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Table 1 Recruitment and training for CHWs from 29 countries [21]

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

Country Name of CHW cadre Selection criteria and process Role and tasks performed Duration and nature of training
Afghanistan CHW Selected through a consultation process between the NGO staff and the community elders
18+ years of age (no upper age limit)
Respected by other community members
No educational requirement
Health promotion, iCCM, family planning counselling, provision of contraceptives, screen and treat TB (DOTS), first aid, maintain map of households in catchment area, report vital events, and send report to the national HIS 17 weeks (three separate 3-week classroom modules and two separate 1-month field experiences)
Bangladesh Shasthya shebika (BRAC [Building Resources Across Communities]) Identification of prospective service supervisors is made by the local Village Health and Development Committee; final selection is made by BRAC staff together with local village leaders and government officials
Women only
Age 25–40
Married with no children younger than 5 years
Motivated
Have at least 8 years of schooling
Does not live near a healthcare facility or a large bazaar
Health promotion, pregnancy identification, family planning, treatment of uncomplicated acute illnesses, referral for immunization, screen and treat TB (DOTS), screen for presbyopia and sell glasses, community mobilization 3 weeks of basic classroom training followed by refresher trainings lasting 1–3 days every few months
Shasthya kormi (BRAC) Preferably be a member of the BRAC local village organization
Respected in the community
Age 20–35
Married
Youngest child older than 2 years of age
Have at least 10 years of education
Not live near a local health facility or a large market
Supervise and support shasthya shebikas, provide ANC, assist with childbirth, provide newborn care, treatment for common illnesses, family planning, TB identification 2 weeks of classroom training followed by 2 weeks of field orientation and then 3 days of intensive residential training every 3 months for a 2-year period
Family welfare assistant (FWA) (government) Women only
Have at least 10 years of schooling
Visit homes of women of reproductive age every 2 months, family planning, counselling on sexual and reproductive healthcare and HIV/AIDS 21 days of classroom training followed by on-the-job training
Health assistant (HA) (government) Either male or female
Have at least 10 years of schooling
Provide immunizations and vitamin A supplementation, distribute ORS packets, detect and treat pneumonia, diarrhoea, malaria, and TB 21 days of training followed by on-the-job training
Community healthcare provider (CHCP) (government) Have at least 12 years of schooling
Local resident
Be able to operate a computer
Provide ANC and PNC, provide injectable contraceptives, conduct growth monitoring and nutrition education, treat minor ailments, health education and promotion 12 weeks
Brazil Agente comunitário de saúde (ACS) Selections are organized by municipalities
Selection based on written test results and personal interviews
Health promotion, provide prenatal, neonatal, and child care, manage infectious diseases, link patients in need to the formal health system, provide immunizations, visit each house monthly, community mobilization 30 weeks (1,200 h) of training in three phases: a formal didactic phase (20 weeks [800 h]), a field training phase (10 weeks [400 h]) and a second formal didactic phase
Ethiopia HEW At least 18 years of age
Have at least 10 years of schooling
Preferably living in or close to the community to be served
Provide iCCM, provide family planning services (including injectable contraceptives and forearm implants), screen and refer patients with symptoms of TB, provide DOTs, and follow-up TB cases, HIV/AIDS treatment, treat malaria, treat minor illnesses, give immunizations, health promotion and disease prevention, community mobilization, home visitation 1 year of pre-service training and in-service training every 2 year
Women’s Development Army (WDA) Adult woman
Preferably literate
Health promotion and disease prevention, support HEWs, community mobilization, serve as a role model for neighbours 52 h of training (2–3 days per week for 2–4 h per day), certificate of competency provided with successful completion of post-training assessment
Ghana Community health officer (CHO) Assigned by Ghana health service managers Health education, iCCM, provide maternal, reproductive, neonatal and child healthcare, manage minor ailments 2 years (both didactic and field training)
Community-based health planning and services (CHPS) CHV Nominated and approved by the community
Both men and women
Residence in the community
Can be trusted with confidential information
Volunteer spirit
Readiness to work under supervision
Honesty
Support CHOs with referrals, transport, community mobilization, disease surveillance, and health promotion 5 days
Guatemala Promotor de salud* Three different scenarios:
  Selected by a community leader
  Selected by health staff
  Inherited from a family member
Health promotion and disease prevention 3.5 weeks (140 h)
Guardianes de salud* Health promotion and disease prevention, identify patients in need of referral, maintain community census 2 h per month
