CHWs (33) Selection of CHWs for pre-service training (2)

9 June, 2019

Dear HIFA colleagues,

We invite you to comment on Recommendation 1 of the CHW Guideline, which relates to selection of CHWs for pre-service training:

'CHW programmes should select CHWs based on criteria including educational level, membership of and acceptance by the community, personal attributes and gender equity.'

WHO Guideline - Selected Highlights: https://apps.who.int/iris/bitstream/handle/10665/275501/WHO-HIS-HWF-CHW-...

QUESTION: Recommendation 1 of the CHW Guideline (below) suggests certain criteria to use and not to use for selection of CHWs. How do these criteria relate to current practice in your country/experience? Are these criteria implementable in your country/experience?

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RECOMMENDATION 1A

WHO suggests using the following criteria for selecting CHWs for pre-service training:

- minimum educational level that is appropriate to the task(s) under consideration;

- membership of and acceptance by the target community;

- gender equity appropriate to the context (considering affirmative action to preferentially select women to empower them and, where culturally relevant, to ensure acceptability of services by the population or target group);

- personal attributes, capacities, values, and life and professional experiences of the candidates (e.g. cognitive abilities, integrity, motivation, interpersonal skills, demonstrated commitment to community service, and a public service ethos).

Certainty of the evidence – very low. Strength of the recommendation – conditional.

RECOMMENDATION 1B

WHO suggests not using the following criterion for selecting CHWs for pre-service training:

- age (except in relation to requirements of national education and labour policies).

Certainty of the evidence – very low. Strength of the recommendation – conditional.

RECOMMENDATION 1C

WHO recommends not using the following criterion for selecting CHWs for pre-service training:

- marital status.

Certainty of the evidence – very low. Strength of the recommendation – strong.

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The Guideline highlights the need to:

- Specify minimum educational levels;

- Require community membership and acceptance;

- Consider personal capacities and skills; and

- Apply appropriate gender equity to context.

(It's interesting to note the words '*require* [my emphasis] community membership and acceptance', which implies a strong recommendation, and yet this aspect of selection is under Recommendation 1A, where the recommendation is 'conditional'.)

The full text of the Guideline [https://apps.who.int/iris/bitstream/handle/10665/275474/9789241550369-en... provides background to the Selection issues:

'Effective CHW recruitment and selection for pre-service training may improve CHW performance and the quality of services delivered. Selection criteria may vary depending on which sociodemographic characteristics are most relevant to the community or to the intervention being delivered. For large-scale CHW programmes, criteria considered typically include age, gender, literacy level, educational attainment, marital status and geographical location (31). The active involvement of the community being served in the recruitment of CHWs is typically assumed to ensure that the CHW is trusted and accepted into the community.'

'The Guideline Development Group (GDG) considered the benefits and harms of having selection criteria for enrolment of candidates in pre-service education to become CHWs. The GDG consensus view was that selection of the most appropriate people as CHWs is crucial to the success of a community health intervention. The choice of criteria to be adopted, however, depends on the evidence of effectiveness, as well as broader policy considerations related to values and preferences, which may vary considerably across different contexts.'

'Furthermore, the GDG noted that this recommendation touches on a human rights dimension, the fundamental right of equality of opportunity and treatment in employment or occupation...'

We look forward to your contributions. Please send by email to: hifa@hifaforums.org

Best wishes, Neil

Coordinator, HIFA Project on Community Health Workers

http://www.hifa.org/projects/community-health-workers

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