HRH dimensions of community health workers: a case study of rural Afghanistan
Bibliographic record
Abstract
INTRODUCTION: There is ample evidence to indicate that community health workers (CHW) are valuable human resources for health in many countries across the globe, helping to fill the gap created by a chronic health workforce shortage. This shortage is not only in number but also in workforce distribution and skill mix. There remains a lack of evidence, however, concerning the size and distribution of CHWs and their relationship to the professionally regulated and recognized health workforce, such as physicians and nurses, and the unregulated and unrecognized health workforce, such as traditional birth attendants and traditional healers. This is particularly the case in low-income, under-resourced countries, such as Afghanistan. METHOD: We conducted a descriptive qualitative analysis involving fieldwork in Afghanistan between 2013 and 2014. We undertook participant observation and in-depth interviews with community members, CHWs, health managers, and policymakers, in an attempt to add more depth to our knowledge of how CHWs function, or could function better, as a recognized health worker. RESULTS: We found that the number of CHWs has increased dramatically in recent years and that CHWs play a variety of roles, including work generally associated with professional providers, such as referral, education, and counseling. Although not a replacement for professional health providers, CHWs, in places where the number of and access to such providers is low, become the only option to meet basic health needs of the population. In places where professional providers are available, CHWs have the potential to extend the services to marginalized populations, provide community health services, and become a recognized member of the health provider team. A limitation of their role in health system strengthening is their lack of integration and a clear career path including into more recognized professional roles. CONCLUSION: CHWs provide a critical human resources for health role in Afghanistan, but there are opportunities for improved integration with other providers which can increase their potential to improve service delivery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.023 | 0.005 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".