In thinking about who is a CHW in relationship to their task, education, and professionalization, we worked with policymakers and UNICEF teams to look at what various cadres of CHWs do and how they are not one homogeneous group but rather a mix of typologies:

Some excerpts from the executive summary:

In addition to a comprehensive literature review, the study used a cross-sectional survey with closed- and open-ended questions administered to UNICEF Country Offices and other key informants to investigate and map CHW characteristics and activities throughout the region. Responses were received from 20 of the 21 UNICEF Country Offices in the UNICEF East and Southern Africa region in May?June 20133. Data on 37 cadres from across the 20 countries made up of nearly 266,000 CHWs form the basis of this report. This report catalogues the types and characteristics of CHWs, their relationship to the broader health system, the health services they provide and geographic coverage of their work.

At the global level, CHWs have largely been considered to be a homogeneous class of healthcare worker. A more nuanced differentiation would be helpful to improve policy coordination, strategic planning and implementation of community-based health care. Based on results of the present survey, a post-hoc classification identified four distinct types of CHWs in ESAR countries:

Summary Table: CHW classification model [*see note below]

1. Case Manager

2. Community Liaison

3. Health Promoter

4. Traditional Birth Attendant (TBA)-plus

There was only one TBA-plus CHW cadre reported in this study. However, this may be due to the underreporting of traditional birth attendants, as these are often considered a separate class of healthcare worker rather than a subset of CHWs. Having TBAs engaged in a slightly broader range of reproductive health activities beyond maternal delivery (including family planning) is likely more widespread and would be a low-cost model for expanding CHW care given the high geographic coverage of TBAs in many countries.

In summary, this research documents that CHWs provide a variety of services with a broad range of potential tools. The report presents current training, responsibilities, and the scale of CHW programs in 20 ESAR countries. It also puts forward a potential CHW classification model to improve advocacy for and targeting of appropriate community health interventions (see Summary Table, Table 3 and Annex 5).

Meghan Kumar

REACHOUT Research Manager

+254 733440052