The Community Health Worker Model: A Grass-Roots Approach for Measles Prevention in Refugee Camps

Main Article Content

Kristina Baier
Raywat Deonandan



Syria’s protracted civil war has resulted in massive population movements into refugee camps. Such movements, in conjunction with lower vaccination rates, potentiate infectious disease outbreaks. Measles transmission is a continuous threat in refugee camps, and a sustainable approach to providing preventative medicine in camps is warranted. The community health worker model can be used to identify unvaccinated persons, detect probable cases and refer individuals to health clinics within the camps for prophylaxis and medi­cal care, respectively. Through this grass-roots approach, community health workers become an on-the-ground surveillance system that can determine demographic trends and facilitate public health responses to potential outbreaks.



L’interminable guerre civile en Syrie a entraîné des déplacements massifs de population vers des camps de réfugiés. De tels mouve­ments de population, en concomitance avec de plus faibles taux de vaccination, accroissent les risques de flambées épidémiques. La transmission de la rougeole est une menace continue dans les camps de réfugiés, et une solution durable dans l’administration de médecine préventive dans ces camps est justifiée. Le modèle des agents de santé communautaires peut être adopté pour identifier les personnes non vaccinées, détecter les cas probables et adresser ces individus aux cliniques de santé des camps pour qu’ils puissent y recevoir de la prophylaxie et des soins médicaux, respectivement. Grâce à cette approche locale, les agents de santé communautaires forment un système de surveillance sur le terrain qui permet de déterminer les tendances démographiques et de faciliter les interven­tions de santé publique contre les épidémies potentielles.

Article Details



1. International Medical Corps. Syria: The 21st Century’s Worst Crisis [Inter¬net]. Los Angeles (CA): International Medical Corps; 2015 [cited 2016 Jul 27]. Available from:

2. Médecins Sans Frontières. Syria two years on: The failure of international aid [Internet]. New York (NY): Médecins Sans Frontières; 2013 Mar 7 [cited 2016 Jul 27]. Available from:

3. Sharara SL, Kanj SS. War and infectious diseases: Challenges of the Syrian civil war. PLoS Pathog. 2014;10(11):e1004438.

4. Seear M. An introduction to international health. Toronto: Canadian Schol¬ars’ Press Inc.; 2007. Chapter 13, Natural and Humanitarian Disasters and Displaced Populations; 259-282 p.

5. Médecins Sans Frontières. Syria: Measles epidemic reveals growing human¬itarian needs [Internet]. New York (NY): Médecins Sans Frontières; 2013 Jun 18 [cited 2016 Jul 27]. Available from: http://www.doctorswithoutborders. org/news-stories/press-release/syria-measles-epidemic-reveals-growing-humanitarian-needs.

6. Stone-Brown K. Syria: A healthcare system on the brink of collapse. BMJ. 2013;347:f7375.

7. Centers for Disease Control and Prevention. Hospital-associated measles outbreak - Pennsylvania, March-April 2009. Morbidity and Mortality Weekly Report. 2012;61(2):30.

8. Kelly HA, Riddell MA, Andrews RM. Measles transmission in healthcare set¬tings in Australia. Med J Aust. 2002;176(2):50.

9. Bryant JH. Community health workers: The interface between communities and health care systems. WHO Chron. 1978;32(4):144-8.

10. Bender DE, Pitkin K. Bridging the gap: The village health worker as the cor¬nerstone of the primary health care model. Soc Sci Med. 1987;24(6):515-28.

11. United Nations High Commissioner for Refugees. Handbook for emergen¬cies. Third Edition ed. [Internet]. Geneva (CH): United Nations High Com¬missioner for Refugees; 2007 Feb [cited 2016 Jul 27]. Available from: http://¬gencies_UNHCR.pdf.

12. Young H, Harvey P. The sphere project: The humanitarian charter and mini¬mum standards in disaster response: Introduction. Disasters. 2004;28(2):99.

13. Walt G, Vaughan P. An Introduction to the Primary Health Care Approach in Developing Countries. A review with selected annotated references. Lon¬don (UK): London School of Hygiene and Tropical Medicine, Ross Institute of Tropical Hygiene Publication No. 13. 1981:61.

14. Cutts F. Training community health workers in refugee camps: A case study from Pakistan. Disasters. 1984;8(3):198-205.

15. Ehiri J, Gunn J, Center K, Li Y, Rouhani M, Ezeanolue EE. Training and deploy¬ment of lay refugee/internally displaced persons to provide basic health services in camps: A systematic review. Global Health Action. 2014;7:1-14.

16. Sparrow A. Syria’s polio epidemic: The suppressed truth [Internet]. New York (NY): The New York Review of Books; 2014 Feb 20 [cited 2016 Jul 27]. Available from:¬lio-epidemic-suppressed-truth/.

17. Stewart JC, Hood WR. Using workers from “ hard-core” areas to increase immunization levels. Public Health Rep. 1970;85(2):177.

