Community health worker

Community health workers (CHW) are members of a community who are chosen by community members or organizations to provide basic health and medical care to their community capable of providing preventive, promotional and rehabilitation care to these communities. Other names for this type of health care provider include village health worker, community health aide, community health promoter, and lay health advisor.

In many developing countries, especially in Sub-Saharan Africa, there are critical shortages of highly educated health professionals. Current medical and nursing schools cannot train enough workers to keep up with increasing demand for health care services, internal and external emigration of health workers, deaths from AIDS and other diseases, low workforce productivity, and population growth. Community health workers are given a limited amount of training, supplies and support to provide essential primary health care services to the population. Programs involving CHW in China, Brazil, Iran and Bangladesh have demonstrated that utilizing such workers can help improve health outcomes for large populations in under-served regions. "Task shifting" of primary care functions from professional health workers to community health workers is considered to be a means to make more efficient use of the human resources currently available and improving the health of millions at reasonable cost.

It is unclear where the usage of community health workers began, although China and Bangladesh have been cited as possible origins. Melinda Gates, co-founder of the Bill & Melinda Gates Foundation, said the nongovernmental organization BRAC in Bangladesh "pioneered the community health worker model." Catherine Lovell writes that BRAC's decision to train locally recruited paramedics was "based on the Chinese barefoot doctor model then becoming known worldwide."

Scientific medicine has evolved slowly over the last few millennia and very rapidly over the last 150 years or so. As the evidence mounted of its effectiveness, belief and trust in the traditional ways waned. The rise of university based medical schools, the increased numbers of trained physicians, the professional organizations they created, and the income and attendant political power they generated resulted in license regulations. Such regulations were effective in improving the quality of medical care but also resulted in a reduced supply of clinical care providers. This further increased the fees doctors could charge and encouraged them to concentrate in larger towns and cities where the population was denser, hospitals were more available, and professional and social relationships more convenient.

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