Abstract

Community health workers and HIV care in low- and middle-income countries: conceptualizing a diverse and complex phenomenon

U. Lehmann

University of the Western Cape, School of Public Health, Bellville, South Africa

The health crisis in many Low- and middle-income countries, sparked by severe health worker shortages, fragile systems and the HIV/Aids pandemic, has led to an unprecedented proliferation in the use of community health workers (CHWs) for the delivery of primary and community care services generally and HIV services more specifically.
This presentation will interrogate the currently existing research evidence on the roles and functions of CHWs in HIV programmes and their impact on health service capacity more generally. It will argue that current research and analysis is conceptually blunt and homogenizes diverse and complex social and systems phenomena. We currently discuss CHWs within the Brazilian Family Health Programme, where they work in close collaboration with doctors and nurses, as fundamentally the same phenomenon as Health Extension Workers in Ethiopia who independently provide the first level of health care in remote areas, and as community carers emerging from HIV self-help groups. This conflation has historical roots, but in today's context muddies policy and academic debates and masks the urgent need to systematically engage with and develop models of community-based, integrated and continuous HIV care which is locally appropriate and responsive, and makes use of locally available resources in ways that are not exploitative but build human and social capital.
The presentation will argue that programmes which utilise and strengthen locally available human resources are not an easy, but a good investment, since the alternative in reality is NO care for many communities, particularly in peripheral areas. They have the potential to be building blocks towards sustainable and equitable health care systems. This does not mean, however, that responsibility for health services can be delegated to fragile communities. In fact, a grave danger to access, quality and equity lies in conflating discourses of community involvement with responsibility for essential health services.