Date of Award

Summer 2024

Language

English

Embargo Period

8-1-2024

Document Type

Dissertation

Degree Name

Doctor of Public Health (DrPH)

College/School/Department

School of Public Health

Program

Public Health

First Advisor

Wendy E. Weller

Committee Members

Christine T. Bozlak, Benjamin Puertas

Keywords

Community Health Workers, Human Resources for Health, Health Workforce, WHO Health System Building Blocks, Primary Health Care, Health Systems Strengthening

Subject Categories

Community Health and Preventive Medicine | Health Services Research | International Public Health | Public Health | Public Health Education and Promotion

Abstract

Human resources for health (HRH) are the backbone of a well-functioning and resilient health system. Issues related to HRH recruitment, retention, planning, leadership and governance have been amplified by the coronavirus disease 2019 (COVID-19) pandemic and have posed additional and unprecedented challenges in many countries. Community health workers (CHWs) in particular, are uniquely positioned to be frontline health care workers (HCWs) that are considered a vital link between communities and the formal health system. Globally, the benefits of CHW programs have been well documented, and there is substantial evidence of the efficacy and effectiveness of these programs. However, countries are still working to formalize, sustain and embed CHWs into the wider health workforce and system.

In Belize, much of the country’s health gains can be attributed to CHWs who continue to support and link formal health services to the broader community. As a significant element of the primary health care (PHC) initiative, the national community health worker program, established in 1982, aims to improve population health and access to essential health services. With over 40 years after the launch of the CHW program, and a decade since the last revision, there has been no published systematic assessment of the CHW program and its intermediary position within the Belizean health system. The overall objective of this study was to assess the national CHW program in Belize and to provide specific recommendations on how to optimize the program, within the context of the World Health Organization (WHO) health systems approach.

The building blocks of the WHO Health Systems Framework and the programmatic components of the Community Health Worker Assessment and Improvement Matrix (CHW AIM) are two tools integrated into the conceptual framework that guided this research study. An exploratory qualitative case study using a health policy and systems research (HPSR) approach was conducted through an extensive desk review and semi-structured key informant interviews (KIIs). The content analysis method was used to analyze all data. The study was conducted in 2023 and 2024 after the approval from the dissertation committee and the Institutional Review Boards (IRB) of both the Ministry of Health and Wellness in Belize (MOHW) and the University at Albany, State University of New York.

The findings of this study indicate that Belize’s health system has significantly influenced the CHW program through strategic structural changes, policy directives, service delivery models, and resource allocation, as part of the broader health sector reform aimed at improving primary health care. This research also elucidates the influence of the WHO health system building blocks on the core components of the CHW program. Evidence suggests that these building blocks have positively influenced the program by providing a necessary framework and strategic direction for the MOHW. They have facilitated the integration of the program into various health policies and plans, while also fostering community ownership and partnerships. Despite these positive impacts, setbacks remain in several of the building blocks, including budget allocation, the availability of medications and supplies, the referral system and coordination with local health facilities, health workforce planning, and the utilization of community-level data. Additionally, findings emphasize the need for developing and implementing dedicated community health policies and plans to better support the program. These findings highlight opportunities for enhancements and underscore the complex and multifaceted influence of the health system on the CHW program in Belize. Consequently, they inform targeted recommendations to optimize the functionality and performance of the program, with the aim of creating a more effective, integrated, and resilient health system.

License

This work is licensed under the University at Albany Standard Author Agreement.

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