of health interventions leading to
related economic benefits. CHWs
serve as a link between a community and the national health systems
and provide insight into community level social and environmental
determinants of health. CHWs have
been recognized as an important
tool in improving the health of a
community [4].

practices and potential models for
other CHW programs. The case
studies offer a window into the
reality faced by CHWs. Appropriate context-driven design of simple,
low-cost technologies can empower
CHWs and improve the efficiency of
isolated rural healthcare centers [9].
Computer-assisted diagnostic software to process patients at rural clinics is a feasible long-term approach,
particularly as smartphones become
accessible, affordable and capable
of supporting compute-intensive
applications [10]. Understanding the
CHW's needs and context of use is
an important first step towards conceptualizing and designing appropriate technology products and services
or policy interventions. The functionality and reliability of the technology itself is typically not as big
of a challenge as the usability, socioeconomics and incentive structures
for all the stakeholders [11].

Case Studies

Brazil
In 1988, the Brazilian Unified
Health System was developed on
the principle that health is a basic
human right of all citizens. Created
with the aim of reaching universal coverage of all people, it was
operationalized through a focus on

For several decades, Community
Health Workers have participated
in primary healthcare delivery in
many countries around the world.
Evidence has shown that CHWs can
aid in improving the health of a population, especially in areas with a
46

primary healthcare and the establishment of Family Health program
or Programa Saude da Familia
(pSF). Through this model, a broad
range of primary care services are
provided by the Family Health
Team composed of one family doctor, one nurse, one assistant nurse,
and about six CHWs. Each Family
Health Team is responsible for a
specific geographic area and monitoring 3000-4500 people [4].
CHWs visit each family in their
geographic area once a month, and
in the case of finding someone
sick, the CHW refers the patient
to the nearest health facility. The
CHW accompanies the patient to
the health facility, maintains contact with the family, and follows up
until the health issue is resolved.
In this way, the CHW serves as
the link between the health system and family in the community.
The Family Health Team is also
required to collect geographic,
demographic and health information on the assigned families, and
to document the services and interventions provided. Ongoing information management challenges
remain at pSF and in the larger
Ministry of Health, and efforts
have been made to move toward
software systems to monitor patient
information and clinical records
[4]. Brazilian CHWs are trained in
building trust within their communities, through approaching issues
of HIV/AIDS and family planning indirectly in the context of
general health [12].The estimated
yearly cost of maintaining the pSF
program is equivalent to $31 to
$50 per individual covered. The
CHWs are considered employees
of the Ministry of Health and earn
the national minimum wage about
$112 per month, paid by the central
state funds. There are also performance based financial incentives
for CHWs in some municipalities.
Ethiopia
The current "Health Extension
program" (HEp), started in 2004, is

IEEE TECHNOLOGY AND SOCIETY MAGAZINE

SprING 2013

Table of Contents for the Digital Edition of IEEE Technology and Society Magazine - Spring 2013