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