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HEAT: transforming community health care around the world

Updated Wednesday, 11th May 2011

How will the HEAT programme transform the education, training and retention of—and access to—community health care workers?

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A global problem

Accessible, affordable health care that is taken for granted in the west is out of the reach of millions of people in developing nations. A staggering 1 billion people never get to see a trained health worker in the course of their lifetime.1 The need for basic, simple health care is urgent.

Research shows that six million of the almost 11 million children who die each year could be saved by low-tech and cost-effective measures2. It is estimated that in sub-Saharan Africa alone, between 1 and 1.5 million more health care workers are required, in particular to reduce under-five mortality by two-thirds by 20153 and to help reach Millennium Development Goals relating to child and maternal health.

Increasingly, the focus is on providing programmes for frontline health workers to enable them to deliver effective health care to people in their communities. But ensuring a well-trained, motivated and committed cadre of community health workers (CHWs) in the context of political, economic and social constraints is not simple. Although many interventions exist in the health sector across Africa, some at huge cost, these do not always reach the communities and individuals that they are meant to be helping.4 And successful, small projects meeting local, highly contextualised needs often have no capacity to scale up.

Existing health worker training is often delivered in residential settings, dislocated from the context in which CHWs work, and providing little support to them once they’re back in their communities. Furthermore, even if leaving their homes and families to attend training programmes is a viable option for CHWs, being away from their health posts severely disrupts the delivery of critical services to the community.5 Research suggests that to be effective, training should be located close to the CHWs’ working context, and structured around competence and practice-based learning resources and activities specifically developed for CHWs.6 All too often, learning resources are out-of-date, drawn from western medical text books with little relevance to the context in which the CHWs live and work.7

Medical action programme in Ethiopia

HEAT: a tangible solution

This is where the HEAT story begins. HEAT (Health Education and Training) is an ambitious programme created by The Open University to help equip governments with a shared standard for healthcare training and to reach at least 250,000 frontline health workers in sub-Saharan Africa by 2016, providing them with the knowledge to save, literally, millions of lives.

HEAT builds on the OU’s expertise in distance learning to create high quality learning resources, which combined with practical skills training delivered by experienced health workers, provides a blended, work-based approach to health education. It’s a model that is flexible, scaleable and can help significantly address Africa’s health challenges.

HEAT has already made a strong start. Working closely with the Ethiopian Ministry of Health, UNICEF, AMREF, the WHO and others, the HEAT team has been working with around 50 African health experts to create a knowledge bank of Open Educational Resources designed for frontline health workers. The learning resources are part of a programme which is helping to raise the standards of health care in rural Ethiopia, where 31,000 Health Extension Workers are bringing basic health care services to over 65 million people.

The programme is currently piloting in six regions, with around 1,000 students and over 100 tutors. In all but one region, students are studying the HEAT learning resources in their workplace or at home, with practical skills training overseen by a cadre of practice mentors, minimizing the disruption to critical health services delivery in the communities. The curriculum covers a wide range of critical health areas, such as maternal and child health, nutrition, communicable and non-communicable diseases, immunisation and family planning. As OERs, the materials are accessible to, and can be adapted by, anyone in the world who wants high quality, structured learning resources created specifically for frontline health workers.

A growing vision

HEAT’s vision is to help radically transform the training of healthcare workers on a global basis, in their locality. By providing a flexible, cost-effective and sustainable approach to CHW education, and working in partnership with governments, WHO, AMREF and others, HEAT is helping to create a consortium to deliver a far-reaching training programme that can be delivered across sub-Saharan Africa. Discussions are also underway with India, Pakistan, Afghanistan, and South America.

We believe the potential for HEAT to contribute to scaleable, meaningful and lasting capacity building for health is a fully realisable ambition.

References and further reading:

  1. GHWA, 2011

  2. UNICEF, 2011

  3. Conway, 2007

  4. Easterly, 2006

  5. Knebel, 2001

  6. WHO, 2007

  7. Nartker et al, 2010


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