Community health workers at the dawn of a new era: 6. Recruitment, training, and continuing education

Abstract

Background This is the sixth of our 11-paper supplement entitled “Community Health Workers at the Dawn of New Era”. Expectations of community health workers (CHWs) have expanded in recent years to encompass a wider array of services to numerous subpopulations, engage communities to collaborate with and to assist health systems in responding to complex and sometimes intensive threats. In this paper, we explore a set of key considerations for training of CHWs in response to their enhanced and changing roles and provide actionable recommendations based on current evidence and case examples for health systems leaders and other stakeholders to utilize. Methods We carried out a focused review of relevant literature. This review included particular attention to a 2014 book chapter on training of CHWs for large-scale programmes, a systematic review of reviews about CHWs, the 2018 WHO guideline for CHWs, and a 2020 compendium of 29 national CHW programmes. We summarized the findings of this latter work as they pertain to training. We incorporated the approach to training used by two exemplary national CHW programmes: for health extension workers in Ethiopia and shasthya shebikas in Bangladesh. Finally, we incorporated the extensive personal experiences of all the authors regarding issues in the training of CHWs. Results The paper explores three key themes: (1) professionalism, (2) quality and performance, and (3) scaling up. Professionalism: CHW tasks are expanding. As more CHWs become professionalized and highly skilled, there will still be a need for neighbourhood-level voluntary CHWs with a limited scope of work. Quality and performance: Training approaches covering relevant content and engaging CHWs with other related cadres are key to setting CHWs up to be well prepared. Strategies that have been recently integrated into training include technological tools and provision of additional knowledge; other strategies emphasize the ongoing value of long-standing approaches such as regular home visitation. Scale-up: Scaling up entails reaching more people and/or adding more complexity and quality to a programme serving a defined population. When CHW programmes expand, many aspects of health systems and the roles of other cadres of workers will need to adapt, due to task shifting and task sharing by CHWs. Conclusion Going forward, if CHW programmes are to reach their full potential, ongoing, up-to-date, professionalized training for CHWs that is integrated with training of other cadres and that is responsive to continued changes and emerging needs will be essential. Professionalized training will require ongoing monitoring and evaluation of the quality of training, continual updating of pre-service training, and ongoing in-service training—not only for the CHWs themselves but also for those with whom CHWs work, including communities, CHW supervisors, and other cadres of health professionals. Strong leadership, adequate funding, and attention to the needs of each cadre of CHWs can make this possible.

Community health workers at the dawn of a new era

“…(2) planning, coordination, and partnerships [28]; (3) programme governance [29]; (4) programme financing [30]; (5) roles and tasks [31]; (6) recruitment, training, and continuing education [32]; (7) supervision [33]; (8) incentives and remuneration [34]; (9) CHWs' relationships with the health system and with the community [35]; (10) programme performance and its assessment [36]; and a concluding article on (11) CHWs leading the way to "Health for All" [37].…”

“…To better respond to their evolving and, in many instances, their gradually expanding roles, there is also a need to develop and implement systematic strategies for recruiting and training CHWs, including continuing education. In their paper, "Recruitment, Training, and Continuing Education" [32], Schleiff et al recommend that effective training approaches cover relevant content, make use of appropriate technical training tools, update CHWs with additional knowledge as needed, and engage CHWs with other health workers during their training. They emphasize that improved and innovative training approaches can enhance the professionalism, quality, and performance of CHWs and contribute to effective scale-up.…”

Community health workers and promotoras’ perspectives of a research best practice course: A focus group study

“…In general, CHW/Ps are increasingly recognized for their ability to help build and maintain trust with people that have historically mistrusted the health care system 22 . These dynamics will only accelerate the ongoing shift in the CHW/P role from being health educators to being health care delivery workers and health research study recruiters 24 . This could be another reason for CHW/Ps in this study stating that periodic refresher training is indeed useful to keep themselves up to date on research opportunities and developments that could be conveyed effectively to the communities that they serve.…”

Examining Roles, Support, and Experiences of Community Health Workers During the COVID-19 Pandemic in Bangladesh: A Mixed Methods Study

“…Government-employed CHWs’ workload was increased because of an already-existing shortage of workers (before COVID-19) and extended responsibilities, such as participating in satellite clinics to arrange immunization sessions, implement a vitamin A campaign in the community, and act as a community skilled birth attendant, if trained. Both government- and NGO-employed CHWs receive 21 days of classroom training, but NGO CHWs receive 1–3 days of refresher training regularly, 28 indicating a discrepancy in knowledge and skills that warrants attention. Additionally, NGO sector CHWs receive different equipment for their work such as bags, umbrellas, and notebooks, which CHWs did not mention in our study.…”