To harness the potential of community health workers (CHWs) to extend health services to poor and marginalized populations and avoid the pitfalls of the post-Alma-Ata period, there is an urgent need to better understand how CHW programs can be optimized. Rigorous evidence that CHW care delivery can improve access to care and reduce mortality continues to accumulate, but the most recent evaluations of national-scale CHW programs remain unfavorable. CHWs can contribute to advancing universal health coverage, but only if they are set up for success via integration into well-designed and adequately funded health systems.
Six organizations – Integrate Health (previously Hope Through Health), Last Mile Health, Living Goods, Muso, Partners In Health, and Possible – have developed high-impact CHW programs with governments and communities across the globe. Understanding that several operational questions are unresolved by current academic evidence, they have come together to create a report identifying insights from their implementation experience.
The report was developed under the premise that enabling the development and implementation of high-performing CHW programs requires that design principles and operational guidelines be approached not as a universal “one-size-fits- all” prototype, but as a series of flexible tools. As a result, the document shares not simply how implementers have solved various delivery challenges, but the ways in which their environments have shaped their responses.
The comparison of the operational practice of these organizations has revealed several areas of alignment. The six implementing organizations have attempted to summarize these areas in a series of design principles that, in their experience, drive programmatic quality and are debated or not commonly found in programs across the globe.
These eight design elements represent, in the experience of these organizations, the minimum viable elements needed for CHWs to succeed.
Further articulating and universalizing an operationally specific quality standard demands a broader coalition. The authors commit to build on this initial body of work and propose the following key recommendations:
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New #CHWimpact report harnesses practitioner expertise to optimize Community Health Systems. #CHW can contribute to #UHC, #GlobalGoals but only if they are set up for success. Join the next steps at: www.CHWimpact.org #HealthForAll