Despite decades of experience with community health workers (CHWs) in a wide variety of global health projects, there is no established conceptual framework that structures how implementers and researchers can understand, study and improve their respective programs based on lessons learned by other CHW programs. Engaging a large group of implementers, researchers and the best available literature, the 5-SPICE framework was refined and then applied to a selection of CHW programs. Insights gleaned from the case study method were summarized in a tabular format named the ‘5x5-SPICE chart’.
Community health workers (CHWs) are increasingly being incorporated into health programs because they are assumed to effectively deliver health messages in a culturally relevant manner to disenfranchised communities. Nevertheless, the role of CHWs-who they are, what they do, and how they do it-is tremendously varied. This variability presents a number of challenges for conducting research to determine the effectiveness of CHW programs, and translating research into practice. We discuss some of these challenges and provide examples from our experience working with CHWs.
In-service training is a key strategic approach to addressing the severe shortage of health care workers in many countries. However, there is a lack of evidence linking these health care worker trainings to improved health outcomes. In response, the United States President’s Emergency Plan for AIDS Relief’s Human Resources for Health Technical Working Group initiated a project to develop an outcome-focused training evaluation framework. This paper presents the methods and results of that project.
Though a wealth of knowledge and evidence is available on key aspects of CHW programs, critical knowledge gaps remain. To enable the environment for increased evidence-based decision making at the country level, adequate emphasis must be placed on continuing to strengthen the evidence base for CHWs. This paper attempts to identify all CHW knowledge gaps and outlines recommendations for the way in which research should be conducted to enable greater benefit and utilization of results.
This paper, together with the Framework for Partners’ Harmonized Support, proposes complementary operational frameworks through which national and international partners may align their actions with the collective goal to normalize a cadre of community workers and collaborate toward integrated, harmonized program designs rather than competitive, siloed, and parallel interventions.
Fragmentation is one of the main challenges to successful and sustainable CHW scale-up - in terms of programming, the service delivery chain, and the multiplicity of public and private organizations, training, deploying and supporting CHWs. This paper proposes a set of generally agreed guiding principles to support countries and their partners in their efforts to:
To ensure that medicines and other health commodities reach the people who need them and contribute to improved health, people in the supply chain management (SCM) field must understand and apply effective approaches for developing and managing supply chain workforces. At the same time, those in the human resources for health (HRH) arena must recognize the crucial role of SCM in health service delivery and ensure that HRH policies, strategies, and plans systematically incorporate the supply chain workforce.
A challenge faced by many countries is to provide adequate human resources for delivery of essential mental health interventions. The overwhelming worldwide shortage of human resources for mental health, particularly in low-income and middle-income countries, is well established.
With efforts coordinate by the Global Health Workforce Alliance, this synthesis paper highlights the synergies among the outcomes of the four community health worker events held in 2012. It aims develop a set of common messages to promote harmonized response and collaborative support for improved access to, and performance of community health workers
Lay health workers (LHWs) perform functions related to healthcare delivery, receive some level of training, but have no formal professional or paraprofessional certificate or tertiary education degree. This review addresses these issues through a synthesis of qualitative evidence and was carried out alongside the Cochrane review of the effectiveness of LHWs for maternal and child health. The overall aim of the review is to explore barriers and facilitators affecting the implementation of LHW programmes for maternal and child health.