Community health nursing is a practice aimed at improving public health by enlisting the services of qualified community members. Community health nurses (CHN), also known as community health workers (CHW), are typically engaged in preventive care, maternal care, health promotion and educational activities within local communities. This kind of nursing practice is especially practical for rural communities or in developing countries where qualified health professionals are in short supply.
The World Health Organization (WHO) recognizes that various forms of CHW practices have existed since around the middle of the 20th Century. National community health projects have been augmented by small-scale community or faith-based initiatives. According to WHO, community health workers play a "crucial role in broadening access and coverage of health services." WHO regards CHWs as instrumental in providing good maternal and child care, access to family planning and in the fight against diseases such as HIV/AIDS, tuberculosis and malaria.
The main advantage of CHW programs is that they can be tailored to the requirements and resources of the community being served. In most successful schemes, the community health workers are members of the community and have been chosen by the community itself. Thus, local acceptance and ownership of the project is achieved. Also, while some medical training of CHWs is advisable, it is not a prerequisite and the level of education, income, age and even literacy of the workers may vary.
The disadvantages of community health programs center on the lack of qualifications and motivation of the health care workers. Inexperience or inadequate training can compromise the efforts of CHW or cause rifts with formal medical staff. Lack of financial and political support, combined with excessive time demands, responsibility and even health risks for the workers (for example when dealing with HIV/AIDS) can lead to stress and discouragement, resulting in high attrition rates often reported in CHW programs. WHO recommends that continued training or formal education as well as effective support and supervision of the CHWs should be applied as part of any scheme.
National or regional community health nursing programs have been successfully implemented in developed countries with sparsely populated regions such as Australia and Canada, but also in rapidly developing countries with strong central governments and rural populations such as China and Brazil. In 2009, China's health ministry allocated 20 billion yuan to support a community health service program, aiming to provide township hospital staff as well as 1.37 million village health workers. Chinese officials claim that community health nurses have been particularly helpful with addressing the public health problems resulting from the 2008 Sichuan earthquake, with the province's 80,000 CHNs actively participating in helping trauma victims and networking with local and international relief partners.
One region facing a significant need for community nursing projects is Sub-Saharan Africa. A review commissioned in 2005 by the International Council of Nurses (ICN) concludes that emigration of registered nurses and the HIV/AIDS epidemic underlie the crisis of both the availability and effectiveness of nursing care in the region. Recommended approaches to tackle the nurse shortage include rural nurse recruitment and community support mechanisms, inherent in the community nursing approach, as well as distance-learning techniques to provide adequate and cost-effective training.
The continuing trend for migration of the global population from countryside to city as well as the general ageing of populations in developed countries puts new emphasis on the needs for community nursing. Urban poverty, homelessness, pollution and lack of medical insurance are some additional factors contributing to persistent health problems faced by city dwellers. These can the addressed through community nursing establishments, such as the community health centers and nurse-managed health centers popular in metropolitan areas of the United States. Community and nurse-managed centers can provide a broad range of preventive and primary care services, which can be legally administered by certified nurses in their respective country.
The overall quality and perception of community nursing schemes is difficult to assess, although some regulatory and academic attempts have been made. A survey ordered by the Scottish government in 2009 indicates that community nurses in Scotland are experienced and have spent considerable time serving their respective communities, while their clients report positive experiences with the community nursing model. An academic study on Australian attitudes toward nursing has found that nurses are perceived as complementary to a general practitioner doctor, rather than substitutes, when considering primary and preventive care.