Maximizing effectiveness: Matching CHWs with CHW programs

By: Steve Hodgins

When you hear the term ‘community health worker’ you may well have in mind quite a specific profile. You may picture someone doing community talks and going house-to-house giving behavior change counseling or perhaps your image includes dispensing or case-management functions, passing out condoms, oral contraceptives or oral rehydration salts. Commonly, this image includes the notion of a continuous service offered by the CHW, perhaps on a full-time or nearly full-time basis. Since the term ‘community health worker’ tends to evoke such a specific picture, it’s not surprising that many people have some pretty specific notions about the requirements for a CHW program to be successful.

In fact, there are a wide variety of profiles that can fall under the term ‘community health worker’. In west Africa, many programs are based on the Community Directed Intervention (CDI) approach, which relies on community health volunteers who mobilize at certain times of the year for specific activities. Similar models are used in west Africa and elsewhere for national polio immunization days, vitamin A supplement or ITN distribution and child health days or weeks.

In other programs, community health workers work full-time as regular government employees. Some mostly do outreach activities, others are based primarily in ‘health posts’ or ‘health huts’, where community members come for primary health care. In yet other programs, CHWs perform regular functions but typically only spend a few hours a week. Some programs use multi-purpose community health workers who have a broad range of functions; others make use of specialist CHWs, whose work supports a single vertical program. Indeed trained traditional birth attendants can be considered specialist CHWs.

There are CHW programs in which the community health workers’ functions are confined to health education and community mobilization. In other programs, CHWs perform almost like physicians, autonomously providing clinical services, including first-aid and treatment of childhood illness. Functions of such CHWs may include giving injections (e.g. immunization or family planning services), dispensing antibiotics or anti-malarials, and using simple lab diagnostics (like rapid tests for malaria or HIV).So when we think about what are the requirements or the necessary conditions for successful CHW programs, it is very important that we first specify what kind of a CHW program we have in mind.

Questions for Discussion:

Drawing from your experience with particular CHW programs (and providing a little bit about the details of the program(s) you’re referring to, e.g. the specific functions of the CHWs, and other important contextual information)

1. How do you determine the particular requirements for CHWs (e.g. training, selection, supervision, incentives, etc.) for specific programs and settings?
2. What factors have you found are important to build into the design of a CHW program?
3. What conditions need to be present for CHWs to be effective?

Steve Hodgins, MD, DrPH , Global Leadership Team Leader, MCHIP, is a public health physician who trained at McGill and UNC-Chapel Hill. He has broad public health and health services interests but his focus has been on public health practice. Through most of his career CHWs have been an important element of his work, beginning when he was a volunteer in north India almost 30 years ago. Together with Claire Glenton, Simon Lewin and others, he has published on community health worker motivation in Nepal.