Burkina Faso has had an active volunteer community health worker (CHW) scheme for many years. CHWs were the mainstay of guinea worm elimination, for example. At a point they even provided community case management (CCM) of malaria when chloroquine was the first line drug.
In 2008 the Ministry of Health realized that the system of multiple volunteers for multiple health issues was not providing integrated services at the grassroots. At this point the Ministry produced two valuable documents. The first documented that various tasks that CHWs can play in the community, while the second developed an integrated communication strategy for CHWs.
It was also during this period that Burkina Faso was successful in winning two Global Fund Rounds to support malaria, Rounds 7 and 8, which have now been merged for easier management. One component of the combined Round 7/8 is delivery of malaria CCM by the workers known locally as Agents Sante Communautaire (ASC). PLAN Burkina is leading that effort and has revised ASC training guides and produced behavior change materials – a flipchart – for ASCs to use in educating the public about cause, prevention and treatment of malaria (see photo).
Normally there are two ASC per village is the population is 3000 or less and at least 4 in larger villages. The Global Fund supported work asks the community to designate one ASC to be trained for malaria CCM and educational activities.
But back to the Ministry – recognizing the need for a well coordinated delivery of an integrated minimum package of community services, the Ministry created just one year ago a new Directorate for Community Health. This Directorate works closely with all program areas in the MOH to ensure and coordinate community delivery of those basic services.
The Directorate draws on existing health staff. Of the seven or eight members of the District health Management Team, one person is specifically in charge of community activities. Also at the primary care health center level there is what is termed an ‘itinerant’ health worker whose job is outreach to and mobilization of communities and especially the supervision and support of ASCs.
In the meantime the Global Fund project implementers have hired animators to work with the malaria ASCs in the catchment of a health center and district supervisors to coordinate the animators. Although this appears to be a parallel system, the ASCs still must link with their nearest health center to get supplies of malaria medicines, and th animators help summarize malaria ACS records for onward transmission to the health center.
At present the system of itinerant health workers cum ASC supervisors needs strengthening because public the sector experiences staffing and funding shortages that often keep these theoretically mobile workers in the clinic.
The new Directorate of Community Health has begun negotiations and discussions with all parties to harmonize the overall ASC scheme with the specific needs of the malaria ASC effort. Ideally all ASC in a village should be able to provide the integrated package including malaria services so that the current single malaria ASC is not overburdened and frustrated.
While still a work in progress, the new Burkina Faso Community Health Directorate points to the future where the aims of the Alma Ata Primary Health Care Declaration can still become a reality for neglected rural populations around the world.
PS – the VOICES Project website is undergoing some major improvements. In the process the original link to this blog has become a link to the new Voices blog. Therefore you can keep up with Voices activities and those of partners at http://www.malariafreefuture.org/blog. Happy reading of both blogs!