Revolutionary progress in healthcare over the last 100 years has aided humanity in addressing critical vulnerabilities due to infectious and chronic diseases. Developments in pharmaceutics, medical technology, and practice have disproportionately but universally increased the life expectancy of people in all countries. Coupled with improved life expectancy, the exponential trend of population growth has driven encroachment on the habitats of other earth-dwelling species increasing the chances of zoonotic transmission of novel diseases. As population growth has begun to slow and taper, new generations of healthcare professionals entering the field today face the unique challenge of addressing the increasing occurrences of novel disease outbreaks in the context of a disproportionately increasing elderly population as large cohorts of existing generations age past their physiological prime and become increasingly immuno-vulnerable. The current care context focuses on secondary and tertiary levels of care in fragmented supply-chain-driven health systems usually centralized to hospitals or ambulatory health centers known as healthcare “silos”. Such downstream models are unsustainable as it faces well-known capacity issues, most recently demonstrated by the COVID-19 pandemic, and are expensive to scale and maintain, making it especially difficult for developing countries to model and develop. To mitigate capacity issues, improve society’s overall health, and be able to detect and address health emergencies quickly, more emphasis must be placed on primary-level health systems. Integrating these systems at the community level can decentralize the burden of care from “silos” and develop early monitoring, detection, and response systems, significantly improving access to quality care.
Primary-level health system models which revolve around the professionalization of community health workers (CHW), an umbrella term used to describe the age-long practice of community-based care by designated healers, have been regaining attention in recent years as innovative health leaders and global health partners have established several successful programs worldwide. CHWs are trusted community members with a deep understanding of their community’s dynamics, language, experiences, and, importantly, their needs. In this capacity, CHWs are very effective in establishing a dynamic relationship between the patient community and healthcare providers essential to better assessing and understanding community needs, constructively strategizing approaches to address these needs, and effectively delivering care to all. As a community-based approach, CHWs decentralize the locus of care from silo facilities and empower communities to take ownership of their stake in the local health ecosystem to improve the access, trust, and quality of care bilaterally, which leads to a more empowered, effective, and sustainable health system level necessary to address the increasing burden of disease.
In recognition of the stark disparity in access to quality healthcare globally, the World Health Organization (WHO) focused 16 of 17 Sustainable Development Goals (SDG) on topics, directly and indirectly, related to improving a population’s access to quality healthcare. The third SDG focuses exclusively on improving health and wellbeing for all at all ages, which includes the “Framework on integrated, people-centered health services” (IPCHS), a strategy passed by the Health Assembly in 2016. This strategy is designed to reorient fragmented supply-chain-driven health systems towards a more cross-sectoral health system centered around the people and communities it serves; to provide responsive services both within and beyond hospital settings irrespective of development status (WHO, 2016). The IPCHS presents a detailed framework with a variety of goals in working towards achieving an integrated people-centered health system, which serves as the primary evaluation framework of this thesis. This thesis reviews studies on CHW programs globally, presenting evaluations on how and which IPCHS goals CHWs can attain and how CHW programs can be utilized to achieve a more sustainable integrated people-centered health system.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/45564 |
| Date | 01 February 2023 |
| Creators | Hansen, Mikas |
| Contributors | Onyango, Monica, McKnight, C. James |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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