Who is a CHW? . But at the same time I want add another question Who is CHV (Community Health Volunteer)?.

When I look at the functional roles of these two I see a lot of differences. For example;

1. Uganda: VHTs are volunteers; midwives, nurse, enrolled nurse etc are CHWs

2. Ethiopia; WDA are volunteers; HEWs are CHWs

3. Nepal : FCHVs are volunteers; VHWs, MCHWs are CHWs

4. Ghana: CHV are volunteers: midwives, nurse, enrolled nurses are CHWs

5. India: ASHAs are volunteers; Nurses are CHWs

Almost all countries have this structure i.e. CHWs are incharge of community health system (which a part of the formal system) and CHVs are volunteers to support them.

It is important to understand this. Because of the following reasons:

1. CHWs are salary paid formal health system workers; they have to follow government rules and regulations for their hours of work, salary, benefits, incentives etc.

2. CHWs are legally responsible for their health facility

3. Any change in their status has to go through the government system and there are p.

4. their motivation problem and issues are the same as clinicians or doctors this can be solved by changing the processes in government system; community can provide only some temporary solutions

Whereas Community Health Volunteers are selected by community and are part of the community. They are not formally linked with health facility. It is expected that they should get strong support from the community like bicycle, incentives, respect, tc. It is important to maintain CHVs motivation in order to reach vulnerable, underserved and hard to reach people. Their motivation is also important for home visits and support patients for self-management.

I hope the discussion of CHWs will keep this in mind and not lumped them together. Because only addressing CHWs problems, without addressing CHVs problems, will not fix the problem of coverage, follow-up, referral and equity at the community level.

Thank you very much.

Ram Shrestha, D.Sc. (hon.), MS, M.Sc.

HIFA profile: Ram Shrestha is a Senior Quality Improvement Advisor, Community Health and Nutrition, USAID Health Care Improvement Project, University Research Company, Bethesda, Maryland, USA. www.hciproject.org         rshrestha AT urc-chs.com