1. Community Health Workers around the World
Preliminary Results from the Community Health Systems Catalog
2017 CHW Symposium
Kampala, Uganda
February 21, 2017

2. Advancing Partners & Communities Project
Objectives for community health systems strengthening
Country Level: provide technical assistance in policy development, analysis, and implementation
Global Level: support harmonization and community health policy efforts by developing practical tools and approaches

3. Community Health Systems (CHS) Catalog
Documenting policy guidance across 25 countries
First developed in 2014
Fills knowledge gaps about community health policy
fragmentation  harmonization
Accessed by researchers, policymakers, donors, and program managers
Updating in to reflect changing landscape of community health

4. Community Health Systems (CHS) Catalog
Capturing health system components
Leadership & governance
Human resources for health
Health management information systems
Supply management
Service delivery

5. Key questions What CHW approaches exist in each country?
What are the CHW trends across countries?
What are the policy gaps in CHW guidance?

6. Methods How was the CHS Catalog developed? Country experts:
collected and reviewed country policy documents
completed an electronic survey
>50 questions about CHW programs
>140 interventions CHWs deliver
APC staff:
verified information
compiled and synthesized preliminary CHW data

7. Updated information for 15 countries
Afghanistan
Ghana
Haiti
India
Liberia
Madagascar
Malawi
Mali
Nepal
Nigeria
Pakistan (Punjab)
Philippines
Senegal
South Sudan
Zambia

8. Policy guidance Across 15 countries…
59 main policies guiding community health (avg 3-4 per country)
Over half (57.6%) created since 2012
Nearly a quarter (23.7%) since 2015
Quality:
Clarity
Consistency
Comprehensiveness

9. CHW cadres 44 CHW cadres (avg 2-3 per country) CHW definitions differ:
Volunteers
Formally paid cadres
Professionally trained
Comprehensive primary health care services
Specific health areas (e.g., FP, HIV)

10. Selection criteria
Which criteria are important?

11. Selection process How are CHWs chosen?
In Malawi, district-level officials recruit health surveillance assistants by posting advertisements and holding interviews.

12. Training How are CHWs trained? Duration varies from 2 days to 2 years
20% have a month or less of training
Refresher trainings for 34.1% of cadres

13. Number of CHWs How many CHWs are recommended? How many exist?
Varies by country and type of CHW
No recommended number for 47.7%
No actual number for 27.3%
India example:
CHW
Recommended
Actual
GAP
Aganwadi Worker (AWW)
1,366,766
1,174,388
-192,378
Accredited Social Health Activist (ASHA)
961,113
859,331
-101,782
Auxiliary Nurse Midwife (ANM)
178,963
212,185
+33,222

14. Coverage ratios What is a CHW’s coverage area?
Expressed in terms of people; households; facilities; villages; etc.
Often a range
Adjust by context
urban/rural (India, Zambia)
geographic area (north/south) (Mali)
terrain (hill/mountain/terai) (Nepal, India)
No information (18.2%)

15. Coverage ratios
How many people to each CHW? :

16. Coverage ratios
How many households to each CHW? :

17. Incentives
What type of incentives do CHWs receive?

18. Incentives What type of incentives do CHWs receive?
Ghana, Haiti, India, Malawi, Mali, Nepal, Nigeria, Pakistan and Zambia all have salaried cadres
Formal social recognition top nonfinancial incentive.
In-kind payments
Preferred access to loans
Scholarships for CHWs’ children
Free legal services
Tickets for pilgrimages to holy sites

19. Incentives What type of financial incentives do CHWs receive?
Ghana, Haiti, India, Malawi, Mali, Nepal, Nigeria, Pakistan and Zambia all have salaried cadres

20. CHWs in Senegal may receive tickets for pilgrimages to holy sites
Incentives
What type of nonfinancial incentives do CHWs receive?
CHWs in Senegal may receive tickets for pilgrimages to holy sites

21. Accessing clients How do CHWs access clients?
84.1% of CHWs walk to their clients
61.4% may have clients come to them at a facility or their homes
43.2% may use bicycles
25.0% may use public transport
9.1% may use boats

22. Supervision Who supervises CHWs?
In Madagascar, CHWs receive supervision and guidance from four different stakeholders.
Who supervises CHWs?
Three quarters of CHW cadres have more than one supervisor.

23. Health areas In which health areas do CHWs provide services?
Over half of CHW cadres provide at least one service in ALL health areas.

24. Family planning
Which family planning methods do CHWs provide?

25. Limitations Information is from policy
Some community health activities not documented in policy
Difficult to catch a moving target

26. Conclusions What are the key takeaways?
More CHW information is available than previously
Gaps in guidance include:
Limited data on the number of CHWs
Less information about processes (selection, supervision, training)
Unclear information about the CHW scope of service

27. Thank you!
Questions?

28. Photo credits:
Slide 1/Cover: Dominic Chavez/World Bank; Morgana Wingard (USAID); Puskar Khanal (JSI-CNCP)
Slide 5: Lauren Seibert
Slide 8: Direct Relief
Slide 9: Dave Llorito (WB)
Slide 14: Puskar Khanal (JSI-CNCP)
Slide 24: Graham Crouch (WB)
Slide 25: Dominic Chavez/World Bank
Slide 26: Graham Crouch (WB)
Icons: