Increasing the Value of Community Health Workers

In developing countries, frontline community health workers (CHWs) extend basic healthcare services to communities. These extensive CHW networks provide services that improve various health indicators. The Philippines has set a goal of one CHW (“Barangay Health Worker”) in every village, while India is close to meeting its goal of one CHW (“ASHA”) per 1,000 people countrywide. CHWs assist health authorities in raising awareness and implementing public health initiatives in rural and distant regions, as well as in encouraging the adoption of healthy behaviors. There is often great scope to improve the value offered by CHWs by providing them with additional or superior products and services – but making it happen can be tricky and barred by surprising obstacles.

CHWs’ impact on the community

CHWs influence their communities because they are part of them. Governments also help these volunteers gain legitimacy by linking them to the health system. Their networks have a major impact on reducing malnutrition, mortality rates, maternal health and other health indicators. In Bangladesh, CHWs make nationwide home visits to teach one woman in every family about diarrhea prevention and administering oral rehydration solution (ORS) to infants. As a result, there has been a significant rise in ORS use to more than 80% of infants and children.

CHWs face structural and geographical constraints that limit their full potential. To offer healthcare services in remote areas, CHWs must travel long distances. The situation is worsened by poor infrastructure and insufficient guidance. Although using digital technology to assist CHWs can help their efficiency, there are few real-world examples of success in adopting technology across a wide area.

Pharma companies can support CHW networks with commercial solutions aimed at achieving work efficiencies and improving basic healthcare indicators. The EVERSANA^TM APAC team works with clients to explore and test solutions that will help CHWs work more efficiently, improve the performance of various health indicators and implement the required health initiatives.

Things to look out for

For pharma companies, engaging with CHWs is an attractive option. However, there is more to it than meets the eye, with some potential roadblocks being:

• Control of the CHW network by the government: Because CHWs are governed by regional or national health authorities, private companies may find it difficult to directly engage with them. It is vital to understand the regulations that govern relationships between private companies and CHW networks.
• Hurdles for an overseas company: In some countries, it is difficult for foreign companies to navigate the bureaucracy and obtain necessary approvals and support. It may be important to partner with local government/NGOs to drive these solutions and offerings.
• Variation in social, political and economic contexts: Socio-political situations differ among countries. Even within a country, regions may vary widely. For example, in comparison to urban areas, remote communities typically have limited access to healthcare services. As a result, gathering insights and information about these difficulties becomes critical to developing solutions and service offerings that can benefit a broader population.

Achieving results

The EVERSANA APAC team has helped pharmaceutical companies understand and address the hurdles private companies face when entering the public health domain. In one case, we found the hurdle was socio-political, as the health authority was reluctant to collaborate on a commercial, for-profit model. We encouraged our client to pursue an outcome-based approach that required the proposed solution to be tested and evidence to be produced to the health authorities. If the suggested solution could successfully demonstrate significant improvement in target health indicators, the authorities would be willing to collaborate in implementation.

In another case, we recommended that an overseas client collaborate with a local NGO to help them navigate the bureaucracy and obtain support from local health authorities. The NGO offered a sense of familiarity to the health authorities, increasing their willingness to work with a foreign company.

During COVID times, it is difficult for overseas companies to deploy resources to understand the challenges faced by CHWs and the communities they are serving, let alone build solutions to address them. The EVERSANA APAC team provides the required cross-geography advisory experience and capabilities to develop crucial insights into community healthcare conditions and difficulties and assist pharma companies who wish to leverage the outreach potential of such CHW networks. Achieving solutions that can be implemented increases the value of the CHWs and provides benefits to patients as well as upskilling the CHWs and supporting local authorities in their objectives.

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