18. Owais A, Hanif B, Siddiqui AR, Agha A, Zaidi AKM. Does improving maternal knowledge of vaccines impact infant immunization rates? A community-based randomized-controlled trial in Karachi, Pakistan. BMC Public Health. 2011;11:239.

19. World Health Organization. Measles [Internet]. Geneva (CH): World Health Organization; 2016 Mar [cited 2016 Jul 27]. Available from: http://www.

20. Moss WJ. Measles control and the prospect of eradication. Current Topics in Microbiology and Immunology. 2009;330:173-189.

21. Perry RT, Halsey NA. The clinical significance of measles: A review. J Infect Dis. 2004;189:S4-S16.

22. Ludlow M, Mcquaid S, Milner D, De Swart RL, Duprex WP. Pathological con¬sequences of systemic measles virus infection. J Pathol. 2015;235(2):253- 65.

23. Moss WJ, Griffin DE. Global measles elimination. Nature Reviews Microbiol¬ogy. 2006;4(12):900-908.

24. Signore C. Rubeola. Primary Care Update for Ob/Gyns. 2001;8(4):138-140.

25. Centers for Disease Control and Prevention. Less pain, more gain: Measles vaccination using a microneedle patch holds great life-saving potential [In¬ternet]. Atlanta (GA): Centers for Disease Control and Prevention; 2015 Apr 1 [cited 2016 Jul 27]. Available from: immunization/stories/microneedle-patch.htm.

26. Cutts FT, Monteiro O, Tabard P, Cliff J. Measles control in Maputo, Mozam¬bique, using a single dose of Schwarz vaccine at age 9 months. Bull World Health Organ. 1994;72(2):227.

27. Sheikh M. The health and well-being of refugee children and adolescents: Challenges and opportunities In: Elliott D, Segal U, eds. Refugees World¬wide Vol 1: Global Perspectives. United States: Praeger; 2012; 135-160 p.

28. Werner D. The village health worker: Lackey or liberator? World Health Fo¬rum. 1981;2(1):46-48.

29. Berman PA, Gwatkin DR, Burger SE. Community- based health workers: Head start or false start towards health for all?
Soc Sci Med. 1987;25(5):443-59.

30. Werner D, Bower B. Helping health workers learn: A book of methods, aids, and ideas for instructors at the village level. 1st ed. Palo Alto (CA): Hes¬perian Foundation; 1982.

31. International Medical Corps. International Medical Corps teams avert out¬breaks in Chad refugee camps [Internet]. Los Angeles (CA): International Medical Corps; 2009 Nov 15 [cited 2016 Jul 27]. Available from: http://

32. Heydt P. Commentary: The role of CHWs in a Crisis like Ebola [Internet]. New York (NY): Office of the UN Secretary-General’s Special Envoy for Health in Agenda 2030 and for Malaria; 2014 Aug 29 [cited 2016 Jul 27]. Available from:

33. Guris D, Harpaz R, Redd SB, Smith NJ, Papania MJ. Measles surveillance in the United States: An overview. J Infect Dis. 2004;189 Suppl 1:S177.

34. Dick B, Simmonds S. Refugee health care: Similar but different? Disasters. 1983;7(4):291-303.

35. Elias CJ, Alexander BH, Sokly T. Infectious disease control in a long-term refugee camp: The role of epidemiologic surveillance and investigation. Am J Public Health. 1990;80(7):824.

36. Lechat MF. Disaster epidemiology (editorial). Int J Epidemiol. 1975;4(1):5.

37. Lechat MF. Disasters and public health. Bull World Health Organ. 1979;57(1):11.

38. Kreiss J. Epidemiology and health planning In: Sandler RH, Jones TC, editors. Medical Care of Refugees. New York (NY): Oxford University Press; 1987.

39. Simmonds S, Brown H. Curative medicine or community health? Appropri¬ate health services with refugees. Disasters. 1980;4(1):107-10.

40. Buist NR. Perspective from Khao-I-Dang refugee camp. Br Med J. 1980;281(6232):36.

41. Bhiwandiwala P. Thai initiatives in Kampuchean refugee camps. Br Med J. 1980;281(6243):812.

42. World Health Organization. Community health workers: What do we know about them? [Internet]. Geneva (CH): World Health Organization; 2007 Jan [cited 2016 Oct 16]. Available from: community_health_workers_brief.pdf.

43. De Zoysa I, Cole-King S. Remuneration of the community health worker: what are the options?. World Health Forum. 1983;4(2):125-130.

44. Haile F, Yemane D, Gebreslassie A. Assessment of non-financial incentives for volunteer community health workers - the case of Wukro district, Tigray, Ethiopia. Hum Resour Health. 2014;12:54.

45. Giblin PT. Effective utilization and evaluation of indigenous health care workers. Public Health Reports. 1989;104(4):361-8.