This article from the Bulletin of the WHO, describes various roles played by Accredited Social Health Activists (ASHAs), India's national cadre of village-based workers, and other innovative community health programs working on maternal and child health, sanitation and hygiene, contraception, immunization and other health issues. CHWs are making major contributions to national efforts to reduce health inequalities and address social conditions that threaten the population’s health and access to care.
This paper is one of a series of background papers commissioned by WHO for the October, 2011, World Conference on Social Determinants of Health. It describes Rwanda's attempt to improve maternal indicators by pairing a community performance-based financing (CPBF) strategy to empower CHWs with a strategy to incentivize mothers. The pilot intervention was conducted in 31 of Rwanda's poorest health centers; three maternal and child indicators were monitored. Results from the pilot showed significant increases in the number of women accessing antenatal care and delivering at health centers.
This is the second (2005) edition of the Community Health Worker Training Manual of Afghanistan’s Ministry of Public Health. The training manual provides an overview of the roles and responsibilities of CHWs in meeting the health needs of the population, as well as key information and skills the CHWs require. Each chapter includes sections on: background, things to know, things to do and key points.
The authors conducted a systematic review of studies conducted between 1987 and 2007 in sub-Saharan Africa on the impact of CHW programs on morbidity and mortality of children under six. Seven studies in which CHWs provided curative treatment were included in the review. The authors conclude that CHW programs have the potential to contribute to large gains in child survival. However, the available evidence is severely limited and therefore large-scale and rigorous studies are urgently needed.
This toolkit provides a variety of resources that form a platform for strengthening policy makers, program managers and service providers' capacity to promote access to maternal, newborn and child heath care. Developed by the Peace Corps, the toolkit includes information on: pregnancy and birth preparedness; labor, post partum and newborn care; community mobilization; child survival; and monitoring and evaluation.
This pre-service education toolkit outlines key programmatic steps, highlights lessons learned, and identifies key resources to assist in developing quality and relevant pre-service education interventions. The toolkit, originally developed by Jhpiego under the leadership of MCHIP, has been shaped significantly by the technical advisory group at MCHIP. Although targeted for midwives, this toolkit may be used for other cadres as well, such as CHWs.
This manual introduces the importance of the community health worker's role in the communities they serve. It also includes course materials for CHWs on the following topics: how to identify signs of illness in a sick child, age 2 months up to 5 years; when to refer children to health facilities for more care; and how families can treat children at home with problems of diarrhea, malaria or fast breathing. The manual provides many exercises in order to facilitate CHW practice.
This case study examines lay health worker attrition by examining three questions: What is the magnitude of attrition in programs? What are the determinants of attrition? What are the most successful ways of reducing attrition? Several important factors have been identified including: supportive supervision, defined roles with specific tasks, locally relevant incentives, incentive systems combining monetary and nonmonetary benefits, recognition, training opportunities, community and policy support, and strong leadership.
This success story demonstrates how CHWs can play a crucial role in educating women and families about basic health needs and maternal and newborn care. In Rwanda, the MOH uses CHWs to improve MCH; nearly 12,000 were trained by the US Maternal and Child Health Integrated Program (MCHIP) to strengthen their knowledge of emergency obstetric and newborn care and active management of the third stage of labor to improve MCH care.
This literature review provides examples of lessons learned in the planning, implementation and evaluation of HRH interventions in maternal, neonatal and reproductive health (MNRH) at the community level in the Asia and Pacific regions. The review outlines interventions in the areas of HRH policy, management, and education and training. It synthesizes what are considered effective ways of working with the community and ways towards building supportive environments for health workers.