Table. 3 Categorization of CHW types
Type of CHW | Recruitment | Duration of pre-service training | Place(s) of work | Employment status | Time commitment | Notes |
|---|---|---|---|---|---|---|
Auxiliary health worker | Not necessarily local | > 1 year | Health post (± some outreach) | Salaried (often civil service, may be transferable to other locations) | Full-time | Examples: Auxiliary nurse-midwives (ANMs) in India and Nepal, lady health visitors in Pakistan, community health extension workers in Nigeria, public health midwives in Sri Lanka, and enrolled nurses in various PHC systems Typically 2 academic years of pre-service training although some are longer, e.g., Nigeria’s community health extension workers) [51]. Commonly hired through some unit of local government or through the state or national civil service structure. Because most health workers in this category are not required to be locally hired, they tend not to be “embedded” in the community to the same degree as other types of workers more commonly labelled CHWs |
Health extension worker | Local, generally at least primary-level education required | ~ 1.5–12 months, provided post recruitment | Health post, usually with significant outreach Some, with home visitation | Salaried or equivalent | Full-time | Examples: Bangladesh’s family welfare assistants and health assistants and Malawi’s HSAs. Ethiopia’s HEWs fall at the dividing line between this category and auxiliary health workers (as secondary school graduates, given 1 year of pre-service training following their recruitment) Most such programmes initially intended that the CHW spend most of her/his time outside the walls of a formal structure; however, in many programmes, CHWs have gravitated towards providing most services from a health post, subcentre, or dispensary. Salaries may be approximately equivalent to government primary school teachers or a little less |
Community health volunteer | Local | A few days to a few weeks | Own home, beneficiary’s home | Non-salaried, may or may not receive financial (or other material) incentives | Occasional to regular part-time | Examples: Niger’s relais, Ethiopia’s Women’s Health Development Army, Nepal’s FCHVs Includes a spectrum, by level of time commitment, which we divide into 1) “regular”, usually with at least some activity every week but not full-time, and given up to several weeks of initial training, as well as continuing short episodes of in-service training; and 2) “occasional” or episodic volunteers, having relatively light, intermittent commitment, and given minimal training |