From the Research
Zambia's Community Health Assistant (CHA) program was established in 2010 as part of the National Community Health Worker strategy to address the country's severe healthcare worker shortage and rural healthcare access challenges. The program was developed to address Zambia's high burden of communicable diseases (HIV/AIDS, TB, malaria) and increasing prevalence of non-communicable diseases, along with maternal and child health challenges. The CHA program was modeled partly after Ethiopia's Health Extension Worker program, creating a formalized community health workforce that differs from existing community health volunteers through standardized one-year training, government salaries, regulatory registration, and formal integration into the health system 1. Some of the key challenges that the CHA program faces include infrequent supervision, lack of medical and non-medical supplies for outreach services, and challenges with the mobile data reporting system 1. However, the program has shown promise in increasing health service provision at referral health facilities and at facilities overall, shifting the burden of basic health services away from more highly trained health workers 2. The Ministry of Health, with support from partners, is currently addressing these challenges through nationwide supervisor and community data trainings, as well as advocating for adding primary health care as a specific focus area in the new National Health Strategy Plan 2017-2021 1. Key factors that have facilitated the scale-up of the CHA program include the perceived relative advantage of CHAs over existing community-based health workers, and the perceived compatibility of CHAs with existing groups of health workers and community healthcare expectations 3. However, limited integration of CHAs in the district health governance system, limited information flow, and insufficient documentation of outcomes have hindered effective program implementation at the district level 3. Overall, the CHA program represents a significant step in Zambia's efforts to bring primary healthcare closer to communities, particularly in underserved rural areas. Some of the benefits of the program include increased access to health services, improved health outcomes, and task-shifting of basic health services away from more highly trained health workers 2. However, to optimize the impact of CHAs, key health-system support structures need to be functioning effectively, such as supervision, community surveillance systems, supplies, and reporting 1.
Key Components of the CHA Program
- Standardized one-year training for CHAs
- Government salaries and regulatory registration for CHAs
- Formal integration into the health system
- Task-shifting of basic health services away from more highly trained health workers
- Increased access to health services, particularly in underserved rural areas
Challenges Facing the CHA Program
- Infrequent supervision
- Lack of medical and non-medical supplies for outreach services
- Challenges with the mobile data reporting system
- Limited integration of CHAs in the district health governance system
- Limited information flow and insufficient documentation of outcomes
Future Directions for the CHA Program
- Nationwide supervisor and community data trainings
- Advocating for adding primary health care as a specific focus area in the new National Health Strategy Plan 2017-2021
- Addressing challenges with supervision, supplies, and reporting
- Evaluating the impact of the CHA program on health outcomes and access to health services.