We have started the second week of Community Health Worker (CHW) training. We are now covering reproductive health. Their final week-long training will be in June, and then they’ll be officially certified CHWs!

The scene reminded me strongly of medical school. There were lectures on healthcare (the head nurse, the public health officer, the reproductive health coordinator). There were several lecturers throughout the day. It was lecture, and not much hands-on work. There was a big class. The teaching was in another language. As painful as these days are (understanding ~1%), it’s making me reminisce about med school, and start to get excited to go back.

But before I go too far, you may actually be wondering what a community health worker is (and if you are not, skip down a paragraph or two). The big idea is this: a community member with a small amount of training who generally goes door to door improving health. There are many variations on this basic idea, but the core is that the biggest gains in healthcare in the developing world are basic.

What’s the big deal with CHW’s? A number of groups have made some pretty big impacts on health using these low-trained people. And like every good idea, everyone’s excited to jump on the bandwagon. Except in this case, the band playing on the wagon is playing a good song.

Partners In Health showed that you could drastically improve HIV treatment if you have health workers deliver the drugs and watch the patient take it. Organizations like CHAI, Living Goods, and Millennium Villages Project have been successful in using CHW’s to improve maternal and child mortality.

We are in the process of researching these models to intelligently design our own. Kenya has a plan and curriculum, and we plan to build on that foundation. There are many things to decide: what will they do? How will they gather data? How will they be supervised? How will they get paid (or will they get paid)? Will they have bonus pay (or pay for performance)? Janine Brown is working very hard to help answer some of these questions, researching the best organizations on each topic.

We’ve tried to do some home visits in the past back before this training, but we failed to communicate to the workers a perfectly clear job description. We also haven’t yet figured out a strong enough system of supervision to know if our people are actually doing their jobs, and if they’re not, to do something about it. We’ve chosen Wednesdays to get out into the field and start visiting homes. Everyone on the healthcare team is in the field on Wednesday. It has given me a good perspective on the state of our program, especially some of the practical difficulties with going door-to-door.

For two more days I will enjoy my mini Swahili med school. And then, energized and with heads full of knowledge, we’ll get back into the field. After a broad search for solutions, we are now focusing. And we are focusing on visiting people where they live; that, I believe, is where the destiny of the Healthcare program lies.