Motivating and Retaining Community Health Workers: The 2011 Annual CBPHC-WG workshop

By: Dr. Paul Freeman

Prior to the recent APHA Annual Meeting, the CBPHC-WG held a day long workshop focusing on Community Health Workers. There were over 110 attendees including presenters and organizers. This was the largest workshop our group has held in the 13 years we have been conducting these workshops. It was a great feeling to see APHA functioning at its best in providing a venue where those from MCHIP, CORE group, academics, members of other NGOs, not-for-profit and for-profit organizations and consultants could share their views in an open, mutually respectful environment and learn from each other. This year JSI personnel, under the leadership of Mary Carnell, worked in partnership with Working Group members in all stages of workshop planning and implementation. The work of Agnes Guyon (who lead the workshop), Sandee Minovi and Kimberley Farnham, all from JSI, and our own Sandy Hoar, Vina Hulamm, Melissa Freeman, Laura and David Paragon, Tonio Martinez and Larry Casazza were outstanding.

Leban Tsuma MCHIP leading. Photo credit: Paul Freeman.

Our norms were: use of an evidence-based approach, the right for all participants to be heard and for their viewpoints to be respected. At this time, renewed attention is being given to the role of CHWs with recognition becoming more widespread now that the Millennium Development Goals, especially those for women and children, cannot be met without community involvement.  The 8 large group presentations and 16 small group discussion sessions covered well a wide range of perspectives on CHW motivation, retention and performance. I am sure some participants were being exposed to different points of view from their own for the first time.

Samuel Yalew, Urban Health Extension Project/JSI (Ethiopia) leading. Photo credit: Paul Freeman.

I would especially like to highlight the area of internal motivation of CHWs. Through Pink’s book “Drive” many of us are becoming acquainted with the “modern” approach to the importance of autonomy, mastery and purpose in motivation. Yet several NGO presentations, such as those by Tom Davis of Care Groups and Connie Gates of Jamkhed, demonstrated that these elements have already been addressed by NGOs for decades as appropriate to local circumstances.

Sarah Shannon from Hesperian facilitating. Photo credit: Paul Freeman

Melissa and I will prepare a report of the workshop to be disseminated early next year. There were many lessons to learn from conducting this workshop that should remain with the International Health Section for years to come. One of the key lessons was that with enough goodwill and cooperation from individual members – things work best with at least 8 volunteers for such an event – memorable events can be implemented by the Section. With enough “hands” each contributing a relatively small amount, things go much more smoothly than if all sit back waiting for a few to do all the work.

Paul Freeman is a physician with advanced training in tropical disease control and general public health, health personnel education, and health program management and evaluation. He has over two and a half decades of experience in capacity building and the design, planning, implementation, monitoring and evaluation of primary health care, child survival and malaria control programs in developing countries and for deprived rural indigenous populations in developed countries. He is a Clinical Assistant Professor at the University of Washington School of Global Health and the Chair-Elect of the International Health Section.

Occupational Health – The Need to Go Global

Guest blogger: Dr. Isobel Hoskins

I never come away from the APHA meeting without being inspired.

This year, the inspiring speech for me came right at the end. I attended the closing session almost by chance when I realised I had a little time. The theme was occupational health so as someone keen on global health I didn’t think it would be all that relevant. When the second speaker took the stand I realised how wrong I was.

Leo Gerard from the United Steelworkers Union showed how health and safety is a global issue and exactly why we need to address occupational health worldwide to match the globalisation of trade. Have you ever thought about who made the clothing you wear, the conditions they work under and the impact that has on their health?

He showed a short video about the Triangle fire – a fire that happened in 1911 in New York at a garment factory. Fire broke out in the factory and panicked workers rushed to the two exits only to find them blocked by fire or locked. The workers couldn’t get out and in desperation some even threw themselves from the upper floors to escape the fire. 146 of them died. This event was one of the drivers of health and safety regulation in theUSA. Those workers were low paid and not allowed to unionise and so negotiate their conditions.

Fast forward to 2010. Gerard described a fire at a garment factory in Bangladesh and guess what? The exits were locked. 29 people died trying to get out, some threw themselves from the upper floors. No regulations prevented this accident in Bangladesh and there was no union to help protect the low paid workers.

Nothing has changed except the geography.

In the rush of globalization, developed country companies are getting round regulation at home by exploiting places where there is none. What does this mean for regulation at home? It means it is under pressure. We could lose all that has been gained since the Triangle fire. In the race to the bottom and the lowest prices, people’s health is being put on the line.

Trade regulations preventing import into the US of goods made in sweatshops or by children, for example, could be a way of forcing global companies to adopt safe working conditions, said Gerard. Having stronger more global unions is another way. Leo’s union the United Steelworkers Union has just gone global – forging partnerships and mergers with other unions worldwide.

Individually I think we can make a difference as well- reading the label and knowing the reputation of companies you buy from could help prevent exploitation. Consumers have power….

Triangle fire:
Bangladesh fire:

Dr Isobel Hoskins manages the Global Health database at CABI.

Annual Meeting, Day 3: Governing Council Action and Section Goals

Apologies for the delay in posting this, but it has taken us all a little while to regroup after the Annual Meeting.

The major event every year on Tuesday of the Annual Meeting is the Governing Council session.  The IH section was, as always, active and vocal in this year’s session.  Nominations Committee Chair and Governing Councilor Amy Hagopian provides a great summary of this year’s session:

The governing council meetings this year were the usual mix of deadly dull and rivetingly interesting. On Saturday we had a lively candidates’ forum, hearing from the six candidates for executive board and the two candidates for chair-elect. The governing council is the electoral body for these positions (although we did vote on a proposal this year to allow the full APHA membership to vote for chair-elect….um, that failed). The candidates for these positions were very high quality this year, and it was hard to choose! Our section was very happy with the results of the election, which took place on Tuesday: Adewale Troutman for chair-elect; and 3 winners for executive board, Lisa Carlson, Durrell Fox and Paul Meissner.

