CHW Program

Summary of the CHW training and expected skills/activities of the health workers after the program:

The IMCI (Integrated Management of Childhood Illness, PCIME in French) program is designed to give health care workers a systematic and evidence-based method to evaluate, treat, and prevent the leading causes of morbidity (illness) and mortality in children under 5 years of age (Actually 2 months to 5 years; a separate program addresses illness in infants less than 2 months). IMCI is not a substitute for primary health care, since the focus is only on a very limited number of illnesses for a specific age group. It should be integrated into the existing health care system. During the training course the community health workers (CHWs, or Agents de Sante Communautaire) learn to use simple and algorithms or protocols to evaluate a child, and to implement or coordinate preventive care services. After the IMCI training, they should be able to do the following:

  1. Assess whether a sick child has “danger signs” that require immediate transport to a hospital
  2. Evaluate a child with cough or difficulty breathing, classifying the respiratory illness as a common cold, pneumonia, or severe pneumonia. Instruct the mother (or father) on simple remedies (no antibiotics) for a common cold, treat pneumonia with an oral antibiotic (cotrimoxazole or amoxicillin), and refer severe pneumonia cases to a hospital after giving the first dose of antibiotics.
  3. Evaluate a child with fever and possible malaria (fever with no other symptoms or signs). Test for malaria with a rapid diagnostic test (RDT), and treat positive cases with ACT (artemisinin-based combination therapy). Give paracetamol  for RDT-negative cases.
  4. Evaluate a child with diarrhea, looking for signs of dehydration. Instruct mother (or father) to treat with oral rehydration solution (ORS) and dispense zinc supplement for treatment. Identify and treat cases of dysentery with antibiotics.
  5. Evaluate a child for malnutrition using the mid-upper arm circumference (MUAC) measurement and checking for edema. Refer those with acute malnutrition to a therapeutic feeding program (if available) or hospital.
  6. Assess whether a child is due for vitamin A supplement (according to MOH/WHO schedule), and administer the supplement in appropriate dose to those who are due to receive it.
  7. Assess the immunization status of a child and arrange or coordinate the administration of the immunizations per MOH/WHO schedule.
  8. Counsel family members in the households for which the CHW is responsible on use of malaria bed nets, sanitation & hygiene, child nutrition and birth control.

After the training the CHWs will keep a record of their activities as described above, and report regularly to the coordinator/supervisor. The supervisor will maintain records of program activities (number of children evaluated, diagnoses and treatment provided, counseling sessions for households, etc.).

For overall assessment of program effectiveness, a household survey will be conducted of the target area/villages, administering a questionnaire to collect data on the number of children under 5 and pregnant women sleeping under a mosquito net, household water treatment and latrine use, ORS use for children with diarrhea, etc, and weighing/measuring children to assess malnutrition prevalence. This could be repeated at some interval, e.g. annually to monitor progress.