India Auxiliary nurse midwife (ANM) (now called multipurpose workers-female) Hired by the district-level health administration
At least 12 years of school
Female
Age 17–35 years
Provide PHC, provide family planning and immunizations, screen and manage NCDs, provide elderly and palliative care 24 months followed by 3–6 weeks of skilled birth attendant training
Anganwadi worker (AWW) Selected by a committee of district and block-level officials
Female
Age 21–45 years
At least a middle-school education
Provide nutritional support to mothers and children; health education 3 months
Accredited social health activist (ASHA) Selected by the community
Female
At least 10 years of education
Age 25–45 years
Health promotion, home visits, household registration, promote birth at health facility, home-based newborn care 20 days within the first 18 months of joining followed by at least 15 days of additional training each year
Village health guide (VHG)* Politicized selection process Care of minor acute illness 3 months
Indonesia Kader Literate
Good spirit
Knowledgeable about the customs and habits of the local community
Local resident
Friendly and sympathetic
Accepted by the local community
Maternal and child healthcare, family planning, immunizations, growth monitoring of children and nutrition counselling Less than 1 week followed by on-the-job training given by more experienced kaders
Iran Behvarz (rural) A formal process led by a behvarz recruitment committee
A written examination and an interview
Qualifications required:
  A diploma degree
  Both men and women eligible
  A native of the service area
Maternal and child healthcare, detection and management of communicable diseases and NCDs, reproductive healthcare, oral healthcare, school healthcare, treatment of minor illnesses For those with no health background, 2 years made up of theoretical and practical coursework followed by clinical placements
For those with a health-related academic degree, 6 months
Moraghebe-salamat (urban) Selection by the district health centre following examinations
A native to the service area
A college degree
An academic degree in family health or midwifery
Maternal and child healthcare, detection and management of communicable diseases and NCDs, reproductive healthcare, oral healthcare, school healthcare, treatment of minor illnesses Similar to behvarz but shorter since they have a higher level of education
Kenya CHV Resident of the community
Has good character
Household registration and home visits, health education, iCCM, maternal and newborn care, community mobilization 13 modules split into two sections, taking around 3 months: 324 contact hours and 160 h of practical experience
Liberia Community health assistant (CHA) Permanent resident of the community
Age between 18 and 50 years of age
Fluency in the local dialect
Good mobilizer and communicator
Interest in health and development matters
Trustworthy and respected by the community
Physically, medically, mentally, and socially fit to provide the required services
Household registration and visitation, surveillance, provision of preventive, promotive, curative, rehabilitative, and palliative services, identification and management of cases of HIV, TB, neglected tropical diseases, and mental illness 8–11 days in four modules followed by several weeks of field experience
  Community health service supervisor (CHSS) Previous training as a healthcare professional such as a nurse, certified midwife, or physician's assistant or graduate of a school of public health Support and train CHAs, coordinate referrals, plan and coordinate outreach services 4 weeks
Madagascar Agent communautaire (AC) Elected in the village general assembly
From the local community
At least 18 years of age
Able to read and write
Have a sense of humanitarian conviction
Available, motivated, and willing to volunteer
Dynamic, sociable, and a good communicator
Honest
Both men and women are eligible
Visit homes, health promotion, participate in water, sanitation and hygiene activities, iCCM, provide family planning and TB screening 5–12 days
  Agents communautaires de nutrition (ACN) Visit homes of malnourished children, growth monitoring and nutrition education, treatment of acute malnutrition, referral of malnourished children, hold cooking demonstrations 10–15 days
Malawi CHW Recruited from the community
At least 19 years of age
Able to speak English and the local language
Have a minimum of a Malawi school certificate of education (MSCE)
Often selected by the community they serve
iCCM, immunization, follow-up of unimmunized children, nutrition promotion, management of acute malnutrition 12 weeks (2 months of classroom training followed by 1 month of field experience)
Mozambique Agent polivalente elementare (APE) Member of the community
Able to read, write, and speak in Portuguese and have basic numeracy skills
Priority is given to women and to communities that are farthest from health posts
Health promotion and disease prevention, diagnosis and treatment of common illnesses, malnutrition screening, deworming 18 weeks
Myanmar Auxiliary midwife (AMW) Women only
Living in a village without health facility or health staff
Interest in health and social work
Desire to stay and serve in the village after the training
Middle school education
In good health
