Community Health Workers (CHW) at the core of Dominica’s transformation in primary health service

Dominica is transforming the health system aiming to achieve universal coverage and access, in a people- and community-centred programme. Triggered by the devastation suffered in the community after Hurricane Maria in September 2017 the country was since committed to strengthening the health system and primary health care services. This month Pan American Organization reports.

The Ministry of Health and Social Services of Dominica in collaboration with Pan American Health Organization (PAHO/WHO) and with the support of Japanese funding through the Universal Health Coverage (UHC) Partnership has implemented numerous changes to bring back the quality in health care the island had once, at the time of Alma Ata declaration in 1978

However, two years before the Hurricane Maria, in an article published in the Revista Panamericana de la Salud Pública by James Macinko et al., the authors found that the Primary Care in Dominica[1] was overall good, although middle- and low- scores were obtained in family-centred care and community-oriented care (0.65) and for access to care (0.57)[2]. This brings the attention to the vulnerability of small islands facing natural disasters when they also suffer from physician and health professional brain drain. Dominica has the highest rate of medical brain drain in the period between 1991 and 2004 among 30 countries more affected according to the study carried out by Bhargava et al in 2011[3]

The report from PAHO regarding the training of the CHWs in Dominica stressed the action as one of the most urgent recommendations for strengthening health system due to the shortage of health personnel.

Today, a new cadre of 27 CHWs trained at the University of West Indies Open Campus in Dominica are carrying the health service at the primary level. The curriculum comprised 13 subject areas of basic clinical skills delivered according to PAHO educational requirement.  The theoretical and practical components of the programme ensure the collaboration of CHW with a number of organizations within the communities.

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[1] ‘Primary care performance in Dominica’ (2015) Rev Pan Salud Pública: 37(2) 104-112.

[2] Primary Care domains scored from 0.00 (worst) to 1.00 (best).

[3] ‘Modelling the effects of physician emigration on human development’ (2011) Economics and Human Biology, 9: 172-183.