Table 1 Summary of roles and tasks performed by CHWs in 29 national case studies [19]
From: Community health workers at the dawn of a new era: 5. Roles and tasks
Role | Examples of related tasks | Examples of CHW programmes where this is carried out |
|---|---|---|
Community mobilization | Build community awareness for immunization | BRAC’s Shasthya Shebikas mobilize mothers to bring their children to outreach sessions when visiting immunization teams come to the community India’s ASHA workers and Anganwadi workers promote awareness about and participation in national polio immunization days as part of the Global Polio Eradication Initiative CHWs across Africa promote awareness in child health days, at which time immunizations are provided, vitamin A and deworming medicines are given, and commodities such as bed nets are distributed |
Health promotion (including health education) | Promotion of healthy household behaviours | Ethiopia’s Women’s Development Army volunteers promote healthy household behaviours Pakistan’s LHWs provide nutrition education |
Family planning education: counselling about birth spacing, family planning, and contraceptives | Afghanistan’s CHWs offer a package of services including health promotion of family planning Bangladesh’s family welfare assistants (FWAs) and BRAC’s Shasthya Shebikas in Bangladesh promote family planning and provide information on how to access services | |
Promotion of ANC and PNC | BRAC’s Shasthya Shebikas in Bangladesh; Mozambique’s APEs, Sierra Leone’s CHWs, Zimbabwe’s CHWs | |
Promote the utilization of facility-based delivery | India’s ASHAs receive an incentive payment for bringing a woman to a facility for delivery | |
Nutrition education: counselling about infant and child feeding (including breastfeeding) | Anganwadi workers in India, Kaders in Indonesia, CHWs in Madagascar | |
Promotion of the importance of clean water, sanitation, and hygiene | CHVs in Kenya, CHWs in Sierra Leone | |
Provision of preventive services | Provision of vitamin A supplementation; oral polio immunization; injectable immunizations; deworming medication; and iron, folate and other vitamins | Shasthya Shebikas and Shasthya Kormis in Bangladesh provide vitamin A supplementation and deworming medication Malawi’s HSAs administer vitamin A supplementation and deworming medication, and they give immunizations as well Nepal’s FCHVs provide deworming medication, vitamin A supplementation, and polio immunization |
Distribute of condoms, insecticide-treated bed nets, oral rehydration salt (ORS) packets | ASCs [community health workers]) in Niger distribute insecticide-treated bed nets Health assistants in Bangladesh distribute ORS packets | |
Provision of clinical services | Identification of pregnant women and children with warning or danger signs for which treatment should be sought | CHOs in Ghana refer patients needing higher-level care and follow up on those patients who had been referred VHWs in Nigeria refer pregnant women to health facilities |
Management of childhood illness (identification of cases, management of uncomplicated cases, referral of cases with complications) | Integrated management of childhood illness is a common role across CHW programmes, including Ghana’s CHOs, Afghanistan’s CHWs, Niger’s ASCs, and Zimbabwe’s VHWs | |
Provision of ANC and PNC | Pakistan’s LHWs coordinate ANC/PNC services | |
Provision of basic curative services | Ethiopia’s HEWs provide basic curative services for selected illnesses, including support to people with chronic illness (e.g., HIV/AIDS patients) Zimbabwe’s CHAs provide basic curative care and refer patients to facilities for further treatment, documenting referrals in community health registers Iran’s Behvarzs and Moraghebe-salamats provide management of NCDs such as diabetes and hypertension as well as oral healthcare Programme assistants working with BRAC in Bangladesh evaluate people with eye problems and provide eyeglasses for older patients with presbyopia | |
Provision of clinical family planning services: provision of birth control pills, injectable contraceptives, and sometimes placing longer-acting contraceptives such as IUDs and subcutaneous implants | Ethiopia’s HEWs provide a full range of family planning services, including provision of longer-acting contraceptives Ghana’s CHOs provide maternal and reproductive health services as well as management of minor ailments | |
Identification of persons with symptoms of TB and referral for further evaluation (or collection of sputum for examination at a TB programme laboratory); provision of directly observed treatment for patients diagnosed with TB | Training packages in Afghanistan have expanded to provide DOT for TB Bangladesh’s Shasthya Shebikas identify suspected TB cases, collect sputum for diagnosis, and provide DOT to diagnosed patients Rwanda’s CHWs support diagnosis and treatment of TB patients | |
Provision of first aid for injuries/accidents | Kenya’s CHVs treat common ailments and minor injuries with guidance from the community health extension workers | |
Provision of mental health services | Afghanistan’s CHWs provide referral for mental health support, but they are trained to provide direct service provision for those with mental health problems and physical disabilities Indonesia’s Kaders are expanding their roles to include mental health counselling Iran’s Behvarzs and Moraghebe-salamats are trained to manage mental disorders Liberia’s CHAs are trained to identify mental health problems and to identify side effects of mental health medications | |
Epidemographic surveillance and record-keeping | Household visits for surveillance: maintaining health records and vital event registration, and surveillance of emerging diseases and of disease prevalence | Brazil’s CHAs maintain household registers and visit households monthly Guatemala’s mobile health teams maintain a community census and conduct epidemiological monitoring India’s ASHA workers carry out malaria case identification and screening for NCDs Sierra Leone’s CHWs carry out community-based disease surveillance, making quarterly household visits to promote preventive behaviours, and collect essential demographic information |