A good day to you all and it's very interesting to read the contributions and thoughts on the issue.
This contribution is on recommendations 1 and 2 that address the selection for pre-service training and duration of training.
For the selection of CHWs to involve multiple factors is a good approach as their relevance and ability to influence their communities does not depend on their availability to take up the role alone but also on how well they are accepted. The role does not end within the confines of the health facility but extends into their daily interactions with community and it's hence beneficial to have one that is accepted by target communities. Community participation in selecting is the way to go. Communities know within their settings who to trust with issues as sensitive as one's health. They should be given the power.
The gender equality in the selection process especially in our setup must be done with caution depending on program area and local context. There's been a tendency to have more females than males which I think has continued to increase the inequalities in access and utilization of health care between men and women. Having a high female ratio may improve uptake by females and perpetuate the gaps in males. Critical analysis on the role of each gender in maximizing the use of a service or intervention is key to help determine the selection. Remembering the ultimate goal is UHC and good health for all and not leave anyone behind.
On recommendation 2, the duration of the training may be an issue of contention especially in most resource limited settings including Zambia. If adopted though is a critical one that can lead to improved quality of work. Health programs ultimately run longer even way after projects are closed. If sustainability is to be improved, this will be an additional recipe. Duration may be crucial in promoting access to health information. The CHWs can serve as message bearers within communities on a wide range of health issues and programs but only if well informed. It is unacceptable to have people continue dying from preventable diseases and mostly due to lack of health information. Access to health information is yet to improve in Zambia, these can play a role as they interact with the communities more than we do. Ensuring they are sufficiently trained and empowered with sufficient knowledge can also help them work with community members in addressing poor attitudes towards certain interventions. The key thing in this recommendation in my opinion is to remember that CHWs are not institutionalized like health care staff and hence should serve as sources of information for people as they interact especially on prevention of disease and promoting healthy behaviors.
The recommendations are simplified and generalizable across all contexts. Health is a Right and we should not leave anyone behind.
HIFA-Zambia profile: Flata Mwale is a Student at the College of Medicine, University of Malawi. Professional interests: Health systems strengthening and health policy. Advocacy for equity and equality in access, utilization and distribution of health care. Email address: fltmwale AT gmail.com