I have been following with interest the first few days of the debate on “CHW data for decision making”. Some of the contributions go to the heart of the matter, which is that at present unfortunately community health workers and other types of community-based practitioners sit at the margin of health systems: not formally recognized, not adequately trained, not properly incentivized, supervised or managed, not adequately counted or monitored.

There are clearly some missed opportunities in this, as the potential of these cadres in some settings to contribute to expand access to some essential health services and improve health outcomes is by now well recognized. Recent research, coordinated by the Global Health Workforce Alliance, has focused on assessing the cost-effectiveness of health programmes led by various types of community-based practitioners, finding that these cadres can represent a cost-effective policy options in some contexts (Mc Pake et al, WHO Bull 2015 http://www.who.int/bulletin/volumes/93/9/14-144899.pdf?ua=1). The case for investment in these cadres in some contexts has therefore a stronger empirical basis now.

However, support for community based practitioners should not take the form of one-off vertical initiatives disjointed from the rest of the health system: national governments that consider community-based practitioners a relevant policy option for their country contexts should invest – and be supported by the international community – in order to ensure that these cadres are adequately supported by and integrated in the health system. As Campbell et al note in a recent editorial (http://www.who.int/bulletin/volumes/93/9/15-162198.pdf?ua=1), maximizing the impact of community-based practitioners entails that (i) national policy-makers move towards the full integration of community-based practitioners in public health strategies, allowing these cadres to benefit from formal employment, education, health system support, regulation, supervision, remuneration and career advancement opportunities; (ii) development partners and funding agencies see the value of investing in these cadres and contribute to the capital and recurrent costs incurred when expanding this workforce; (iii) normative agencies such as WHO and ILO address the evidence and classification gaps by developing more precise definitions and categories for these cadres.

Related to this last point, which some of you already commented on, WHO is planning on developing guidelines on the role, education and integration of community-based practitioners for publication in 2017.

Many of the participants in this conversation have also commented on the need to ensure that we have better data on community health workers and other types of community-based practitioners. Efforts at developing better metrics for these important cadres should take place in the context of broader initiatives to enhance health workforce information systems.

WHO’s emerging Global Strategy on Human Resources for Health: Workforce 2030 (http://www.who.int/hrh/resources/online_consult-globstrat_hrh/en/), to be considered by the World Health Assembly in May 2016, calls for investments in strengthening country analytical capacities of HRH and health system data on the basis of policies and guidelines for standardization and interoperability of HRH data. The GSHRH puts forward the adoption of a National Health Workforce Account (NHWA) as a harmonized, integrated approach for annual and timely collection of health workforce information (http://www.who.int/hrh/documents/brief_nhwfa/en/). This approach, or related ones to strengthen health workforce metrics, should be extended to cover also community-based practitioners.

Best wishes,


HIFA profile: Giorgio Cometto is a Technical Officer at the World Health Organization in Switzerland. Professional interests: Human resources for health.      comettog AT who.int