Developing and Strengthening Community Health Worker Programs at Scale: A Reference Guide for Program Managers and Policy Makers

"The effective functioning of large-scale CHW [community health worker] programs offers one of the most important opportunities for improving the health of impoverished populations in low-income countries. This guide presents principles and programmatic suggestions that we hope will be useful as decision-makers and program implementers consider the initiation, expansion, or strengthening of CHW programs in their country."

This document offers an in-depth review of issues and questions to be considered when addressing key issues relevant for a large-scale CHW programme. Intended for in-country use by national-level policy makers and planners as well as programme implementers, it includes practical examples from CHW programmes around the world. The contents are in 4 sections and contain a total of 15 chapters covering such topics as: a history of CHW programmes; planning, governance, and financing; roles and tasks; recruitment, training, supervision, motivation, and incentives; relations with the community and health systems; scaling up; and measurement and data use. There is an appendix containing case studies from Bangladesh, Brazil, Ethiopia, Iran, Nepal, and Pakistan, as well as a summary of perspectives on large-scale CHW programmes.

One section of the resource focuses on community participation in large-scale CHW programmes. Key points presented in the chapter include:

• Balancing the inherent tensions of a large-scale CHW programme, where the CHW is the lowest tier worker of a national health system and also acts on behalf of the always changing local world of a community, will be an ongoing challenge requiring decentralised flexibility in programme policy, design, and implementation.
• A successful CHW programme requires the support and ownership of the community, as well as a supportive social and policy environment for community participation at national, district, and local levels.
• The development and support of community networks, linkages, partners, and coordination are necessary to enable a comprehensive community participation approach for better health.
• Village health committees and other local governance structures can be effective mechanisms to ensure local leadership, legitimacy, participation, and governance, but these committees require continued training and investment.

The Maternal and Child Health Integrated Program (MCHIP) invites "on-the-ground" comments and examples that can bring strength and relevance to the document. MCHIP invites public review of the reference guide, whether by assessing the entire document as a whole or specific chapters (see links below). Reviewers are asked to email written comments to CHW@MCHIP.net and/or to post a comment in the comment box at the bottom of the applicable page here (Key questions for readers to consider as they review the chapter are posed at the bottom of each chapter here). Please respond by January 31 2014.