Beryl Pilkington, RN, PhD, School of Nursing, Faculty of Health, York University in Toronto, presented at AMREF's Coffeehouse Speaker Series on global development on the intersection of health and development with specific focus on the community level in the Dadaab refugee camps. The coffeehouse speaker series looks at international development and global health, specifically focusing on Africa.

1. .
Beryl Pilkington, RN, PhD
School of Nursing, Faculty of Health
York University

2. The issue:
 In the Global South, there are currently
over 15 million people caught in refugee
situations for protracted periods
 Dadaab, Kenya: about half a million
refugees, many living here for > 10
years
 Living conditions pose severe health
challenges

4. Health Issues
 High morbidity and mortality due to
preventable conditions
(e.g., diarrhea, communicable
diseases, malaria, childbirth
complications, malnutrition)
 Reliance on international NGOs
 Insecurity in camps severely hampers health
service delivery
 Volunteer health workers

5. Needed: ‘Primary Health Care’
 What is primary health care (PHC)*?
 Essential health care;
 Based on practical, scientifically sound, and
socially acceptable method and technology;
 Universally accessible to all in the community
through their full participation; at an affordable
cost;
 Geared toward self-reliance and self-
determination
*WHO & UNICEF (1978)

6. Needed: Higher Education in
Health
 Need for health education identified in a
feasibility study conducted by Borderless
Higher Education for Refugees (BHER)
project*
*Dippo, D., Orgocka, A., & Giles, W. (2013).
Reaching Higher: The Provision of Higher Education
for Long-Term Refugees in the Dadaab
Camps, Kenya.
Available: http://crs.yorku.ca/bher

7. BHER Partners & Aims
 Partners:
 Canada: York U, U British Columbia, WUSC
 Kenya: Wendle Trust Kenya, Kenyatta U, Moi U, Africa
Virtual University
 Aims:
1. Improve the equitable delivery of quality education in
refugee camps and adjacent local communities through
university training opportunities which will prepare a
new generation of male and female teachers;
2. Create targeted, continuing opportunities for young men
and women in university programs that will enhance
their employability through portable
certificates, diplomas and degrees;
3. Build the capacity of Kenyan academic institutions
that already offer onsite/on-line university degree
programs to vulnerable and marginalized groups.

9. Why Higher Education for
CHWs?
 Why not focus, instead, on education for
physicians and/or nurses?
 Utilization of CHWs in PHC:
 Evidence that they can add significantly to
efforts to improve the health of the
population, particularly where there is a
shortage of motivated and capable health
professionals (GHWA & WHO, 2010)
 But do CHWs need university
education?

10. What is Known about Utilization
of CHWs in Health Care?
 Global Health Workforce Alliance (GHWA)
commissioned a study as part of its
mandate to implement solutions to the
global health workforce crisis. The resultant
report:
 Global Experience of Community Health
Workers for Delivery of Health Related
Millennium Development Goals: A Systematic
Review, Country Case Studies, and
Recommendations for Integration into National
Health Systems (GHWA & WHO, 2010)

11. Key Findings:
1) CHWs should be coherently inserted in the
wider health system, and should be explicitly
included within the HRH strategic planning at
country and local level;
2) Village health committees should
contribute to participatory selection processes
of CHWs;
3) Pre-service training curriculum should
include scientific knowledge about preventive
and basic curative care;

12. Key Findings…
4) CHWs should continually assess
community health needs and
demographics;
5) CHWs should have established referral
protocols with formal health services and
social service agencies;
6) CHWs should benefit from regular and
continuous supportive supervision and
monitoring.

13. Priority Areas for Further
Research*
 cost-effectiveness, effectiveness of paid vs
volunteer workers, quality & effectiveness of
services, whether CHWs promote equity and
access, role of CHWs in HIV/AIDS prevention
& care, sustainability of interventions
provided, #s of CHWs required according to
volume of work*
 Findings address training, but not higher
education
 Also, role of CHWs in refugee context not
addressed
*(GHWA & WHO, 2010)

14. Community Health
Professional:
A Response to Contextual
Issues Security
 Recognition of training
 Gender inequity

15. Challenges & Questions
 Besides Moi U, what other partners in
Kenya should be involved in developing the
new CHP program?
 What should the CPH program look like?
 Curriculum, # of students, teaching-learning
resources & facilities?
 How can the CHP role can be integrated
into existing healthcare?
 employment, supervision, and continuing
education opportunities; referral mechanism?