Developing Capacities of Community Health Workers in Sexual and Reproductive, Maternal, Newborn, Child, and Adolescent Health: A Mapping and Review of Training Resources

Abstract

BackgroundGiven country demands for support in the training of community health workers (CHWs) to accelerate progress towards reaching the Millennium Development Goals in sexual and reproductive health and maternal, newborn, child, and adolescent health (SR/MNCAH), the United Nations Health Agencies conducted a synthesis of existing training resource packages for CHWs in different components of SR/MNCAH to identify gaps and opportunities and inform efforts to harmonize approaches to developing the capacity of CHWs.MethodsA mapping of training resource packages for CHWs was undertaken with documents retrieved online and from key informants. Materials were classified by health themes and analysed using agreed parameters. Ways forward were informed by a subsequent expert consultation.ResultsWe identified 31 relevant packages. They covered different components of the SR/MNCAH continuum in varying breadth (integrated packages) and depth (focused packages), including family planning, antenatal and childbirth care (mainly postpartum haemorrhage), newborn care, and childhood care, and HIV. There is no or limited coverage of interventions related to safe abortion, adolescent health, and gender-based violence. There is no training package addressing the range of evidence-based interventions that can be delivered by CHWs as per World Health Organization guidance. Gaps include weakness in the assessment of competencies of trainees, in supportive supervision, and in impact assessment of packages. Many packages represent individual programme efforts rather than national programme materials, which could reflect weak integration into national health systems.ConclusionsThere is a wealth of training packages on SR/MNCAH for CHWs which reflects interest in strengthening the capacity of CHWs. This offers an opportunity for governments and partners to mount a synergistic response to address the gaps and ensure an evidence-based comprehensive package of interventions to be delivered by CHWs. Packages with defined competencies and methods for assessing competencies and supervision are considered best practices but remain a gap.

Access to Adolescent Pregnancy Prevention Information and Services in Ghana: A Community-Based Case-Control Study

“…Not different from previous studies [e.g., Maravilla et al (53)], non-pregnant adolescents in the current study were more likely to have access to pregnancy prevention information from health facilities and health workers compared to pregnant adolescents. Available literature has shown that health workers are effective in the provision of community health information to both young and old people on SRH issues to develop not only adolescent reproductive health but also a wider range of maternal and child health issues (67)(68)(69). Similarly, although studies have shown that adolescents feel ashamed going to these health centers for information or services relating to sex and contraception due the perception of unwelcoming attitude at the facility (70,71), there is evidence that delivering quality services that are tailored to adolescents needs (e.g., extension in operation hours, reduction in prices of SRH services, transforming physical design to promote privacy or confidentiality) may result in an improvement in service use, adherence to contraceptive methods, and increase the probability of seeking on-going health care (1,72).…”

Linking communities to formal health care providers through village health teams in rural Uganda: lessons from linking social capital

“…Although there is a significant reference in the literature that VHTs and CHWs in general, serve to “link”, “connect” and “bridge” communities with formal health care providers [4, 5, 9, 11, 22–24], empirical evidence on how that should materialise remain scanty. In what they describe as the “determinants of the success of community health worker programs”, Haines et al identify factors that determine the success of a CHWs programme to include socio-economic and political, health systems, community and international factors ([5], p. 2125).…”

“…Studies elsewhere equally demonstrate that CHWs have positive effects on health because they act as “entry points”, “links”, “bridges” or “connectors” between communities and formal health care services, systems and resources [4, 5, 18–21]. However, some reviews that counter such claims suggest that CHWs “have suffered from poor integration into the broader health system” and that they are not a solution to weak health systems [22]. Such reviews have tended to base their evidence on factors such as high levels of attrition, lack of motivation and poor incentives for CHWs [23–25].…”

Innovating home visiting to mothers and infants by community health workers: an action-oriented guide

“…So far, with few exceptions, reported evidence of these efforts is limited. 5 In Brazil, some interventions to improve the quality of CHWs' performance have been described for pre-natal care, 6 health problems of children under five years 7 and breastfeeding promotion. 8 Table 2 Main contents for each home visit recommended by the Guide for Innovative Home Visits to Pregnant Women and Infants up to nine (9) months.…”