Date: January 2018
Authors: Marta Schaaf, Caitlin Warthin, Amy Manning, Stephanie Topp
Publication type: Learning Exchange Report
Published by: Accountability Research Center and Averting Maternal Death and Disability
Community health workers (CHWs) are increasingly put forward as a remedy for lack of health system capacity, including addressing challenges associated with low health service coverage and with low community engagement in the health system. CHWs are often explicitly mandated or implicitly expected to enhance or embody health system accountability to the populations they serve.
While definitions vary, CHWs are generally community-based workers who: are members of the communities where they work; are (at least in part) selected by the communities they serve; and are required to represent and/or deliver health services (WHO, 2007). CHWs are also commonly envisioned as being answerable to the community for their activities, and they often perform a linking function between communities and the health system (WHO, 2007).
In June of 2017, thirty researchers, health advocates, and program implementers from eight countries attended a two-day ‘think-in’ at American University. While many country experiences were discussed, the meeting focused in particular on the experiences of Brazil, India, South Africa, and the United States. These countries were selected because, with the exception of the United States, they have large, scaled-up CHW programs where there have been at least some instances of CHWs facilitating—or demanding—greater health system accountability.
This brief is intended to provide background to participants of the meeting on Community Health Worker Voice, Power, and Citizen’s Right to Health. The guiding questions for the meeting are as follows: What factors promote or undermine community health workers as accountability agents? (and) Can these factors be intentionally fostered or suppressed to impel health system accountability? The text below provides a basic overview on community health workers and accountability, as well as a non-exhaustive discussion of some of the kinds of issues that will likely arise during the meeting.