Community Health Extension Workers: The Unsung Heroes of Maternal Health

Introduction

Community health extension workers (CHEWs) aggressive and zealous role in the quest to achieve better maternal and newborn health outcomes is yet another vital workforce that has been widely overlooked in the global effort. Being at the crossroad of the health system and local communities, CHEWs can be essential to the efforts to close the maternal health gap, particularly in underserved, rural, or marginal communities. These practitioners do not simply act as health educators or referral agents, but are in fact neighbor’s, mentors and life savers in most scenarios.

Maternal health measures cannot be achieved just through hospitals and other health providers that identify their facilities in the urban settlements but also through hardworking CHEWs who take care to the homes and hearts of community. They are important to create trust, cross-cultural gaps, foster healthy practices, and identify risks before it is too late to close them and have a significant impact on maternal and neonatal mortality.

The significance of the community health extension workers in enhancing maternal and infant outcomes is addressed in this article. We will look at their credible presence and the sensibility of the community, and investments in policies that will enable and expand their work.

The Crucial Role of CHEWs in Maternal and Newborn Health

Building Trust Through Community Presence

The fact that CHEWs have a strong relationship with the communities they also serve is one of the strongest features of CHEWs. As opposed to external health workers, who can rotate in and out of the communities, CHEWs tend to be recruited within their towns, and they have cultural, linguistic, and social connection with the patients. This relationship builds special kind of trust and hence it becomes easy for them to:

• Train women on safe method of pregnancy and childbirth.
• Dispel evil myths or native taboos about giving birth.
• Promote prenatal medical attendance and hospital childbirth at the right time.

CHEWs tend to reach pregnant women and new mothers who would otherwise shun the formal health systems because of fear or distrust, because they are seen as peers and not outsiders.

Delivering Culturally Sensitive Health Education

The CHEWs are not based on one-fit-all health campaigns. Rather, they improve the way they communicate with local culture and correct the misconceptions in a considerate manner, allowing the information to be readable and applicable. This includes:

• Explaining the signs of a pregnancy risk through local dialects.
• Use of common examples or analogy on how to explain medical advice.
• Showing honour to community guidelines with all severity and softly controlling the conduct.

As another example, in communities where herbs or other spiritual practices are regimented during pregnancy, the respectful conversation employed by the CHEWs provides an explanation of how and why biomedical care is necessary, particularly in an emergency situation.

Early Detection of At-Risk Pregnancies

Monitoring of pregnancies in their zones of operation is one of the fundamental functions of CHEWs. They keep records of households and do home visits and this allows them to:

• Detect risky pregnancies at their early stages like when they are done by adolescent mothers or when there is a case of undernourishment or previous complications.
• Pay attention to the symptoms of hypertensive disorders or infections.
• Women should be encouraged to come to facilities at the right time.

This early detection is a life-saving surveillance. Failure to identify danger signs is among the three leading delays that lead to maternal deaths, and CHEWs contribute to overcome that gap.

Acting as Referral Agents and Health System Connectors

The CHEWs play a crucial role of a connection between the community and the formal health care facilities. They are thought to:

• Administer care at the first response level and stabilize the conditions under their scope.
• Refer patients experiencing difficulties to other higher health centers.
• Accompany or mobilize transport services to carry women in labor or at emergency.
• Exchange information with health facilities to support smooth care.

Such referral system is especially significant in the rural setting where there might be no transport and infrastructure. The absence of CHEWs would mean that a number of women would incur delays that can prove to be tragic.

Support Postpartum Mothers and Newborns

CHEWs do not disappear post child birth. They are highly important during the postnatal period when many complications can happen to mothers and babies. One of their support features includes:

• Ensuring that there is no postpartum bleeding, infection or depression.
• The encouragement of exclusive breastfeeding and correct care of the newborn baby.
• Carrying out vaccination at home or vaccination referral.
• Training of the families in birth spacing and contraceptives.

Postnatal care is not appreciated in most societies. The CHEWs contribute to prioritization and normalization of this important stage of the maternal and newborn health.

Why CHEWs Are Indispensable in Underserved Areas

Overcoming Geographical Barriers

In places where clinics are far afield and roads cannot be traversed, CHEWs deliver healthcare to the doorsteps of the people. Their home visit model minimizes transportation usage making sure that no woman or child is left behind.

