CITATION: Community Health Worker Programmes in the WHO African Region: evidence and options – policy brief

by Nana Twum Danso, Uta Lehmann, Jennifer Nyoni et al.

World Health Organization, Regional Office for Africa, 2017

23 pp. 1.0 MB

‘The purpose of this policy brief is to inform discussions and decisions in the World Health Organization (WHO) African Region on policies, strategies and programmes to increase access to primary health care (PHC) services and make progress towards universal health coverage (UHC) by expanding the implementation of scaled-up Community Health Worker (CHW) programmes. This brief summarizes the existing evidence on CHW programmes with a focus on sub-Saharan Africa and offers a number of context-linked policy options for countries seeking to scale up and improve the effectiveness of their CHW programmes, particularly with regard to needs such as those of Guinea, Liberia and Sierra Leone, the three countries that were the most affected by the 2014–2015 Ebola Virus Disease outbreak.’


There is unanimity in the literature that CHW cadres and programmes have enormous potential in strengthening health and community systems at the interface that is now increasingly identified as community health systems. The key foundational elements of successful CHW large scale programmes are:

(a) Embeddedness, connectivity and integration with the larger system of health care service delivery, the health workforce and community governance, as opposed to functioning as stand-alone or short-term interventions;

(b) Cadre differentiation and role clarity in order for the scope of work and accountability responsibilities to be clear, to minimize confusion, and to manage the expectations of the formal health system and community members;

(c) Sound design, based on local contextual factors and effective people management. Specifically, evidence confirms that CHW programmes will fail unless CHWs are provided:

– initial and continuing training commensurate with their roles;

– regular, skilled and supportive supervision;

– adequate and appropriate incentives and compensation, whether monetary or other types;

– prospects for career development and progression.

(d) Ongoing monitoring, learning and adapting, based on accurate and timely local data to ensure heir optimal fit to the local context, since one size does not fit all.

Best wishes, Neil

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