title: Challenges Facing Successful Scaling Up of Effective Screening for Cardiovascular Disease by Community Health Workers in Mexico and South Africa: Policy Implications.
abstract: The integration of community health workers (CHWs) into primary and secondary prevention functions in health programs and services delivery in Mexico and South Africa has been demonstrated to be effective. Task-sharing related to adherence and treatment, from nurses to CHWs, has also been effectively demonstrated in these areas. HIV/AIDS and TB programs in South Africa have seen similar successes in task-sharing with CHWs in the areas of screening for risk and adherence to treatment. In the area of non-communicable diseases (NCDs), there is a policy commitment to integrating CHWs into primary health care programs at public health facilities in both Mexico and South Africa in the areas of reproductive health and infant health. Yet current programs utilizing CHWs are not integrated into existing primary health care services in a comprehensive manner for primary and secondary prevention of NCDs. In a recently completed study, CHWs were trained to perform the basic diagnostic function of primary screening to assess the risk of suffering a CVD-related event in the community using a non-laboratory risk assessment tool and referring persons at moderate to high risk to local government clinics, for further assessment and management by a nurse or physician. In this paper we compare the experience with this CVD screening study to successful programs in vaccination, reproductive health, HIV/AIDS, and TB specifically to identify the barriers we identified as limitations to replicating these programs in the area of CVD diagnosis and management. We review barriers impacting the effective translation of policy into practice, including scale up issues; training and certification issues; integrating CHW to existing primary care teams and health system; funding and resource gaps. Finally, we suggest policy recommendations to replicate the demonstrated success of programs utilizing task-sharing with CHWs in infectious diseases and reproductive health, to integrated programs in NCD.
authors.affiliation: Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Abrahams-Gessel
authors.initials: AG
authors.lastname: S
authors.affiliation: Center for Health and Society Studies, El Colegio de Sonora, Sonora, Mexico.
authors.forename: C A
authors.initials: CA
authors.lastname: Denman
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Gaziano
authors.initials: G
authors.lastname: Ta
authors.affiliation: Division of Diabetic Medicine and Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Private Bag x3, Observatory 7935, Cape Town, South Africa.
authors.forename: Levitt
authors.initials: L
authors.lastname: Ns
authors.affiliation: School of Public Health, University of the Western Cape, South Africa.
authors.forename: Puoane
authors.initials: P
authors.lastname: T
keywords: Cardiovascular disease; Community health; Community health workers