The role of Community Health Workers. Historical perspective of facilitators and barriers. Case study in Vaupés, Colombia

Thesis (Master's)--University of Washington, 2016-06

Background: The use of community health workers (CHWs) has been identified as an important strategy to extend health care and improve the health of populations, particularly in low-income countries and rural areas.2,3 However, they are also a vulnerable group that face the consequences of all the complex political, economic and social factors that have shaped their role over the last 30 years. This study focuses on the role of CHW in Vaupés and on how their role has changed over time. It aims to understand the factors that have influenced their role over the last 30 years and how changes to their role have affected the CHWs’ performance. Methods: We conducted a qualitative exploratory study using focus group discussions and in depth interviews/life stories with CHWs and key informant interviews with health authorities at the local and national levels. Results: Several global, national or external and local or contextual factors have affected the role of community health workers over time. The global factors include structural adjustment programs, and policies and international demand for drugs. The external/national factors include the 1993 health care reform, narco-trafficking and the internal conflict. The contextual/local factors include the geographical barriers and indigenous context. Conclusions: The CHWs’ role in Vaupés, Colombia has been changed dramatically the past couple of decades, negatively affecting the health outcomes for many marginalized communities. The results highlight the key position CHW can have, bridging two medical systems and contributing to the improvement of health outcomes of isolated communities. In the post conflict scenario, the figure of the CHW can be important for peace building and conservation inside the communities, and help in the process of recovering communities’ trust in the State.