Developing the national community health assistant strategy in Zambia: a policy analysis View Full Text


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Article Info

DATE

2013-12

AUTHORS

Joseph Mumba Zulu, John Kinsman, Charles Michelo, Anna-Karin Hurtig

ABSTRACT

BACKGROUND: In 2010, the Ministry of Health in Zambia developed the National Community Health Assistant strategy, aiming to integrate community health workers (CHWs) into national health plans by creating a new group of workers, called community health assistants (CHAs). The aim of the paper is to analyse the CHA policy development process and the factors that influenced its evolution and content. A policy analysis approach was used to analyse the policy reform process. METHODOLOGY: Data were gathered through review of documents, participant observation and key informant interviews with CHA strategic team members in Lusaka district, and senior officials at the district level in Kapiri Mposhi district where some CHAs have been deployed. RESULTS: The strategy was developed in order to address the human resources for health shortage and the challenges facing the community-based health workforce in Zambia. However, some actors within the strategic team were more influential than others in informing the policy agenda, determining the process, and shaping the content. These actors negotiated with professional/statutory bodies and health unions on the need to develop the new cadre which resulted in compromises that enabled the policy process to move forward. International agencies also indirectly influenced the course as well as the content of the strategy. Some actors classified the process as both insufficiently consultative and rushed. Due to limited consultation, it was suggested that the policy content did not adequately address key policy content issues such as management of staff attrition, general professional development, and progression matters. Analysis of the process also showed that the strategy might create a new group of workers whose mandate is unclear to the existing group of health workers. CONCLUSIONS: This paper highlights the complex nature of policy-making processes for integrating CHWs into the health system. It reiterates the need for recognising the fact that actors' power or position in the political hierarchy may, more than their knowledge and understanding of the issue, play a disproportionate role in shaping the process as well as content of health policy reform. More... »

PAGES

24

References to SciGraph publications

  • 2009-12. Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia in BMC HEALTH SERVICES RESEARCH
  • 2012-12. The role of health extension workers in improving utilization of maternal health services in rural areas in Ethiopia: a cross sectional study in BMC HEALTH SERVICES RESEARCH
  • 2009-12. Community health workers for ART in sub-Saharan Africa: learning from experience – capitalizing on new opportunities in HUMAN RESOURCES FOR HEALTH
  • 2009-12. What impact do Global Health Initiatives have on human resources for antiretroviral treatment roll-out? A qualitative policy analysis of implementation processes in Zambia in HUMAN RESOURCES FOR HEALTH
  • 2010-12. Prospective policy analysis: how an epistemic community informed policymaking on intentional self poisoning in Sri Lanka in HEALTH RESEARCH POLICY AND SYSTEMS
  • 2011-12. Community case management of malaria using ACT and RDT in two districts in Zambia: achieving high adherence to test results using community health workers in MALARIA JOURNAL
  • 2012-12. Knowledge and performance of the Ethiopian health extension workers on antenatal and delivery care: a cross-sectional study in HUMAN RESOURCES FOR HEALTH
  • 2010-12. A systematic review of task- shifting for HIV treatment and care in Africa in HUMAN RESOURCES FOR HEALTH
  • 2013-12. Mothers’ experiences and satisfactions with health extension program in Jimma zone, Ethiopia: a cross sectional study in BMC HEALTH SERVICES RESEARCH
  • 2012-12. Developing lay health worker policy in South Africa: a qualitative study in HEALTH RESEARCH POLICY AND SYSTEMS
  • 2011-12. The human resource for health situation in Zambia: deficit and maldistribution in HUMAN RESOURCES FOR HEALTH
  • 2012-12. Increasing community health worker productivity and effectiveness: a review of the influence of the work environment in HUMAN RESOURCES FOR HEALTH
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    DIMENSIONS

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/23870454


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    41 schema:description BACKGROUND: In 2010, the Ministry of Health in Zambia developed the National Community Health Assistant strategy, aiming to integrate community health workers (CHWs) into national health plans by creating a new group of workers, called community health assistants (CHAs). The aim of the paper is to analyse the CHA policy development process and the factors that influenced its evolution and content. A policy analysis approach was used to analyse the policy reform process. METHODOLOGY: Data were gathered through review of documents, participant observation and key informant interviews with CHA strategic team members in Lusaka district, and senior officials at the district level in Kapiri Mposhi district where some CHAs have been deployed. RESULTS: The strategy was developed in order to address the human resources for health shortage and the challenges facing the community-based health workforce in Zambia. However, some actors within the strategic team were more influential than others in informing the policy agenda, determining the process, and shaping the content. These actors negotiated with professional/statutory bodies and health unions on the need to develop the new cadre which resulted in compromises that enabled the policy process to move forward. International agencies also indirectly influenced the course as well as the content of the strategy. Some actors classified the process as both insufficiently consultative and rushed. Due to limited consultation, it was suggested that the policy content did not adequately address key policy content issues such as management of staff attrition, general professional development, and progression matters. Analysis of the process also showed that the strategy might create a new group of workers whose mandate is unclear to the existing group of health workers. CONCLUSIONS: This paper highlights the complex nature of policy-making processes for integrating CHWs into the health system. It reiterates the need for recognising the fact that actors' power or position in the political hierarchy may, more than their knowledge and understanding of the issue, play a disproportionate role in shaping the process as well as content of health policy reform.
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