Preparing frontline health workers for community-led change

Nenet L Ortega, CNS Special Correspondent
Photo credit: Nenet L Ortega/CNS
If care for people affected by TB is going to be truly patient-centred, TB services will have to be demand driven and communities will need to be actively involved in the planning and implementation of care. A genuine patient centred TB service rests upon the readiness of its providers, the facility, the TB patients themselves and the whole community. Ideally, services in a TB facility should be rendered by trained health practitioners like the doctors, nurses and other allied health workers.

In resource limited community settings, non-clinicians are almost always in the frontline providing information about TB, assessing and counselling clients, administering the DOTS treatment, updating the records of each TB patient and, most importantly, encouraging and bringing more clients for TB diagnosis and treatment—a long list of work indeed.

While there has been a significant acknowledgement about this at a strategic level, it is necessary to prepare front-line healthcare workers in practical terms, for this fundamental change to become a reality--from a doctor centric TB care and control to a patient/community centric one.

Issues that need to be addressed across health and community organizations to achieve this change were discussed in a symposium at the 45th Union World Conference on Lung Health in Barcelona, by sharing best practice examples of collaborative working across health and community services from countries like South Africa, Mexico, Namibia, and the Russian Federation.

Tatiana Fedotkina, Russia Fed.
Engaging and preparing every frontline healthcare worker to be deployed in a community based TB service facility entails a lot of preparation and consideration. Each of the country presentations highlighted the strength in keeping and making their health workers stay to continue providing services to the community. All these countries have volunteer management systems comprising of lay persons, but at the same time they also have a roster of modestly paid nurse staff.

A well planned and prepared TB health facility should provide for staff and volunteer safety to avoid getting TB infection and other diseases. In the case of Russian Federation,  modest health and accident insurance is available for all their staff and volunteers. According to Tatiana Fedotkina of the Federation, providing insurance as part of the compensation package is important because the workers conduct community outreach work to identify potential TB clients.

Steven Neri, Namibia
Jose Martinez from Mexico said that they have mobilized a community health team that creates the demand for TB services and clients are accompanied to the TB facility centre for clinical assessment and diagnosis by the medical staff. This model involves stakeholders within the health and non-health sector partnering with each other. Steven Neri of Namibia shared that their team is working in collaboration with the Ministry of Health.

As part of  the preparation of  the frontline health providers to work in a TB facility, training for skills and capacity building is one of the most important component. Training frontline health workers enhances their skills in communicating TB facts and information, helps in creating demand and contributes to an increase in the number of cases of referrals for TB diagnosis and treatment.

Components of the training contain basic TB prevention, diagnosis and treatment module, addressing psycho social needs of the TB clients and other vital learnings key to becoming an effective TB community worker. But then dealing with the burnout and stress that may be encountered by the health workers themselves has also been considered. Thus a complete human resource development package includes stress management for the workers.

An important recommendation suggested was developing a training system in collaboration with the Ministry of Health so that standard training modules could be utilized. Constant post-training monitoring to build the competency of the trained providers and getting a certification issued by the Ministry of Health would also help.

Though country specific local initiatives are reaping success, each of them is faced with challenges-- fast turn over of trained staff because of low compensation, multitasking, and burnout. These are recognizable challenges that can happen in any treatment facility for TB.

Over all, it is important to address the problems facing community health systems with a view to increasing their efficiency so that they are better able to serve their local constituencies. There is also need for programmes to be well funded to be able to continue engaging community workers for providing quality health services. It is also important to build layers of community volunteers and workers to have a sustainable service delivery network of facilities and providers for addressing health as well as non health issues of clients holistically and sustainably.

Nenet L Ortega, Citizen News Service - CNS
31 October 2014
(The author is reporting for Citizen News Service (CNS) from 45th Union World Conference on Lung Health from Barcelona, Spain with support from Lilly MDR TB Partnership. Email:

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