Policy review on the management of pre-eclampsia and eclampsia by community health workers in Mozambique (2)

3 March, 2019

Dear Neil,

Thanks for sharing; You asked two questions to which I submit the following comments:

1. What do we know about training of CHWs to prevent/manage pre-eclampsia and eclampsia in other LMICs? This was not explored in the paper.


Developing the PACK Nigeria programme for Primary Health Care clinicians in Nigeria enlightened members of the PACK Nigeria programme team to the full workings of the community health practitioners - CHPs (Junior Community Health Extension Worker (JCHEW; Community Health Extension Worker (CHEW); and Community Health Officer (CHO), with seniority in that order. Entrants to the cadre of CHP are selected in a structured manner following pre determined criteria such as level of educational qualification, etc. They undergo structured training following a curriculum designed for each cadre, the JCHEW and CHEW train in the schools / colleges of Health Technology graduating with certificate or diploma. The CHO are trained in affiliated Universities and graduate with higher diplomas. They have salaried and pensionable employment and are promoted as applicable, after graduation.

2. On a different but related question: To what extent are CHWs in different countries trained to manage childbirth? I am thinking that CHWs would normally refer women to have facility-based delivery, and yet it seems likely that any individual CHW will find him/herself in the position of being the main person responsible for a home-based delivery.


You may recall that on this forum we have discussed at various times over the years ‘who is a community health worker’ and that the definition differs from country to country. Therefore the role of CHW will vary from country to country depending on their selection, training (if any), certification (if any) and so on. This will also determine whether they have a career path and whether they are remunerated. The recently released WHO CHW guideline is helpful in solving some of these questions, for instance it recommends training and certification, remuneration and career path. This means that as countries adopt and implement the guideline in future there should emerge some uniformity in definition, selection, training and certification, job description, pay, monitoring and monitoring. That is some standardisation will emerge globally.

Joseph Ana.

HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: www.hriwestafrica.com Joseph is a member of the HIFA Steering Group: http://www.hifa.org/people/steering-group


jneana AT yahoo.co.uk