An integrated approach of community health worker support for HIV/AIDS and TB care in Angónia district, Mozambique

A participant-observer description of the evolution of community health worker support to the health services in Angónia district, Mozambique.An integrated community health team approach, established jointly by the Ministry of Health and Médecins Sans Frontières in 2007, has improved accountability, relevance, and geographical access for basic health services.The community health team has several advantages over 'disease-specific' community health worker approaches in terms of accountability, acceptability, and expanded access to care.Sub-Saharan Africa faces a dire shortage of human resources for health, a situation exacerbated by the overwhelming demands of the dual epidemics of HIV/AIDS and tuberculosis (TB) that have swept over the region [1]. Community health workers (CHWs) were promoted as part of the Alma Ata Declaration thirty years ago in order to increase access to basic health care services and to reach "health for all [...] by the year 2000." Subsequently, different types of CHW were engaged to support primary care services, but there was considerable variation in their background, role, motivation, and the quality of services they provided. Despite some successful experiments, enthusiasm for CHW programmes declined in subsequent decades, mainly due to difficulties in recreating successful models at the national level [2,3].In resource-limited settings, the CHW approach has regained credibility in the last few years through its support of HIV/AIDS care, in particular voluntary testing and counselling (VCT), and treatment adherence support for people on HIV and TB treatment [4]. Community engagement is also gaining support in some specific disease areas such as for the diagnosis and treatment of malaria [5] and maternal-child health [3]. These vertical initiatives have however been criticized as contributing to fragmented service delivery and heterogeneous coverage [3].This paper provides a participant-observer perspective of the evolution of CHWs from ve