title: The role of 'hidden' community volunteers in community-based health service delivery platforms: examples from sub-Saharan Africa.
abstract: Community-based research on child survival in sub-Saharan Africa has focussed on the increased provision of curative health services by a formalised cadre of lay community health workers (CHWs), but we have identified a particular configuration, that deserves closer scrutiny. We identified a two-tiered CHW system, with the first tier being the lessor known or 'hidden' community/village level volunteers and the second tier being formal, paid CHWs, in Ethiopia, Mali, and Niger. Whilst the disease-focussed tasks of the formal CHW tier may be more amenable to classic epidemiological surveillance, we postulate that understanding the relationship between formalised CHWs and volunteer cadres, in terms of scope, location of practice and ratio to population, would be important for a comprehensive evaluation of child survival in these countries. We report on the findings from our joint qualitative and quantitative investigations, highlighting the need to recognise the 'hidden' contribution of volunteers. We need to better characterize the volunteers' interaction with community-based and primary care services and to better understand ways to improve the volunteer systems with the right type of investments. This is particularly important for considering the models for scale-up of CHWs in sub-Saharan Africa.
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; natalie.leon@mrc.ac.za.
authors.forename: Natalie
authors.initials: N
authors.lastname: Leon
authors.affiliation: School of Public Health, University of the Western Cape, Cape Town, South Africa.
authors.forename: David
authors.initials: D
authors.lastname: Sanders
authors.affiliation: School of Public Health, University of the Western Cape, Cape Town, South Africa.|Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Van Damme
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
authors.forename: Donela
authors.initials: D
authors.lastname: Besada
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Daviaud
authors.affiliation: UNICEF, New York, NY, USA.
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Oliphant
authors.affiliation: UNICEF, Niger Country Office, Niamey, Niger.
authors.forename: Rocio
authors.initials: R
authors.lastname: Berzal
authors.affiliation: Global Community Health and Behaviour Sciences, Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Mason
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.|School of Public Health, University of the Western Cape, Cape Town, South Africa.
authors.forename: Tanya
authors.initials: T
authors.lastname: Doherty
mesh_terms: D000328:Adult; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers / Q000458:organization & administration*; D003299:Cooperative Behavior; D003906:Developing Countries; D005002:Ethiopia; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008302:Mali; D008875:Middle Aged; D009548:Niger; D024382:Professional Role; D014838:Volunteers
keywords: child mortality; community volunteers; community-based care; developing countries; global health; health systems; population health; sub-Saharan Africa