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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. Other names for this type of health care provider include village health worker, community health aide, community health promoter, and lay health advisor.〔International Labour Organization. ''International Standard Classification of Occupations, 2008 revision''. Geneva, ILO.〕 In many developing countries, especially in Sub-Saharan Africa, there are critical shortages of highly educated health professionals.〔World Health Organization, 2006. (''The World Health Report 2006: working together for health.'' ) Geneva, WHO Press.〕 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.〔World Health Organization, 2007. ( ''Task shifting to tackle health worker shortages''. ) Geneva, WHO.〕 ==History== 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. In the 1940s Chairman Mao Tse Tung in China faced these problems. His anger at the "urban elite" medical profession over the maldistribution of medical services resulted in the creation of "Barefoot doctors". Hundreds of thousands of rural peasants, chosen by their colleagues, were given rudimentary training and assigned medical and sanitation duties in addition to the collective labor they owed the commune. By 1977 there were over 1.7 million barefoot doctors.〔Rosenthal MM, Greiner JR. The Barefoot Doctors of China: from political creation to professionalization. ''Hum Organ''. Winter 1982;41(4):330-341〕 As professionally trained doctors and nurses became more available, the program was abolished in 1981 with the end of agricultural communes. Many Barefoot Doctors passed an examination and went to medical school. Many became health aides and some were relieved of duty. Brazil undertook a medical plan named the Family Health Program in the 1990s that made use of large numbers of community health agents. Between 1990 and 2002 the infant mortality rate dropped from about 50 per 1000 live births to 29.2.〔Macinko J, Guanais FC, de Fatima M, de Souza M. Evaluation of the impact of the Family Health Program on infant mortality in Brazil, 1990-2002. ''J Epidemiol Community Health''. Jan 2006;60(1):13-19.〕 During that period the Family Health Program increased its coverage of the population from 0 to 36%. The largest impact appeared to be a reduction of deaths from diarrhea. Though the program utilized teams of physicians, nurses and CHWs, it could not have covered the population it did without the CHW. Additionally there is evidence in Brazil that the shorter period of training does not reduce the quality of care. In one study workers with a shorter length of training complied with child treatment guidelines 84% of the time whereas those with longer training had 58% compliance.〔Huicho L, Scherpbier RW, Nkowane AM, Victora CG. How much does quality of child care vary between health workers with differing durations of training? An observational multicountry study. ''Lancet''. Sep 13 2008;372(9642):910-916.〕 Iran utilizes large numbers of para-professionals called ''behvarz''. These workers are from the community and are based in 14,000 "health houses" nationwide. They visit the homes of the underserved providing vaccinations and monitoring child growth. Between 1984 and 2000 Iran was able to cut its infant mortality in half and raise immunization rates from 20 to 95%. The family planning program in Iran is considered highly successful. Fertility has dropped from 5.6 lifetime children per woman in 1985 to 2 in 2000. Though there are many elements to the program (including classes for those who marry and the ending of tax incentives for large families), behvarz are extensively involved in providing birth control advice and methods. The proportion of rural women on contraceptives in 2000 was 67%. The program resulted in profound improvement in maternal mortality going from 140 per 100,000 in 1985 to 37 in 1996.〔Roudi-Fahimi F, Bureau PR. ''Women's reproductive health in the Middle East and North Africa.'' Population Reference Bureau; 2003.〕 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「community health worker」の詳細全文を読む スポンサード リンク
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