 District 6.1 Managua, Nicaragua, 10 January 2010 – Those among us who have spent countless days and nights working and learning alongside community health workers (CHWs) don’t flinch at the notion that they are an indispensable part of any high-functioning health care system. Their contributions are many, and include the delivery of messages of prevention and wellness, not to mention the delivery of basic curative health care services (yes, they can treat pneumonia and malaria as good as a doctor). These services, among many others, are especially important for the majority poor, whether they reside in the rural Mississippi Delta or in the urban slums of Mumbai, India. Simply put, CHWs are the only chance we’ve got to achieve any sense of basic health care equity in the 21st Century.
Formal recognition of their contributions has been sporadic at best. China’s barefoot doctor program achieved widespread implementation, however, has since faltered. Recently, progress has been seen in the recent rollout of the Indian Rural Health Program, where a variety of CHWs are seen as the head cornerstone in their effort to reduce intolerable rates of maternal and child mortality. The journey to full recognition of the CHW as an integral component of formal health care systems is still long and winding, and there is much work yet to do.
Our collective experiences on the ground confirm our gut feeling that community health workers make a difference. Yet this difference has been little demonstrated in the scientific literature. One can count the number of rigorous randomized controlled trials evaluating the efficacy of the community health worker on two hands.
Thus enter the Managua Cardiovascular Health Initiative, a strong collaboration between the Nicaraguan Ministry of Health, the University of Miami’s Jay Weiss Center, and Atención Primaria en Salud. In less than a half a year, the groundwork has been laid for a rigorous randomized controlled trial that aims to demonstrate the efficacy of the community health worker in the assessment and management of cardiovascular disease risk. Eighty percent of all cardiovascular disease deaths occur in resource-poor settings, and half of those deaths are blood-pressure-related, killing 8 million people globally, per year.
This month, one of the finest and most experienced groups of community health workers Nicaragua has ever seen will take to the streets of urban Managua. They will take with them messages of prevention, aiming to demonstrate through their own lifestyle changes (they’re exercising more and eating more fruit since October) that together we can begin to halt the devastation of cardiovascular disease. But more than that, they will be armed with the tools needed to take the blood pressure of their fellow community members, and will engage in a number of activities aimed to achieve rates of blood pressure control that exceed those seen in wealthy nations. Through a combination of educational messages and directly observed therapy, they will do their part to help keep the silent killer of high blood pressure at bay. Let the paradigm shift begin!
Christopher Dodd |
