CHWs (47) Selection of CHWs for pre-service training (8)

10 June, 2019

Comment: Nigeria already has clear criteria for the selection of community health practitioners (CHP) equivalent to community extension health workers, which the training schools and colleges use to admit students for pre service training to become registered in the CHW cadre by their regulatory body, the community health practitioners regulatory body (CHPRB): the cadre comprises Junior Community Health ExtensionWorkers (JCHEWs) who receive certificates; Community Health Extension Workers (CHEWs) receive certificates and CommunityHealth Officers (CHO) who receive diplomas. The training institutions also have curriculum foreach of the cadre and during training the students take their practicals in the practicum sites (they shadow established staff). Nigeria also has guidelines called Standing Order for these CHW to use in the primary care clinics when they graduate. It is interesting to notice that in some countries Traditional Birth Attendants have been added to the cadre of CHWs, but not yet in most states of Nigeria. For now the opportunity offered by TBAs remain only partially tapped in Nigeria.  For the question 'Are these criteria implementable in your country/experience?' The answer is that the criteria in the WHO guideline are implementable in Nigeria because already there is a structured modus for selection.

But it must be stated that the criteria are implemented in difficult circumstances, due to the weakness of the health system in general. With a dearth of healthcare providers (physicians, nurses, midwifes), JCHEWs, CHEWs and CHOs are critical to reaching patients including women and children in mostly rural, hard-to-reach areas. Nigeria has produced a Task Shifting Policy as an addition to the effort to deal with the dearth of the usual providers. 

To meet the selection criteria, fully, Nigeria would need to include the ‘gender equity’ criterion as that is not a specific criteria for now. 

Joseph Ana.

HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group: jneana AT