Dominica: Strengthening Primary Care with a New Cadre of Community Health Workers

New community health workers. (Credit: PAHO/WHO)

ROSEAU, Dominica, Wednesday July 24, 2019 – In Dominica, an island with a population of just over 70,000, change is underway to transform the health system into one that focuses increasingly on primary health care, is people- and community-centred and is better placed to achieve universal health coverage and access (or Universal Health, as it is known in the Region of the Americas).

The Pan American Health Organization, the regional office of the World Health Organization (PAHO/WHO) has been working with the Dominica Ministry of Health and Social Services to undertake a thorough assessment of the health system, and specific recommendations are now being implemented.

One example of this is the cadre of 27 new community health workers (CHW) who graduated from a training programme in September 2018, and are now starting work in communities to support health services at the primary level.

In 1978, at the time of the Alma Ata declaration, the Dominica health system was a model for primary health care, but over the past several years the primary health care system grew weaker faced with resource constraints and a greater national focus on hospital care. Unfortunately, the population’s health situation in Dominica worsened following Hurricane Maria, which devastated the island in September 2017. This has had a significant impact on human resources for health and the operation of community health centres, several of which were destroyed or made non-functional.

A systematic approach to strengthening the health system and primary health care services was required. Japanese grant funding through the UHC -Partnership supported a comprehensive assessment of the Dominica health system after Hurricane Maria. The PAHO/WHO technical team was comprised of seven persons focusing on various strategic aspects of universal health coverage and access. The team conducted the assessment in association with the Dominica Ministry of Health and Social Services and the National Health Commission during 2018 and early 2019.

It culminated in a comprehensive report which argued strongly that UHC in Dominica will only be achieved through strengthening primary health care and simultaneously addressing weaknesses within the health system relating to governance, health financing, resource allocation and management, and ensuring an integrated approach to health services delivery with intersectoral and community participation. The report made several high-level recommendations to implement action during 2019-2020.

The training of the CHWs was just one of the more urgent recommendations for health system strengthening. The skills-based training of CHW in Dominica intends to address the shortage of health personnel and increase the capacity to deliver people-centered care within community settings and multidisciplinary teams. All this greatly strengthens primary health care.

The Ministry of Health and Social Services in collaboration with PAHO and with the support of Japanese funding through the UHC Partnership, has trained a cadre of 27 CHWs. The CHW training was conducted by skilled and experienced Dominica-based nurses in collaboration with the Ministry of Health and Social Services and WHO /PAHO. The curriculum was developed by the course instructors and vetted and approved by PAHO.

The six-month programme took place at the University of the West Indies Open Campus in Dominica, and comprised 13 subject areas and Basic Clinical Skills.

Minister of Health and Social Services Dr Kenneth Darroux congratulated the graduates on the successful completion of the programme. He said that the training was conceptualized in-order to respond to the need for increased human resource capacity in the health sector.

Minister for Health and Social Services Dr Kenneth Darroux presented an award to the top student, Alphanica Robert.

“Taking into consideration the constantly increasing demand on our health services both quantum and quality and juxtaposing this against available resources human and otherwise, you can appreciate that today’s ceremony is a step in the right direction towards narrowing this ever-widening gap,” he said.

Bertisha Bertrand spoke on behalf of the graduating class. She said that on starting the course she had very little knowledge about the role of a Community Health Aide. She is pleased to also now have a more in-depth awareness of the meaning of health.

“The course was a great opportunity to achieve clarity on health, the community and what makes a community, how it functions and what can affect its functionality. Health is broad and has many areas which taught us that we have to adapt to different personalities and to different environments. The course has produced 27 qualified foot soldiers for their respective communities and by extension the primary health care service in Dominica,” Bertrand said.

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