Community health workers are not new. Since at least the 1950s, the potential of community health workers has been evident, with different models flourishing in different contexts—from “barefoot doctors” of the Chinese Cultural Revolution, to the Last Mile Health-trained frontline health workers who work in remote villages of Liberia today.
With the African Union calling for 2 million more CHW employed by 2020 to close Africa’s healthcare gap, now is the time to take a close look at what works in the field. Twenty-three countries have adopted principles for institutionalizing community health, and CHWs are highlighted as a key strategy by the World Health Organization. A collective process of reflection has resulted in a set of 8 “design principles that drive programmatic quality:
- Accredited: CHWs must prove their competency before carrying out their work.
- Accessible: point of care user fees should be avoided when possible.
- Proactive: For active disease surveillance, CHWs go door-to-door looking for sick patients and providing training on how to identify danger signs and quickly contact a CHW.
- Continuously Trained: Continuing medical education is not only available to but required of CHWs.
- Paid: CHWs are compensated competitively.
- Part of a Strong Health System: CHW deployment is accompanied by investments to increase the capacity, accessibility, and quality of the primary care facilities.
- Part of Data Feedback Loops: CHWs report all data to public-sector monitoring and evaluation systems which improves programs and CHW performance.