1.1 Introduction
Community health workers (CHWs) are defined by the World Health Organization (WHO) as members of communities who are selected, trained, and tasked with providing basic health and medical care, health education, and support for disease prevention within their communities (WHO, 2020). They are not professional health practitioners but serve as an essential link between the formal healthcare system and the community, particularly in areas where access to qualified medical professionals is limited (Lehmann & Sanders, 2007).
The importance of public health lies in its ability to address collective health challenges such as communicable diseases, maternal and child health, malnutrition, environmental health, and health education. In many developing countries, including Nigeria, limited resources, poor infrastructure, and shortage of healthcare professionals have led to a widening gap in the effective delivery of health services (Perry et al., 2014).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitation of the study and Definition of terms.
1.2 Background of the Study
Community health workers (CHWs) have increasingly been recognized as essential contributors to the improvement of healthcare delivery systems, especially in low- and middle-income countries. According to the World Health Organization (2020), CHWs are community members who receive training to provide health services and education in their local areas, thereby enhancing access to essential healthcare for populations that are often underserved. Lehmann and Sanders (2007) asserted that CHWs are a bridge between formal health facilities and communities, helping to reduce inequalities in health service delivery (Lehmann and Sanders, 2007).
The importance of CHWs is particularly evident in countries with critical shortages of healthcare professionals and infrastructure. Perry, Zulliger, and Rogers (2014) reported that CHWs have a long history of improving maternal and child health, promoting vaccination campaigns, and contributing to the reduction of disease burdens in both rural and urban communities. They also contended that without the presence of CHWs, many vulnerable populations would remain excluded from even the most basic health services. Singh and Sachs (2013) affirmed that the scale-up of CHWs across sub-Saharan Africa was a crucial step in addressing gaps in healthcare access, particularly in reducing maternal and child mortality rates.
Cultural acceptance and the grassroots presence of CHWs further underscore their relevance. Kok et al. (2015) stated that CHWs are most effective when they are trusted by the community and integrated into existing healthcare systems, as this strengthens local ownership of health initiatives. On the other hand, their effectiveness is sometimes hindered by inadequate resources, poor supervision, and low recognition from policymakers, which weakens the sustainability of their contributions. Nkonki, Cliff, and Sanders (2011) contended that challenges such as lack of remuneration, insufficient training, and social resistance undermine the potential of CHWs to deliver consistent and high-quality health services.
In the Nigerian context, CHWs play a pivotal role in addressing issues of maternal and child health, malaria control, immunization, and awareness creation about communicable and non-communicable diseases. They bring healthcare closer to marginalized populations, particularly in rural areas where health facilities are scarce. As Okafor and Orji (2019) reported, community health initiatives involving CHWs have been instrumental in improving immunization coverage and reducing disease prevalence among children. Nevertheless, the full potential of CHWs is often constrained by limited government support, lack of structured training programs, and weak health system integration. This study is set against the backdrop of understanding the role of community health workers in improving public health.
1.3 Statement of Problems
Investigation revealed that the effectiveness of CHWs in improving public health is hindered by several issues. Limited training and lack of continuous capacity building is reducing their ability to adequately handle health emergencies, preventive care, and health education. On the other hand, the low level of recognition and support given to CHWs by health authorities and policymakers is creating challenges of motivation, job satisfaction, and retention, which further weaken the healthcare delivery system.
Furthermore, lack of proper monitoring, supervision, and evaluation mechanisms is reducing the accountability and sustainability of community health interventions, leading to inconsistent outcomes in public health improvement. It is against this backdrop that this study seeks to assess the Role of Community Health Workers in Improving Public Health.
1.4 Aim and Objectives of the Study
The aim of this study is to assess the role of community health workers in improving public health. The specific objectives of this study include:
- To examine the specific roles community health workers play in public health delivery.
- To identify the challenges faced by community health workers in performing their duties.
- To evaluate the impact of community health workers on maternal, child, and community health outcomes.
- To investigate the level of support, supervision, and training available to community health workers.
- To assess the extent to which community health workers are integrated into the formal health system.
1.5 Research Questions
Based on the stated objectives, the study will address the following research questions:
- What specific roles do community health workers play in public health delivery?
- What challenges do community health workers face in performing their duties?
- How do community health workers impact maternal, child, and community health outcomes?
- What forms of support, supervision, and training are provided to community health workers?
- To what extent are community health workers integrated into the formal health system?
1.6 Significance of the Study
It is believed that at the completion of the study, the findings will serve as a useful reference for policymakers, healthcare providers, and stakeholders interested in strengthening grassroots healthcare delivery. For healthcare institutions, the study will reveal how proper supervision and training will improve the quality of healthcare delivery at the grassroots level.
Furthermore, the study will show how CHWs will empower individuals with knowledge, skills, and resources that will encourage healthier lifestyles and promote active participation in health initiatives.
Academically, the study will serve as a resource for future researchers by providing a foundation for further studies on CHWs and their role in improving public health. It will add to the body of knowledge by identifying challenges and opportunities that will shape future interventions and policies.
1.7 Research Hypotheses
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: Community health workers do not significantly improve public health outcomes in underserved communities.
- H1: Community health workers significantly improve public health outcomes in underserved communities.
Hypothesis Two
- H0: Lack of adequate training, support, and supervision does not reduce the effectiveness of community health workers in improving public health.
- H0: Lack of adequate training, support, and supervision reduces the effectiveness of community health workers in improving public health.
1.8 Scope of the Study
The scope of this research is focused on the role of community health workers in improving public health in Oyo State, Nigeria.
1.9 Limitations of the Study
A study of this nature is bound to experience certain problems as such the constraints imposed on the research include:
- Time Constraints: A study of this nature needs relatively long time during which information for accurate or at least near accurate inference could be drawn. The period of the study was short, time posed as constraints to the research.
- Financial Constraints: The research would have extended the survey to other area at the empirical level, but limitation as included cost of transportation to the source of material and the cost of time setting of the already completed work.
- Lack of Cooperation: Many of the respondents are usually aggressive on issue that border cooperation among the respondents border.
- Response Bias: The study will involve surveys and interviews with cooperative managers and members. Response bias may occur if respondents provide socially desirable answers or if there is reluctance to disclose negative financial information due to privacy concerns or fear of repercussions.
1.10 Definition of Terms
Community Health Workers (CHWs):
According to WHO (2020), CHWs are individuals selected and trained within their communities to provide health education, basic treatment, and referrals, acting as a link between the healthcare system and local populations.
Public Health:
Winslow (1920) defined public health as the science and art of preventing disease, prolonging life, and promoting health through organized community efforts. In this study, public health refers to collective efforts aimed at improving the health and well-being of communities.
Primary Healthcare:
According to the Alma-Ata Declaration (WHO, 1978), primary healthcare is essential healthcare that is universally accessible to individuals and families in the community through their full participation. It emphasizes equity, prevention, and community involvement.
Health Outcomes:
As stated by Perry et al. (2014), health outcomes are measurable changes in health status that result from healthcare interventions, such as reduced disease prevalence, improved maternal survival, and higher immunization coverage.
Healthcare System:
Lehmann and Sanders (2007) asserted that a healthcare system refers to the organized structure of people, institutions, and resources that deliver healthcare services to meet the health needs of populations.
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