No more than 30 years of age
Recommended by the local midwife and/or the village leader
Health education, ANC, home delivery, maternal and child healthcare, immunization, promotion of sanitation, detect and report epidemic outbreaks 6 months (3 months of theory and 3 months of practice)
CHW Interested in delivering healthcare and messages to the rural community
Preferably younger than 35 years of age
At least a middle-school education
Ability to read and write the Burmese language and speak the local dialect
Living in a rural area where there is no health facility
Health education, sanitation, detect epidemic outbreaks, immunization 28 days
Malaria volunteer Able to read and write
At least primary-school level of education
Recommended by the village health committee
Living in a hard-to-reach, malaria-endemic village without basic health staff
Not too young or too old
Interested in volunteer work
Diagnose and treat malaria, health education, screen for other infectious diseases 6 days
TB volunteer Selected by basic health staff and township medical officer in collaboration with the community TB screening, sputum collection and transport, accompany suspected patients for diagnosis, provide follow-up treatment support 4 days
Nepal Female community health volunteer (FCHV) Women aged 25–45 who are married and have children
Preference given to those who are literate and living in the local community
Health education, counselling for birth preparedness, newborn care, family planning, help with outreach/immunization clinics, help with referrals to a health facility 18 days (in two phases of 9 days each)
Niger Agent de santé communautaire (ASC) At least a primary-school education
Most are males
Home visits, iCCM, basic PHC, provide immunizations, provide vitamin A and ITNs 6 months with additional training following deployment
Relais volunteer Respected by community elders
Both males and females are eligible
Support ACSs, home visits Not standardized, variable in length (usually just a few days)
Nigeria Volunteer village health worker (VVHW) and community-directed distributor (CDD) Chosen by co-villagers Participate in community mapping and community census; health promotion, identify pregnant women and refer them for prenatal care, promote use of ITNs and preventive malaria treatment for pregnant women, diagnose and treat malaria, treat diarrhoea and pneumonia, collect and distribute medicines to the community for onchocerciasis and other priority diseases Training may take place in the afternoon for a few hours over the course of several weeks
Community health extension worker (CHEW) Formalized recruitment process
Local government health department consults with community leaders
Some secondary education required
Resident in the local government area (not necessarily the village of service)
Follow standing orders (algorithms for clinical care) for their treatment of patients at the health facility where they are based 3 years, in formal residential school
Pakistan Lady health worker (LHW) Woman
At least 8 years of education
Between 18 and 50 years of age
Resident of the area
Accepted by and recommended by the community they would serve
Preferably married
Willing to work away from home
Selection process: LHW posts are advertised; applicants are then interviewed and selected based on the above criteria by a selection committee; be recommended by a local elected official, and provide a written affidavit; then formally appointed by the district health officer
Promote and provide family planning services, ANC, treat illnesses (such as diarrhoea, malaria, pneumonia) and refer more serious cases, deworming of children, treat TB patients with DOTS 15 months in two phases: first phase consists of 3 months of classroom training; second phase consists of on-the-job training for 12 months (3 weeks of field work followed by 1 week of training per month), and 15 days of refresher training each year
Rwanda Binôme Selected by the community
Criteria:
Between 20 and 50 years of age
At least a primary school education
Willing to volunteer
Resident of the village
Honest, reliable, and trustworthy
Visit all households regularly, health promotion, iCCM, maternal and neonatal care, diagnosis and treatment of malaria, promote family planning and provide contraceptives, treatment of HIV and TB (DOTS), management of NCDs 3 months (on average, but not well standardized)
Animatrice de santé maternelle (ASM) Female
Otherwise same as above
Visit all households regularly, health promotion, identify pregnant women and refer them for ANC and facility delivery, provide PNC and newborn care, visit pregnant women for birth preparedness, provide family planning services, screen children for malnutrition 3 months (on average, but not well standardized)
Sierra Leone CHW Selected jointly by the local community governance structure and the peripheral health unit
Permanent resident of the community
No minimum educational requirement
iCCM, disease surveillance, basic reproductive, maternal, neonatal and child care 24 days follows by 1 month of field practice
South Africa Ward-based primary healthcare outreach team (WBPHCOT) member Either male or female
18 years of age or older
Priority given to those who are currently working as a community-based worker in another programme
Residency in the community being served is preferred
