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Journal Club at College of Health Systems Management (CHSM), Naresuan University is a weekly forum for M.Sc. and PhD students where they present research articles, research methodologies pertinent to their academic research interest. It greatly helps graduate students to prepare them for writing their thesis or dissertation through critical thinking. The forum is also helpful for boosting their presentation skills before large audience including academic communities. As such, Proloy Barua, a PhD Student presented an article on 21 Feb 2017 entitled “Community Health Workers (CHWs) in Low-, Middle-, and High-Income Countries: An Overview of Their History, Recent Evolution, and Current Effectiveness”. The paper represented his academic interest. Mr Barua showed the way of extracting information from a journal article, converting a concept into measurable variables, and finally identifying methodological drawbacks of the paper if any. This is an useful technique for writing review literature and finding out knowledge gap in the body of literature through critical thinking. He started his presentation with operational definition of CHWs as “the workers who” assist individuals and communities to adopt healthy behaviors” while helping “to conduct outreach” and “advocate for individuals and community health needs”. Then he showed the way of converting a theoretical concept into measurable variable such as concept (i.e. effectiveness) → indicator (e.g. maternal health)→variable(e.g. maternal mortality rate)→value(in % form) from the journal article. Next, he showed the contribution of CHWs to measure the effectiveness in terms of reducing reducing mortality and morbidity among reproductive aged women and under five children in developing (e.g. Bangladesh, Nepal) and developed countries (e.g. the USA). The brief history of CHW and their effectiveness are presented below:

History of CHWs : CHWs originated in China in 1920s and rapid growth of CHWs happened in 1950s. Later, in 1960s, CHW program expanded in others countries like Indonesia, India, Tanzania, Venezuela, Honduras, and Guatemala. By seeing the success of CHW program, World Health Organization (WHO) documented a book called “health by the people” in 1975 and organized an international conference on primary health care in Alma-Ata, Kazakhstan in 1978. After that conference, government and NGOs of respective countries expanded CHW program at national scale between 1970s and 1980s.

Effectiveness : (a) globally, exclusive breastfeeding increased 5.6 times greater among mothers who received CHW intervention than mothers without CHW intervention. (b) CHW intervention reduced prevalence of acute malnutrition from 19% to 4% among Vietnamese. (c) globally, vitamin A supplementation intervention by CHW reduced the risk of death among children by 23%, (d) globally, CHW intervention reduces the risk of death by pneumonia among children by 36%, (e) globally, oral rehydration salts (ORS) intervention by CHW may reduce the risk of death by diarrhoea among children by up to 93%, (f) newborn care by CHW reduces neonatal mortality by 24% , (g) globally, maternal mortality reduced by 37% due to CHW interventions.

In addition, the CHWs are effective in promoting preventive measures of communicable (malaria, tuberculosis, HIV/AIDS) and noncommunicable diseases (diabetes, cancer, obesity, hypertension, cardiovascular diseases) in developing and developed countries respectively.

Bibliography: Perry, H. B., Zulliger, R., & Rogers, M. M. (2014). Community health workers in low-, middle-, and high-income countries: An overview of their history, recent evolution, and current effectiveness. Annual Review of Public Health, 35, 399-421. DOI:10.1146/annurev-publhealth-032013-182354