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By Kate Gilroy, Peter Winch

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In CHW programming, concentrating on the needs of the community and tailoring activities to fit these needs can greatly influence the effectiveness of the programme and its sustainability. Programmes that are highly adapted to local communities usually target a defined area and may be limited in their coverage. Expanding effective intervention packages to cover greater populations may shift the focus from the community to health systems and ministry of health hierarchies, and programmes operating on a broad scale are often criticized for their failure to meet communities’ needs or fit within local contexts.

Improve documentation and evaluation of referral practices. Programmes should characterize referral policies in a comprehensive manner. Checklist 2 in Annex C, page 60, provides a guide to components that might be included in referral systems and that should be described in detail in Documentation and evidence MANAGEMENT OF SICK CHILDREN BY COMMUNITY HEALTH WORKERS 35 programme documents. The expected outcomes of community-to-facility referral need to be explicitly stated in programme documentation.

In many cases, the community participates in the implementation of the programme but does not define the health problem or solution. In the Thailand malaria volunteer programme, for example, the programme strategies and disease target are defined, but programme activities are carried out by communities (36). In some cases, the community is directly responsible for supervising and providing benefits or incentives to the CHW, often through such formal mechanisms as a community health committee. Community-based health information systems are another approach that facilitates collaboration between CHWs, the community and programme managers.

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