• Non-communicable diseases (NCDs)

Non-communicable diseases (NCDs)

Rapid improvements in health and nutrition in developing countries may be ascribed to specific, deliberate, health- and nutrition-related interventions and to changes in the underlying social, economic, and health environments. This chapter is concerned with the contribution of specific interventions, while recognizing that improved living standards in the long run provide the essential basis for improved health. Consideration of the environment as the context for interventions is crucial in determining their initiation and in modifying their effect, and it must be taken into account when assessing this effect.

In the past several decades, people’s contact with trained workers has been instrumental in improving health in developing countries. This factor applies particularly to poor people in poor countries but is relevant everywhere. Community-based programs under many circumstances provide this crucial contact. Their role is partly in improving access to technology and resources, but it is also important in fostering behavior change and, more generally, in supporting caring. This chapter argues that such programs may also play a part in mobilizing social demand for services and in generating pressure for policy change.

Mothers and children are the primary focus, but others in the household should participate. The existence, training, support, and supervision of the community workers are indispensable features of these programs. Thus community organizations are a key aspect of community-based health and nutrition programs (CHNPs). 

This chapter focuses on large-scale (national or state) programs. Although these programs are primarily initiated and run at the local level, links with the national level and levels in between are necessary. Most of these programs include both nutrition and health activities, aimed particularly at the health and survival of reproductive-age women and children. The arguments presented draw on these

In conclusion, the chapter suggests that the question of incentives, training, and support for community workers urgently needs research, both from current experience and with prospective designs. The issues include the following:

• What is the CHNW’s status, relative to the community or to the government (or NGO) hierarchy?

   

• How are CHNWs selected and to whom do they report (for example, community health committees, supervisors employed in the health or other system)?

   

• What educational background and how much training and retraining—and by what methods—are needed for CHNWs?

   

• What ratios of CHNWs to households are effective (or most cost-effective), both as part-time workers (volunteer or otherwise) and as full-time employees?

   

• What supervision ratios work?

   

• What remuneration and incentives are effective?

   

• How can these efforts be financed?

   

• Full text of document
• Publisher details
• Send to a friend