CHWs (2) Thematic Discussion - Community Health Workers (2) Questions for discussion

19 October, 2019

Dear all on HIFA,

Please see below our questions for Part 2 of our WHO-supported discussion on the CHW Guideline, starting this Monday 21st October. These are offered as a framework. Note, however, that we welcome and encourage contributions on *any* aspect of CHWs at *any* time for the whole duration of this project.

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Our second thematic discussion starts on 21 October 2019. The main discussion will take place on the HIFA (English) forum with parallel discussions on HIFA-French, HIFA-Portuguese, HIFA-Spanish, and CHIFA (child health).

The main findings of both discussions will be presented at the 2nd International Symposium on CHWs in Dhaka, Bangladesh, 22-24 November 2019.

The work is led by the HIFA working group on Community Health Workers.

Q1. Recommendation 6 suggests certain strategies (appropriate supervisor–supervisee ratio allowing meaningful and regular support; ensuring supervisors receive adequate training; coaching and mentoring of CHWs; use of observation of service delivery, performance data and community feedback; prioritization of improving the quality of supervision) to use for supportive supervision of CHWs. How do these relate to current practice in your country/experience? Are they implementable in your country/experience?

Q2. Recommendation 7 recommends remuneration of CHWs for their work with a financial package commensurate with the job demands, complexity, number of hours, training and roles that they undertake. WHO suggests not paying CHWs exclusively or predominantly according to performance-based incentives. How does this relate to current practice in your country/experience? Is it implementable in your country/experience?

Q3. Recommendation 8 recommends providing paid CHWs with a written agreement specifying role and responsibilities, working conditions, remuneration and workers’ rights. How does this relate to current practice in your country/experience? Is it implementable in your country/experience?

Q4. Recommendation 9 suggests that a career ladder should be offered to practising CHWs, recognizing that further education and career development are linked to selection criteria, duration and contents of pre-service education, competency-based certification, duration of service and performance review. How does this relate to current practice in your country/experience? Is it implementable in your country/experience?

Q5. Recommendation 10 suggests using the following criteria in most settings to determine a target population size in the context of CHW programmes: expected workload based on epidemiology and anticipated demand for services; frequency of contact required; nature and time requirements of the services provided; expected weekly time commitment 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). How feasible is it in your country/context to determine CHW:population ratios taking these factors into consideration? If your country/programme currently does this, what tools do you use?

The WHO Guideline: Health policy and system support to optimize community based health worker programmes is available here.

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: