title: An exploration of the feasibility, acceptability, and effectiveness of professional, multitasked community health workers in Tanzania.
abstract: Despite four decades of global experience with community-based primary health care, the strategic details of community health worker (CHW) recruitment, training, compensation, and deployment remain the subject of continuing discussion and debate. Responsibilities and levels of clinical expertise also vary greatly, as well as contrasting roles of public- versus private-sector organisations as organisers of CHW effort. This paper describes a programme of implementation research in Tanzania, known as the Connect Project, which aims to guide national policies with evidence on the impact and process of deploying of paid, professional CHWs. Connect is a randomised-controlled trial of community exposure to CHW integrated primary health-care services. A qualitative appraisal of reactions to CHW implementation of community stakeholders, frontline workers, supervisors, and local managers is reviewed. Results highlight the imperative to plan and implement CHW programmes as a component of a broader, integrated effort to strengthen the health system. Specifically, the introduction of a CHW programme in Tanzania should draw upon community structures and institutions and strengthen mechanisms to sustain their participation in primary health care. This should be coordinated with efforts to address poorly functioning logistics and supervisory systems and human resource and management challenges.
authors.affiliation: a Mailman School of Public Health , Columbia University , New York , USA.|c Ifakara Health Institute , Dar es Salaam , Tanzania.
authors.forename: Colin
authors.initials: C
authors.lastname: Baynes
authors.affiliation: b Ministry of Health and Social Welfare , Dar es Salaam , Tanzania.
authors.forename: Helen
authors.initials: H
authors.lastname: Semu
authors.affiliation: c Ifakara Health Institute , Dar es Salaam , Tanzania.
authors.forename: Jitihada
authors.initials: J
authors.lastname: Baraka
authors.affiliation: c Ifakara Health Institute , Dar es Salaam , Tanzania.
authors.forename: Hildegalda
authors.initials: H
authors.lastname: Mushi
authors.affiliation: a Mailman School of Public Health , Columbia University , New York , USA.|c Ifakara Health Institute , Dar es Salaam , Tanzania.
authors.forename: Kate
authors.initials: K
authors.lastname: Ramsey
authors.affiliation: a Mailman School of Public Health , Columbia University , New York , USA.|c Ifakara Health Institute , Dar es Salaam , Tanzania.
authors.forename: Almamy Malick
authors.initials: AM
authors.lastname: Kante
authors.affiliation: a Mailman School of Public Health , Columbia University , New York , USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Phillips
mesh_terms: D003153:Community Health Services; D003150:Community Health Workers / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated; D005240:Feasibility Studies; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D036301:Qualitative Research; D013636:Tanzania; D000078329:Workforce
keywords: Community health workers; Tanzania; health systems; implementation research; primary health care