CHWs (107) Reflections on CHW Discussion Week 3

30 June, 2019

During week 3, we discussed length of CHW training, competency domains, and modalities.

CHWs often provide sexual and reproductive information and services. On June 17th, our colleague from IBP, Nandita, shared some useful resources that delve more deeply into best practices and case studies. One such resource is the "WHO Summary Brief on Task Sharing to Improve Access to Family Planning/Contraception," published 2017. On page 7, it states:

"There needs to be more rigorous evidence about the effectiveness or acceptability of lay heath workers providing injectable contraceptives in various contexts or conditions, especially when being considered for implementation and scaling up. Particular attention must be given to specific issues such as risks or harms for which little or no relevant information is available."

It is now becoming more common for CHWs to provide both depo provera (DMPA-IM) and sayana press (DMPA-SC). This is an example of how the "competency domains" can be quickly expanded as new treatments and/or knowledge becomes available. This WHO summary brief and other such statements should be living documents, quickly incorporating new pilots and shifting recommendations so that all governments and NGOs that work with CHWs are well-informed about the kinds of tasks that CHWs may take on.

Sunanda's contribution on June 18th provided quite useful implementation concerns about CHW selection. I particularly appreciated the following:

"The less educated of the workers are often the best for practical work with mothers and children but the graduates are better at documentation of work. We continue with the practice of pairing the less educated older women (with better managerial skills) for work with the young graduates as they complement each other with their knowledge and skills."

These are the kinds of on-the-ground experiences that are difficult to capture in guidelines with large scopes and overarching questions, but are nevertheless extremely valuable. I hope those working with CHWs utilize online fora, such as CHW Central, or in-person conferences, as the CHW Symposium (Dhaka, Bangladesh in November), to take heed of these experiences in implementation.

Lastly, Neil raised quite a useful set of questions regarding the competency domains covered in pre-service training. One such question was, "Are there advantages to make training modular, so that all CHWs in a given country would have the same pre-service training, with the option to specialise later by taking further modules?"

I wonder how that would affect the community members' understanding of the roles of CHWs, and usage thereof. Would it just spread through a community that their CHW now had a particular test or new service? Or would there be any confusion caused if certain CHWs covered a particular specialization and others did not? How does that work now in villages where multiple NGOs train CHWs to do slightly different work?



HIFA profile: Amelia Plant is the Portfolio & Impact Manager at Preston-Werner Ventures, a San Francisco-based foundation looking to create scalable impact at the intersection of climate change and social justice. Amelia specializes in sexual reproductive health and rights, focusing on family planning information & access. She is currently based in Cairo, Egypt. She is a member of the HIFA working group on Family Planning and the HIFA wg on Community Health Workers.

Email address: asiplant AT