At least 12 years of schooling required
Able to work flexible hours
Mobile and able to undertake visits
Legally cleared to work with children and older persons
Health promotion and disease prevention, screening and referral, rehabilitative and palliative care 1 year
Tanzania CHW The village health committee (VHC) manages the CHW nomination process
At least 18 years of age
At least a secondary school education with a pass in biology
Nominated by the VHC
Online application and nomination
Community mobilization, health promotion and education, identify danger signs in pregnant women and neonates and refer them for care, treat diarrhoea and pneumonia, promotion and provision of family planning services, support HIV and TB patients, provide first aid, identify mental disorders, early response and management of disease outbreaks 1 year
Thailand Village health volunteer (VHV) At least 18 years of age
Living in the community for at least the past 6 months
Literate (but no formal education requirement)
Has good interpersonal relationships
Generous
Has at least one job
Health education and promotion (nutrition, basic medical care, sanitation and clean water, maternal and child health and family planning, immunizations, dental health, mental health, HIV prevention and control 43 h of classroom work with ongoing in-service training
Uganda Village health team (VHT) Selected by community members and local leaders
Respected and trustworthy, good listener, dependable, approachable
Preferably previous experience in volunteering
At least 18 years of age
Able to read and write and speak the local language
Be a good communicator and community mobilizer
Home visits, health education and promotion, promote good nutritional practices and safe water use, promote utilization of maternal and child health services and family planning, treat childhood malaria, pneumonia, and diarrhoea, and support drug distribution for endemic diseases 5 days (+ an additional 6 days for those who learn iCCM
Zambia Community Health Assistant (CHA) Completion of 12 years of school and 2 “O” levels (one should be in English)
18–38 years of age
Living in the recruitment catchment area for at least 6 months
Endorsed by the Neighbourhood Health Committee and traditional leaders
Passed a personal interview with a panel of Neighbourhood Health Committee members, health centre staff, and a member of the district health office
Have previous experience with community health work
Health education and promotion, provision of basic curative services at a health post, iCCM, mental health counselling, pregnancy and HIV testing, promote family planning and provide oral contraceptives, take blood pressure to identify patients with hypertension, measure urine glucose to identify patients with diabetes, provide first aid and palliative care, identify disease outbreaks, promote use of ITNs, promote clean water, water purification, latrines (and support community-led total sanitation efforts), and food hygiene, identify patients in need of referral, provide deworming medicine, provide immunizations, map the catchment area 1 year (36 weeks of formal classroom training followed by 16 weeks of field training)
Zimbabwe Village heath worker (VHW) At least 25 years of age
Married resident of the village
Able to read and write
Possesses strong communication skills
Respected in the community
Interested in health and development issues
Willing to work in the community on a volunteer basis
Able to keep personal health information confidential
Health promotion and prevention, promote immunizations and support immunization campaigns, provide DOTS for TB patients, provision of basic curative services, support patients with chronic conditions, malaria prophylaxis for pregnant women and children, growth monitoring, promote HIV voluntary counselling and testing 5 months
  1. All of the information in this table has been abstracted from the 2020 book, Health for the People [34]. Each of the 29 case studies in this book has a section on selection and training of CHWs. All of the CHW cadres described here are working in the public sector except for the shasthya shebikas and shasthya kormis in Bangladesh, who work under the auspices of an NGO, BRAC, and operate independently of—though in cooperation and in collaboration with—the public sector. The CHWs in Afghanistan are trained and hired by NGOs who receive government contracts that are set the guidelines for their training. Similarly, the nutrition CHWs in Madagascar, agents communautaires de nutrition (ACNs), work for NGOs who are contracted by the government. The book does not provide detailed or consistent information about the process of selection of CHWs. Further details about the roles and tasks of each CHW cadre as well as further information about how the cases were selected can be obtained from the book, which is available at: https://pdf.usaid.gov/pdf_docs/PA00WKKN.pdf
  2. ANC antenatal care, CHV community health volunteer, DOTS directly observed therapy, short course (for TB), HEW health extension worker, HIS health information system, iCCM integrated community case management (of childhood illness), ITN insecticide-treated bed net, NGO nongovernmental organization, NCDs noncommunicable diseases, ORS oral rehydration salts, PHC primary healthcare, PNC postnatal care
  3. *not currently functioning