Tuesday’s full-day governing council meeting opened with a riveting (not) discussion of detailed bylaws changes. We did vote on changes to the membership categories, which will favor members who join during their student years and transition into “new professionals.” We voted on the theme for the 2013 conference, and chose (by 54%): “Think Global, Act Local: Best Practices Around the World.”

We adopted 23 resolutions on a variety of policy matters, including six sponsored by the International Health Section:
B1: Improving Access to Higher Education Opportunities and Legal Immigration Status for Undocumented Immigrant Youth and Young Adults
B2: Improving Housing for Farmworkers in the U.S. is a public health Imperative
C1: Prioritizing non communicable disease prevention and treatment in global health
C3: Call to Action to Reduce Global Maternal, Neonatal & Child Morbidity and Mortality
C7: Highlighting the health of men who have sex with men in the global HIV/AIDS response
D1: APHA Endorses the World Health Organization’s Global Code of Practice on the International Recruitment of Health Personnel

We also approved two policies supported by the IH section:
B6: Reducing PVC in Facilities with Vulnerable Populations (sponsored by our friends in the Occupational Health Section)
LB2: Opposing the DHS-ICE “Secure Communities” Program (in support of immigrant rights)

The governing board also made some changes to the policy submission process. Some highlights:
1) Late-breakers now must be submitted 10 days before the conference
2) There are no longer two categories of policy submissions (short resolutions vs. policy statements); now all policies should be about 10 pages with plenty of evidence and background

Further, we accepted the report of the ad hoc “Policy Working Group,” which worked for two years to discuss how to manage policy resolutions that can be characterized as largely based on qualitative data or are values-based.

And, finally, there was a fun “wild card” vote on a statement to support the Occupy movement. It passed, 76% to 24%:
“The Occupy Wall Street movement is now active in more than 1,000 cities in the US and has related protests around the world. APHA supports its call for greater social equality, social justice, reducing income inequality, and its demand that corporate crime be investigated and prosecuted. We ask members to identify opportunities to build on the energy and enthusiasm of the nationwide Occupy movement and its synergies with public health.”

The governing council meetings are always open to the general membership at the annual conference. Next year, stop in and watch for a while–it’s always interesting! Even during the bylaws conversations!

The section also held its third and final business meeting, during which members discussed the section goals that emerged from the most recent Strategic Plan and ways to implement those in a concrete way.  The leadership will continue this discussion in more detail during the next conference call, which (as always) is open to any member who wishes to call in.

Annual Meeting, Day 2: A Visit to the Hill, Refugees, and the Awards Dinner

This morning I got a preview of what those of you who are signed up for Thursday’s Advocacy Day will experience.  Since I will not be able to stay in DC until Thursday, I decided to take some time while I was here to visit the office of my own Congressman, Representative Michael McCaul.  While the Congressman was not able to meet me himself, I spoke with DoD fellow Christian Lyons (who manages his foreign affairs portfolio) and made my case for global health funding.  While he was very polite and expressed support for my concerns, he was just as eager to raise some issues of his own, so be prepared to answer questions and be on your toes!

After a long walk back from Capitol Hill, I took my “passport” to the Public Health Expo, determined to put my name in for the drawing (go free registration for APHA12!).  Walking around the expo is a great way to scope out job opportunities, pick up stress balls, and get free smoothies.  For me, it is also a great way to get comfortable with meeting and talking to people.  If networking does not come naturally to you (it has always been awkward for me), the best way to get good at it is to practice.

In the afternoon, I attended a session on refugee health.  Those presentations were particularly interesting to me, as I have done some research and writing on the side related to displacement and refugee health issues.  We heard from researchers who work with refugee populations, as well as a very interesting presentation from a representative from Physicians for Human Rights.

At the IH Social this evening, members got together to chat, make connections, and reminisce as we honored this year’s section awardees.  Congratulations to all of this year’s award winners.  Pictures will follow soon!

Annual Meeting, Day 1: Meetings and Opening General Session

The APHA Annual Meeting kicked off today with the Opening General Session, which featured Pamela Hyde, administrator of the Substance Abuse and Mental Health Services Association; Jonathan Jarvis, director of the National Parks Service; and former Senate Majority Leader Tom Daschle.  The session began with some very inspiring words from current APHA President Linda Rae Murray; however, I have to confess that I was less than impressed by the speeches – and somewhat baffled by the choices of Jarvis (not quite sure why national parks are relevant to public health) and Daschle (Obama’s first failed choice for Secretary of HHS).  That is just my personal opinion, though – many at the IH section’s first business meeting enjoyed the talks.

For some of us, however, the meeting began before the opening session.  Section members greeted and helped orient international attendees at our International Welcome Booth, which the Global Health Connections Committee is hosting for the third year in the a row.  The GHCC also held its annual meeting in the hour before the opening session.  We discussed our progress on the Global Health Expertise Directory and discussed ways to get involved in the section and make connections with other members.  After the opening session, the section held its first business meeting, where longtime members reconnected and new members learned about opportunities to get involved.

For many of us, one of the main highlights of the Annual Meeting is the wide array of scientific sections, which begin tomorrow – so get excited!  I have my own reason to be excited as well – although I cannot stay for the section’s very first Advocacy Day, I am going to my Congressman’s office to advocate for international aid funding!