Recommendation 5 of the CHW Guideline says:
WHO suggests using competency-based formal certification for CHWs who have successfully completed pre-service training.
Certainty of the evidence – very low. Strength of the recommendation – conditional.
Here is the background to this recommendation (p43-44):
'A key component of quality health care delivery is workforce standards. This implies defining professional roles, scope of work, responsibilities and tasks, along with educational standards and minimum competency requirements for different health service positions. Credentialing provides a formal recognition awarded to those meeting predetermined standards (93). The availability of and requirements for CHW certification vary across countries. In many cases, CHWs have been identified as “community volunteers” and are casually trained to provide services in the community without any clear mechanism for certification. In some countries, however, standards and procedures for CHW certification exist.
'For CHWs, certification programmes might have some theoretical benefits: certification may increase their motivation, sense of self-esteem and respect from other health workers. Certification that describes the learning achieved enables transferability to other settings, thus reducing the need to repeat training if the worker moves location; or it can be used as evidence as part of admission criteria for further education. In some countries, certification can legitimize the work of CHWs and provide opportunities for the reimbursement of CHW services (94). From the perspective of citizens and communities, formal certification may protect the public from harm resulting from the provision of inappropriate care rendered by providers lacking any training but purporting to be qualified (95).
'To reduce CHW drop-out rates and to ensure a sense of commitment to service, an earlier review suggested that CHW programmes should set up clear appointment and deployment strategies for CHWs who pass the final exam at the end of a training and receive a certificate of course completion (13). However, there is little formal evidence that suggests that certification improves outcomes. In this section, the guideline explores the evidence and provides policy guidance on competency-based, formal certification for CHWs who have successfully completed pre-service training.'
While preparing this discussion, the HIFA CHW working group suggested we put the following questions to the HIFA community to explore this issue further:
Does your country/program have a formal CHW Certification process in place or are you working toward on? If so, what is the process, what authority manages the certification process, and how often do CHWs have to re-certify?
What challenges exist in your setting regarding competency-based certification of CHWs?
Best wishes, Neil
Coordinator, HIFA Project on Community Health Workers
Access the CHW Guideline here:
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