CHWs (6) Length of pre-service training for CHWs

17 June, 2019

Dear HIFA-Zambia colleagues,

Thank you for your contributions during weeks 1 and 2. There has been a lot of discussion about the CHW Guideline on our sister forum HIFA (more than 60 contributions). You can review HIFA messages on the HIFA RSS feed here:

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This week we are looking at Recommendations 2, 3 and 4 (length of pre-service training, competency domains and modalities).

We invite you to consider Recommendation 2 (length of pre-service training). The policy question that is addressed by the Guideline is: "For CHWs receiving pre-service training, should the duration of training be shorter versus longer?"



WHO suggests using the following criteria for determining the length of pre-service training for CHWs:

• scope of work, and anticipated responsibilities and role;

• ccompetencies required to ensure high-quality service delivery;

• pre-existing knowledge and skills (whether acquuired through prior training or relevant experience);

•¢ social, economic and geographical circumstances of trainees;

• institutional capacity to provide the training;;

• expected conditions of practice.

Certainty of the evidence: ­ low. Strength of the recommendation: ­ conditional.


As a personal comment, this recommendation is (like the majority of recommendations) 'conditional', ie context-dependent. As the Guideline states, 'The most appropriate duration of training should be established in a national or subnational context on the basis of local needs and circumstances.'

The Guideline notes that: 'Currently the length of CHW training is not standardized, with its duration ranging from a few hours to several years'. It does not propose any minimum or maximum lengths of pre-service training, with the implication that there may be contexts in which a few hours or several years, or anything in between, may be appropriate.

Interestingly and perhaps surprisingly, the 'systematic review of reviews found that... training duration had no consistent effect on the effectiveness of the intervention'. Perhaps it is quality of training that matters, as well as other factors such as supportive supervision and the existence or otherwise of in-service training?

Have you received training to become a community health worker? We look forward to learn from your experience. How long is CHW training in Zambia? Is this too short, too long, or about right?

Do you have experience in training CHWs? We look forward to hear your views on length of pre-service training.

As a reminder: We welcome any messages on any aspect of CHWs at any time - please send your contribution by email to:

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: