By Kate Hawkins, 18 June 2014
Last week many of us were busy at the CAHRD meeting in Liverpool. This was a major consultation on the future of applied health research and delivery over the next 10-20 years which attracted a large audience of academics, policy makers, and practitioners from around the world.
Close-to-community providers featured in many of the conference sessions, where participants had a chance to reflect on some of the critical issues raised in background papers. REACHOUT was centrally involved in drafting the paper on close-to-community providers. Sally Theobald very valiantly outlined some of the key opportunities and challenges in close-to-community programming in a lightening talk of about 5 minutes! She explained how close-to-community programmes are well placed to extend health services and equity. Whilst there are evidence gaps in how far they can do this, promising practice, for example in the work of BRAC in Bangladesh, gives a sense of the possible benefits that these types of programmes could bring. Amuda Baba, from IPASC, Democratic Republic of Congo, opened the health systems stream with a discussion about human resources for health in fragile and conflict affected states, highlighting the importance of close to community provider who are embedded within communities. Close-to-community providers can play a role in translating community level knowledge for the health system and other sectors such as education and water and sanitation. However these programmes face challenges. Crucially staff need to be retained, motivated and supported to do their jobs well and systems for this are not well developed in all contexts.
The view from Bangladesh
We were fortunate to be joined at the meeting by Sadia Chowdhury, the Executive Director of the BRAC Institute of Global Health. Her presentation focussed on the way that community health workers and informal providers of health care are central to the provision of community-level care in Bangladesh. Informal providers are relatively overlooked by Government and tend not to receive the supervision or training that they require to serve their communities well. Because they charge for their services remuneration does not seem to be an issue for informal providers, but this is not the case for community health workers whose pay rises are irregular. Sadia explained how more could be done to coordinate between informal providers and community health workers and to facilitate communication between the two groups given that they are usually dealing with the same clients/patients.
Are we future focussed?
Because the conference was developing a research agenda for the next couple of decades participants were challenged to think to the future. Chris Whitty from DFID reminded us that we need to think about urban health systems, changing demographics, the rise of non-communicable diseases. He also suggested that in 20 years time it is likely that there will not be enough health care workers to meet demand and they will be drawn to the private sector serving the middle classes. A deepening human resource crisis has real implications for close-to-community programmes serving economically marginalised communities.
Lung health was one of the meeting themes. We heard some alarming statistics on the current burden of illness and projections for the future. Sundeep Salvi explained how an estimated 3.5 million patients visit a doctor for Chronic Obstructive Pulmonary Disease (COPD) or asthma in India every day. Providing the global overview, Kevin Mortimer outlined how 235 billion people have asthma, 80 million are living with COPD and there are 8.6 million new cases of TB a year. He predicted that if trends continue COPD will become the third commonest cause of death globally by 2030. Kevin suggested that there is a role for community health workers in preventing lung ill-health and also sign posting concerning symptoms to primary health care services.
The expansion to of close-to-community provider’s responsibilities to other health issues, such as supporting people with disabilities as a result of Neglected Tropical Diseases, was echoed by other plenary speakers. This prompted some debate. Bertie Squire asked who is preparing the curricula that will equip health workers for the problems that they will face in 10 or 20 years time. Miriam Taegtmeyeragreed that close-to-community providers are both driven and motivated. But she asked with the addition of new responsibilities, who is thinking through problems related to supervision and integration with broader health systems. Finally Korrie de Koning called on governments to take up the lead in mobilising, capacitating and coordinating close-to-community providers to manage an expanded portfolio of work.
So the meeting left us with many questions about close-to-community providers but also a sense that an expanded range of health stakeholders are beginning to realise their potential in expanding coverage and equity. Devising a research agenda that is fit for the future and expanding multi-stakeholder platforms to bring the existing evidence base to a wider range of actors are key priorities.
Matt Goodfellow took some lovely shots of the conference which you can view here…
Photo courtesy of Matt Goodfellow