CHWs (72) Target population size (3) Are we setting CHWs up to fail? (3)

19 November, 2019

Dear HIFA colleagues,

In Recommendation 10 of the CHW Guideline, WHO suggests a number of criteria in determining a target population size in the context of CHW programmes (expected workload based on epidemiiology and anticipated demand for services; frequenccy of contact required; nature and time requirementss of the services provided; expected weekly time commmitment of CHWs (factoring in time away from service provision for training, administrative duties, and other requirements); local geography (including proximity of households, distance to clinic and population density).

In the Background to this Recommendation, the Guideline states:

'Prominent among the many challenges that may result in poor CHW performance is an excessive workload, often indirectly linked to an increased population size served by each CHW. The factors in question are the optimal population size or caseload that maximizes the effectiveness of community health workers. While many factors have been highlighted as influencing CHW performance, few studies have actually tested which intervention works best to manage CHW workload and improve CHW performance, and how such interventions should be implemented. Closely related to this interest in understanding how to balance the workload of community health service staff is the interest in determining whether CHWs should be assigned a targeted population size and how this population size might impact CHW productivity, coverage and health outcomes.'

We would be very interested to hear the experience of people who plan and administer CHW programmes. How do you address the question of target population size? Do you use some or all of the above criteria already? What are the challenges in practice?

Is there any evidence in your country that CHWs are being expected to do too much. As Edwin van Teijlingen said in a message on HIFA yesterday, Are we setting CHWs up to fail? This might be through many factors:

1. A situation where a CHW is expected to provide services single-handed (Are such situations common, where a single CHW is expected to be the first frontline health worker for all health sitations across the community? Or can CHWs be deployed in teams, where they might have complementary skills in different aspects of health?)

2. Situations where the CHW is overwhelmed - whether constantly or intermittently - because of excessive numbers of people they are responsible for.

3. Situatons where the CHW is frequently faced with health crises for which they are not adequately trained and/or where there is insufficent support or referral systems.

We would love to hear also from CHWs directly. If you are a CHW, or have worked with CHWs, we would be grateful for your inputs.

Best wishes, Neil

Coordinator, HIFA Project on Community Health Workers - Supported by the World Health Organization

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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: