By: Katharine Shelley, Gasto Frumence, and Amalberga Kasangala
Modern Community Health Workers in Tanzania have a history dating as far back as eight decades. Each worker is trained to provide village health interventions and other essential preventative services and is required to have obtained a secondary education prior to training. Despite a long and established history, Tanzania requires a needs assessment to assess the cumulative value of Community Health Workers for population health.
Tanzania has a long history of community health dating to the late 1960s when the first village- based Volunteer Community Health Workers (CHWs) were trained. In 2014, Tanzania approved the National Community-Based Health Program (CBHP) Policy Guidelines, paving the way to establish a national public sector cadre of paid CHWs.
The pilot class of CHWs graduated in November 2016 and approximately 12,000 CHWs have been trained to date. Financing constraints and other challenges have limited the ability of the government to employ CHWs and scale up the program further. Adaptation to the original CBHP Policy Guidelines are currently under review by the government.
CHW responsibilities include a mix of health promotion and basic curative services provided within the community, including tasks such as implementing community health interventions; collecting and analyzing community-based data; conducting household visits and community education; identifying patients needing referral; and collaborating with other community-based cadres (e.g., volunteers) as well as with local governance structures and community groups. Two CHWs cover one village in rural locations or one mtaa (street) in urban locations.
Applicants for CHW training are required to have completed their secondary school education and be a resident of the locality, 18 years or older, and nominated by the Village Health Committee. Accepted students are assigned to a government-accredited Health Training Institution nearest to their locality, and they are expected to pay for their own training fees. The CBHP pre-service training consists of a 12-month integrated competency-based curriculum It includes 14 modules aligned with Tanzania’s National Essential Health Package, with classroom and practical components. Upon completion, trainees receive a Basic Technician Certificate in Community Health.
CHWs receive on-the-job supportive supervision and training on clinical tasks from the In- Charge/Focal Persons at the nearest Health Dispensary or Health Center. Administratively, CHWs are supervised by the Village Executive Officers, to whom they report daily. The CBHP policy recognizes the role of non-clinical community-based staff (e.g., Agricultural Extension Workers) as a resource for CHWs to refer patients and provide information that CHWs may not have. In addition, periodic supportive supervision is conducted by staff at district (called da council in Tanzania), regional and national levels.
Incentives and remuneration
CHWs are supposed to receive a monthly salary equivalent to approximately US$ 140 per month, plus benefits such as health insurance and annual leave. However, the government has not yet begun employing and paying CHWs. Non-financial incentives include community recognition and opportunities for further career advancement.
Establishing a cadre of government-salaried, multipurpose CHWs is a historic step in Tanzania’s journey toward Universal Health Coverage. Formal research and evaluation will be necessary to assess the impact of the CBHP policy and contribution to improving health equity.