CHWs (26) What do policymakers think of the CHW Guideline?

7 June, 2019

Dear HIFA colleagues,

This week we have been discussing Question 1: What are your thoughts on WHO's CHW Guideline? What questions do you have about it?

I would like to invite policymakers on HIFA to comment, especially those who in ministries of health in LMICs, for whom the Guideline is largely targeted. I also invite comment from those who work *with* policymakers, including (inter alia) researchers, public health professionals, representatives of the health professions, health advocates, and CHW leaders.

What aspects of the Guideline do you find most useful? Does the Guideline ask the right questions? Are there other questions you would like to see addressed?

In what ways do you see the various recommendations in the Guideline being considered in your country?

There are 18 recommendations in the Guideline. Recommendation 1 and 7 are divided into three and two recommendations, respectively, making a total of 18 Recommendations.

Recognising that in many cases the certainty of the evidence is low or very low, and considering that the most appropriate strategies may vary by context, the vast majority (14/18) of the recommendations are 'Conditional'.

'For most recommendations a low or very low certainty of the evidence translated into conditional recommendations. For a few recommendations, the GDG made a strong recommendation despite the low or very low certainty of the evidence, taking into account other factors, including health workers’ rights and equity and gender considerations. In the cases where strong recommendations were proposed despite a low or very low certainty of the evidence, the GDG took an explicit vote, the outcome of which is reported in the sections referring to the specific recommendations. In the cases when voting took place, a majority was defined as 80% or above of the voting members in attendance at the

GDG meeting.' (Guideline, p27)

As Dr Tedros says in the Foreword, the Guideline makes 'pragmatic recommendations on how to improve and strengthen their selection, education, deployment, management, supervision, career advancement, community embeddedness and system support'.

In line with guideline protocols introduced by WHO a few years ago, the Guideline includes a section on Guideline Use: 1. Plans for guideline dissemination and 2. Plans for guideline adaptation, implementation and evaluation.

With regards to the latter, the Guideline states:

'In order to maximize the opportunities for the guideline to be implemented, it will need to be adapted and contextualized, including through a number of derivative products made available in relevant languages to promote uptake at country level. Beyond the adaptation, simplification and development of user-friendly summaries of messages, a range of accompanying activities will be considered and implemented, subject to resource availability. Some of these activities might be directly implemented and supported by WHO, others by or in collaboration with other agencies and partners involved in the Global Health Workforce Network CHW hub, or other institutions. A non-exhaustive and non-binding list of activities that will be considered includes...

[there follows an impressive list of activities including:

• development of a dedicated online portal;

• a one-stop shop suite of derivative products, including toolkits, to ensure the guideline is easily comprehensible and is taken up by stakeholders (this will include translation of the guideline into the WHO official languages), with the assets filtered through different lenses by audience (such as funders, implementers);

• a series of webinars;

• regional workshops bringing together regional and country champions and stakeholders involved with CHWs to assess which countries would election of a few countries in which to prioritize policy dialogue and capacity-building activities, supported by drafting a regional and country implementation map;

• meetings of country stakeholders involved with CHWs to present the guideline and design a partner support plan (agree on roles and responsibilities and contributions);

• a workshop with government stakeholders (ministry of health, ministry of finance, development partners) for awareness raising and country mapping of existing CHW situation and policies, to create a baseline and, poten-tially, a roadmap for uptake of the recommendations, and to support the ministry of health in advocacy with the ministry of finance;

• a self-assessment tool based on the recommendations of the guideline that supports countries in developing baseline information related to CHWs, and that can be used to monitor and evaluate implementation of policies and programmes aligned with the recommendations.]

This section reflects the huge size of the challenge (and opportunities) ahead in terms of supporting use of the Guideline in promoting positive change in national policies on CHW deployment in the wider framework of health workforce development. The work has just begun, and HIFA is privileged to play our small part to maximise its impact.

The Guideline is available here in several languages, in both full and selected-highlights versions.

Best wishes, Neil

Coordinator, HIFA Project on Community Health Workers

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: