National community health worker programs: how can they be strengthened?

ABSTRACT

PIP: A collaborative research study of policy and practice in large, national community health worker (CHW) programs in developing countries was conducted. The report was based on a review of the literature, case studies in Botswana, Colombia and Sri Lanka, and an international workshop on the future of CHW programs. The objective of the study was to reexamine the implementation of national CHW programs, looking at policy, planning and management implications to suggest improvements. The chief findings were poor initial planning, unrealistic expectations of the workers, difficulties in maintaining quality and problems of sustainability. National CHW programs have suffered from conceptual and implementation problems. With political will, however, governments can adopt more flexible approaches by planning CHW programs within the context of overall health sector activities, rather than as a separate activity. Weaknesses in training, task allocation and supervision need to addressed immediately. CHWs represent an important health resource whose potential in providing and extending a reasonable level of health care to undeserved populations must be fully tapped.