Addressing Gender and Social Inequities

Women in patriarchal cultures might lack the freedom to seek care or such cultures do not allow women to attend health facilities without someone. CHEWs that are usually females themselves assist:

• Involve men of the family in maternal discussions on healthcare.
• Create a safe space for women to be able to inquire, to be able to disclose things that are going on.
• Provide education at the household levels where women are more comfortable.

Adapting to Local Realities

CHEWs are skilful in the capacity to manoeuvre health beliefs, financial resources and infrastructure. When meeting them with village elders, they tailor their negotiating style to the situation, or when advising families to budget on the cost of travelling to a clinic.

Policy Imperatives: What Governments Must Do

Although CHEWs have been imagined to have an astonishing effect, their policies are being disregarded by the costs of neglect and underinvestment. Governments should pledge to enhancing this workforce through thorough support.

1. Professional Training and Certification
   • Standardised trainings ensures that CHEWs have adequate knowledge in maternal and newborn health.
   • Respectful maternity care, family planning, recognizing signs of danger and being able to communicate should be included in curricula.
   • Refresher courses on a regular basis play a vital role in ensuring that one is competent and fits within the emerging challenges in health.

2. Supervision and Accountability Structures
   • Nurses or midwives are needed to provide appropriate supervision over CHEWs in order to exercise quality control.
   • Performance and morale is enchantable by feedback mechanisms.
   • It should then follow up mother visits, referrals and maternal outcomes through monitoring systems.

3. Fair Compensation and Career Growth

CHEWs are too often underpaid or even supposed to work in volunteer capacity. This is not feasible and unethical. Governments must:

• Pay wage fairly, consistently with benefits.
• Give incentives to remote postings.
• Design career ladders to enable the CHEWs to work as supervisors or attain higher learning in the field of healthcare.

4. Integration into National Health Strategies

CHEWs are not supposed to work in isolation. Their contributions have to be appreciated by:

• Nationalised maternal health care plans
• Health labor planning
• Budget allocations
• Data systems of tracking outcomes in motherhood.

5. Community Engagement and Support

The local leaders ought to be used to support CHEWs so that they can win trust and legitimacy. Monitoring at community level can as well keep CHEWs accountable and make them work in accordance to the needs of the locals.

Real World Successes of CHEW-Led Interventions

Nigeria’s National CHEW Program

The training by the Nigeria health extension worker program has produced tens of thousands of CHEWs who work in both primary healthcare facilities and communities. Through location such as Kano and Katsina were registered with an improvement in maternal health indicators because of:

• Antenatal registration that is done door to door.
• Preeclampsia prediction at an early stage.
• Increased utilization of deliveries in facilities.

Ethiopia’s Health Extension Workers

Trained CHEWs form an important part of Ethiopia community-based health program. They have assisted in reducing maternal deaths in the following ways:

• Women are being assisted to ensure four antenatal visits.
• Creating delivery with competent attendants.
• Promoting post partners post natal clinics family planning.

Pakistan’s Lady Health Worker Program

Pakistan has a scale model with more than 100,000 women trained so far. These CHEWs in the rural areas have:

• More tetanus vaccination.
• Softened maternal deaths through knowledge on danger signals.
• Provided birth control (contraceptive) advising to mothers after delivery.

The Future of Maternal Health Belongs to CHEWs

Maternal health outcomes cannot be improved without giving due credit and investment concerning the fundamental role of CHEWs. Hospitals and digital technologies alone will not be able to reach the same number of people, their cultural fluency, and human connection. Maternal health is one of the global priorities enshrined within the Sustainable Development Goal 3, so it is time to:

• Extend CHEW programs to all the underserved communities.
• Handle CHEWs as professionals, and not as volunteers.
• Create a health system that appreciates closeness, compassion and prevention.

Conclusion

Maternal and newborn care the pulse of community health extension workers in resource-limited settings Community Health extension workers in resource-limited settings, Community Health extension workers are the heartbeat of maternal and newborn care. They also provide life-saving expertise, compassion, and dedication into houses that would remain otherwise inaccessible to the official health care services. They can be an effective agent of change because they are close to the communities, and they can identify a threat in time, as well as overcome cultural barriers.

Governments, donors, and development partners should go beyond paying lip service to position CHEWs as the central part of the national health strategies. The training, supervision, proper payment and integration of data are not optional instead they are necessary. Through the empowerment of these unrecognized heroes, we do not only cut on the maternal mortality rate- but also create a just, accessible, and humane health system to all.