World Health Organization 20, Avenue Appia

Community participation / CHWs
Community participation was identified as a component of PHC in the Declaration of Alma-Ata 
(65). 
Communities have a wealth of untapped resources and energy that can be harnessed and mobilized for 
health care delivery 
(66). In many countries, existing CHWs live in the same community as patients and can 
visit them at home, daily if necessary. Existing, supervised CHWs can be trained in as little as a few hours 
to provide emotional support, to observe for uncontrolled symptoms, unmet social needs and improper 
use of medicines, and to report their observations to a supervising nurse at the CHC 
(25). As needed, the 
nurse can then speak with and provide instructions to the patient or family caregiver by mobile phone. The 
nurse also may make a home visit and/or speak with a supervising primary care physician at the community 
level or a physician at the district level for advice. If necessary, the patient can be brought to the CHC or 
transferred to a hospital for higher-level palliative care. It is essential to establish easy and reliable methods 
of communication and referral between all levels of the health care system, from the home to the CHC to 
the hospital.
Where no CHWs exist, a network of community palliative care volunteers can be established 
(67). The 
well-being of someone in need of palliative care is a concern of many people around that person. Family 
members, friends, colleagues and neighbours may have an interest in ensuring the patient’s comfort. In 
addition, compassionate people interested in the well-being of fellow human beings can be found in most 
communities. If these people can be identified, given rudimentary training in palliative care (and primary 
care) principles and organized, they can then assist the primary care team to provide and monitor palliative 
care 
(67). Some such initiatives consider chronic and incurable illnesses as biosocial problems or even as 
social problems with medical components rather than the commonly held reverse view (
68,69). 
Community participation is strongest when community members are empowered to become an integral