Over half the world's rural population, and many in urban slums, have minimal access to health services. This book describes how to set up new, and develop existing, community-based health care for, by and with, the community.

This book examines the present and future role of community health workers (CHW) as part of ongoing efforts to develop sustainable health systems and improve public health. Noting that many programs based on the use of community health workers have fallen short of initial expectations, the book draws on numerous evaluations conducted over the past three decades to identify problems, explore their roots, and propose concrete solutions. Information ranges from advice on the composition and functions of village health committees through a discussion of the effect of cost recovery programs on community participation, to the simple reminder that programs that were never correctly implemented should not be dismissed as ineffective. Throughout lessons learned from past experiences are discussed in terms of their relevance to market-oriented reforms that are currently changing the health sector. The analysis is presented according to three main groups of factors known to have an impact on the performance of CHW programs. Attitudes are considered in the first chapter, which aims to define the actions health authorities can take to improve the attitudes of health workers and communities towards each other. Proposals include changes in selection criteria, curricula, teaching methods, on-the-job training, and supervision. Ways to increase community participation are also discussed. Chapter two focuses on the management and structure of district health systems as an area where organizational reform could have a significant impact on the success of CHW programs. Three components of the district health system are given particular attention: health service structure, health management structure, and health development structure. Practical advice is given for improving the functions of village health committees securing community participation and involving traditional healers. The final chapter, on resources, considers the important issues of remuneration, planning and budgeting for programs, and mechanisms for securing financing from governments, communities, and the private sector. Experiences from Thailand and Jamaica are used to explore methods for assessing program costs. The book concludes with a call for continuing international commitment to the CHW concept and a discussion of the main challenges likely to confront programs in the future. .

Mental, neurological, and substance use disorders are common, highly disabling, and associated with significant premature mortality. The impact of these disorders on the social and economic well-being of individuals, families, and societies is large, growing, and underestimated. Despite this burden, these disorders have been systematically neglected, particularly in low- and middle-income countries, with pitifully small contributions to scaling up cost-effective prevention and treatment strategies. Systematically compiling the substantial existing knowledge to address this inequity is the central goal of this volume. This evidence-base can help policy makers in resource-constrained settings as they prioritize programs and interventions to address these disorders.

The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

Foundations for Community Health Workers Foundations for Community Health Workers is a training resource for client- and community-centered public health practitioners, with an emphasis on promoting health equality. Based on City College of San Francisco's CHW Certificate Program, it begins with an overview of the historic and political context informing the practice of community health workers. The second section of the book addresses core competencies for working with individual clients, such as behavior change counseling and case management, and practitioner development topics such as ethics, stress management, and conflict resolution. The book's final section covers skills for practice at the group and community levels, such as conducting health outreach and facilitating community organizing and advocacy. Praise for Foundations for Community Health Workers "This book is the first of its kind: a manual of core competencies and curricula for training community health workers. Covering topics from health inequalities to patient-centered counseling, this book is a tremendous resource for both scholars of and practitioners in the field of community-based medicine. It also marks a great step forward in any setting, rich or poor, in which it is imperative to reduce health disparities and promote genuine health and well-being." Paul E. Farmer, MD., PhD, Maude and Lillian Presley Professor of Social Medicine in the Department of Global Health and Social Medicine at Harvard Medical School; founding director, Partners In Health. "This book is based on the contributions of experienced CHWs and advocates of the field. I am confident that it will serve as an inspiration for many CHW training programs." Yvonne Lacey, CHW, former coordinator, Black Infant Health Program, City of Berkeley Health Department; former chair, CHW Special Interest Group for the APHA. "This book masterfully integrates the knowledge, skills, and abilities required of a CHW through storytelling and real life case examples. This simple and elegant approach brings to life the intricacies of the work and espouses the spirit of the role that is so critical to eliminating disparities a true model educational approach to emulate." Gayle Tang, MSN, RN., director, National Linguistic and Cultural Programs, National Diversity, Kaiser Permanente "Finally, we have a competency-based textbook for community health worker education well informed by seasoned CHWs themselves as well as expert contributors." Donald E. Proulx, CHW National Education Collaborative, University of Arizona