CHWs serve as counselors, educators, treatment supervisors, and advocates experienced in identifying the needs of their communities. They:

1. Provide home-based care
2. Provide psychosocial support to patients undergoing treatment
3. Act as the link between the patient and the health center
4. Carry out active casefinding
5. Educate the community on a variety of health topics

1. Provide home-based care

At PIH programs, CHWs provide the bulk of daily care to patients, especially in supporting those who have chronic illnesses such as HIV and TB. CHWs are responsible for administering all outpatient TB- and HIV-related medications. They directly observe the ingestion of pills at the same time once or twice a day in the patient’s home and record the patient’s adherence (example: Adherence form).

By working to ensure that patients adhere to medications, CHWs fulfill an essential function in optimizing patients’ clinical outcomes and preventing or delaying the emergence of drug-resistant disease. CHWs also routinely visit HIV-positive patients who are not receiving ART to assess their ongoing needs and those of the family.

CHWs explain the importance of adherence to medication and work with the patient to identify and address obstacles to adherence. Through their daily visits, CHW teach patients how to manage complex drug treatments and cope with possible side effects. CHWs ensure that they safely store the medications they provide to patients, keep them away from children, away from sunlight, in a dry place and in the same container in which they come from the health center. The CHWS are also responsible for ensuring that drugs are taken with the appropriate food and drink if required, and that any allergic reactions or side effects to medicines are quickly identified and reported to the health center.

In PIH’s Prevention and Access to Care and Treatment (PACT) Program in Boston, United States, CHWs work with patients who have long histories of poor adherence to AIDS treatment. These patients need extra support to improve their clinical outcomes and quality of life. The PACT Project involves two types of CHWs. Health Promoters (HP) make weekly home visits to assess adherence (PACT adherence form), provide extensive adherence counseling, and accompany patients to medical and social service appointments. For those patients who need more intensive support in maintaining adherence, a DOT specialist visits the patient daily and observes ART.

CHWs are also a vital link between the health center and pregnant women in the community (see Accompagnateurs curriculum section – Women and HIV/AIDS). CHWs stress the importance of prenatal and postnatal care and encourage pregnant women to visit the health center for check-ups, undergo HIV testing, and deliver at the health center. In the case of a home delivery, they encourage women to bring their babies to the health center as soon as possible after the birth.

2. Provide psychosocial support to patients undergoing treatment

As the primary contact with the patient and the patient’s family through daily visits, CHWs see first-hand the stresses that affect a patient’s health status and adherence to treatment and health status. Through their own experience as members of the same community, and their knowledge, commitment, and ability to access to other resources, CHWs can support the patient and his/her family in important non-medical ways during treatment and beyond.

CHWs respect the privacy and confidentiality of the patient (see Accompagnateurs curriculum section – Psychosocial Support and Effective Communication). When the patient and the CHW start working together, they establish ways to respond to questions about their relationship. Some patients may prefer to describe the CHW as a friend or a cousin. Following the wishes of the patient and keeping information about him/her confidential are crucial for building trust.

CHWs provide emotional and practical support to patients by helping reduce their sense of isolation and by encouraging them to discuss their illness with their families (see Accompagnateurs curriculum section – Stigma and Discrimination). They alert the staff at the health center if the patient’s mental, social, or economic state is precarious.

CHWs may also provide counseling and facilitate referrals on mental heath, substance abuse, domestic violence and other social issues, as they do in the PACT Program (PACT Progress Report).

3. Act as the link between the patient and the health center

Community Health Workers are the eyes and ears of the clinical team in the community. CHWs also accompany their patients to the health center, sometimes assisting with arranging transportation, childcare, or other logistics.

At the same time, they advocate for the patient by assessing, monitoring, and attending to patients’ need for food, housing, safe water, education, or financial assistance (example: Addressing Basic Needs at PIH Lesotho). They notify the clinical staff and the social worker at the health center when these non-medical problems impact patients’ adherence, treatment or overall health.

4. Carry out active casefinding

As CHWS are living and working in the community, they may be able to proactively identify sick or otherwise needy people, especially family members or other close contacts of patients. They may recognize opportunistic infections or TB symptoms and encourage these people to undergo testing and treatment at the health center; CHWs should pay particular attention to groups at particular risk for TB: children, people living with HIV/AIDS, and malnourished people. CHWs may also identify social and economic obstacles that impact on health, such as problems with children’s schooling, or housing or economic hardship, and help to obtain support for these social needs.

5. Educate the community on a variety of health topics

CHWs provide accurate information about chronic diseases such as HIV/AIDS and TB, explain how to prevent them, encourage community members to undergo testing, and correct people’s misunderstandings or myths. They also encourage community members to accept and provide support to people living with HIV/AIDS, especially orphans. Beyond AIDS and TB, CHWs formally and informally educate the community on a wide array of health center activities and health topics, ranging from vaccination campaigns to hygiene and sanitation.

The multifaceted work of a community health worker is highlighted in this example from PIH’s program in Rwanda.