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. .

The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and patient safety. Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education. These core competencies include patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics. This book recommends a mix of approaches to health education improvement, including those related to oversight processes, the training environment, research, public reporting, and leadership. Educators, administrators, and health professionals can use this book to help achieve an approach to education that better prepares clinicians to meet both the needs of patients and the requirements of a changing health care system.