CHWs (50) Selection of CHWs for pre-service training (10)

11 June, 2019

Dear HIFA colleagues,

I reproduce below extracts from Recommendation 1 on the selection of CHWs for pre-service training. The Guideline can be downloaded here in several languages: https://www.who.int/hrh/community/en/

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7.1.2 RATIONALE FOR RECOMMENDATION

On balance, based on an assessment of the available evidence, the GDG experience, and a rights-based perspective, the GDG concluded that the potential benefits outweigh the harms when CHWs are selected for pre-service training based on personal attributes and capacities, such as motivation, integrity, interpersonal skills, memberships of and acceptability by the community, through community engagement in the selection process, and appropriate minimum education level. Conversely, the potential risks, particularly in relation to unfair discrimination, probably outweigh the potential advantages with regard to criteria such as age and, in particular, marital status. Given multiple barriers that women face to workforce participation and the resultant gender stratification inequities in the global health workforce, proactive policies are encouraged to promote gender equity and maximize women’s participation in selection and recruitment. And in some circumstances – where the role and cultural norms of CHWs dictate – it may be appropriate to restrict selection to women, for instance where the delivery of reproductive and maternal health services is accepted by the communities only if the providers are female...

7.1.3 SUMMARY OF EVIDENCE

The systematic review (Annex 6.1)4 addressing the following question – “In community health workers being selected for pre-service training, what strategies for selection of applications for CHWs should be adopted over what other strategies?” (34) – identified 16 eligible studies, of which three were quantitative (35–37) and 13 were qualitative (38–50). Ten of them referred to CHW programmes in sub-Saharan Africa, with three studies from South-East Asia and two from the Region of the Americas... Overall, the certainty of the evidence was rated as very low...

The stakeholder perception survey identified a high acceptability and feasibility of selecting CHWs on the basis of their personal attributes (for example, cognitive abilities and prior relevant experience) and membership of the target communities, but variable and uncertain feasibility and acceptability of selection based on level of education and, especially, age.

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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