The role of 'hidden' community volunteers in community-based health service delivery platforms: examples from sub-Saharan Africa
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Date
2015Author
Leon, Natalie
Sanders, David
Damme, Wim Van
Besada, Donela
Daviaud, Emmanuelle
Oliphant, Nicholas P.
Berzal, Rocio
Mason, John
Doherty, Tanya
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Show full item recordAbstract
Community-based research on child survival in sub-Saharan Africa has focussed on the increased provision
of curative health services by a formalised cadre of lay community health workers (CHWs), but we have identified
a particular configuration, that deserves closer scrutiny. We identified a two-tiered CHW system, with
the first tier being the lessor known or 'hidden' community/village level volunteers and the second tier being
formal, paid CHWs, in Ethiopia, Mali, and Niger. Whilst the disease-focussed tasks of the formal CHW tier
may be more amenable to classic epidemiological surveillance, we postulate that understanding the relationship
between formalised CHWs and volunteer cadres, in terms of scope, location of practice and ratio to
population, would be important for a comprehensive evaluation of child survival in these countries.We report
on the findings from our joint qualitative and quantitative investigations, highlighting the need to recognise
the 'hidden' contribution of volunteers. We need to better characterize the volunteers' interaction with
community-based and primary care services and to better understand ways to improve the volunteer systems
with the right type of investments. This is particularly important for considering the models for scale-up of
CHWs in sub-Saharan Africa.