IEEE Technology and Society Magazine - Spring 2013 - 47

implemented by "Health Extension
Workers" (HEW), who are selected
by their communities and provided
one year of training. The requirements for the selection process for a
HEW state that the person must be
female, at least 18 years old, have
completed grade 10, and be a wellrespected member of the community. The criteria are relaxed in rural
and pastoralist areas where educational requirements may not be met
by women in particular. The training is well structured with clear curriculum training materials, and is
available at all the technical training
facilities around the country. In contrast to the CHW program in Brazil,
the HEWs in Ethiopia are entitled to
upgrade their education to a level of
registered nurses through a distance
learning program and hands-on
training [13].
The HEWs are responsible for
a population of 5000 people, and
are supported by a group of Volunteer Community Health Workers
(VCHW); one VCHW for every
250 people. The HEWs spend about
25% of their time on administrative
duties at the health post and 75% of
their time in the field. part of their
field work includes training "model
families" in waste management, separating human and animal quarters,
family planning, malaria monitoring, mosquito breeding sites, information on common health problems,
and general support and encouragement [4]. The HEWs have also been
tasked with HIV/AIDS education,
psychological support, prevention of
mother to child HIV transmission,
and home care visits [13].
Bangladesh
The Bangladesh rural Advancement Committee (BrAC) is the
largest national non-governmental
organization with semi-voluntary
CHWs. BrAC began in 1972 and
provides basic and curative healthcare through ShasthoSebikas (SS),
the local name for CHWs. The
SS are women between 25 and
45 years of age, with a few years

The community empowerment model
of CHW programs promotes the
sustainability of health interventions
leading to related economic benefits.
of schooling, and a willingness to
provide volunteer services in their
community. The SS work 2 hours
a day, 6 days a week for 15 days a
month. Their roles include health
education in five essential components: water and sanitation,
health and nutrition, family planning, basic curative services and
immunization. They sell medicine,
contraceptives, sanitary latrines,
vegetable seeds, and tube-wells.
SS have a strong focus on pregnant women by encouraging them
to utilize services in government
facilities, visit women at 42 days
of delivery, and give special care
to low birth weight babies. They
also connect with the community
by using interactive communication through folk music and theater.
There are currently about 78 000
SS and each SS is responsible for
150-200 households [4].
Once chosen, SSs are trained in
fundamental and essential curative
health for 4 weeks, spending about
four days per week at the regional
office. They are trained specifically in the following common illnesses: ringworm, scabies, worm
infestation, common cold and
cough, diarrhea, anemia, gastric
and peptic ulcers, angular stomatitis, and dysentery. SSs must continue monthly refresher programs
for the next two years. These meetings discuss problems SSs have
encountered in the past month and
disseminate new health and nutrition knowledge [4]. SS workers
are volunteers and do not receive
a salary. They make an income
from the sales of drugs and health
commodities (contraceptives pills
and condoms). Motivational factors are enforced, such as social
prestige and fame that comes with

IEEE TECHNOLOGY AND SOCIETY MAGAZINE

SprING 2013

being an SS and the enthusiasm to
work for the betterment of one's
community. Certain paid incentives have been given for specific
tasks that involve pregnancy and
health of newborns. CHWs have
been found to be more cost-effective than government services for
the implementation of the DOTS
campaign against tuberculosis in
resource-poor settings [14].
Pakistan
In 1994, the federal Lady Health
Workers program was developed
to provide services for family planning and primary healthcare. With
about 90 000 trained Lady Health
Workers (LHW), the program was
designed to address the high maternal mortality ratio of 320 deaths
per 100 000 live births. The LHW,
responsible for about 1000 individuals, provides primary health services and organizes women groups
and health committees in her area.
She is expected to visit 5-7 households each day and re-visit them
every 2 months. LHWs promote
family planning and encourage
mothers to seek pre- and post-natal
care, among other primary health
services [4].
The LHWs attend 15 months
of training consisting of two parts,
three months of integrated classroom training and 12 months of
task-based training. After training,
the LHWs report to the training site
once a month for refresher training
and supplies, to ask questions and
turn in reports. LHWs are paid during training followed by a salary
of pakistani rs. 3090 (~USD 35)
every month. They supplement their
income by selling contraceptives to
their clients. Lady Health Supervisors are trained for a one-year
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Table of Contents for the Digital Edition of IEEE Technology and Society Magazine - Spring 2013