Table 2

Community health worker (CHW) programme design and implementation issues to be considered in policy development

Design issuesImplementation issuesKey questions for policy development (from Perry et al6 2014, chapters 8–11)
Recruitment:
  • Align job requirements with job descriptions and skills profile across all cadres.

  • Explore whether there is a pool of people eager to become CHWs and what motivates them.

  • Ensure recruitment processes are transparent, well-thought through and clearly communicated.

Recruitment:
  • The recruitment process and criteria are clearly communicated and understood by communities and pool of potential applicants.

  • Relevant community structures are involved in recruitment and selection.

  • Recruitment criteria and processes are adhered to.

  • What are the specific recruitment needs for the CHW programme?

  • What are the CHW selection criteria?

  • What is the CHW recruitment process?

  • How do available resources influence CHW recruitment?

Training:
  • Initial and continuing education frameworks, structures and processes are put in place.

  • Relevant and appropriate training materials are developed in the local language.

  • Issues of certification and accreditation are attended to.

Training:
  • Trainers and training materials are available (in the relevant local language).

  • Training is adapted to the needs of trainees locally, their roles and local contexts.

  • Trainees are able to attend training.

  • There are opportunities for continuing education.

  • What sort of CHW and training programme is being planned?

  • What level of education will be required for entry to the programme?

  • How should the training programme be organised?

  • Who should be responsible for the governance and management of the training programme?

  • How can optimal performance be achieved through training?

Supervision and support:
  • Supervisions requirements are adequately understood and resourced.

  • Supervisors are identified and designated.

Supervision and support:
  • Supervisors are available, trained and aware of their responsibilities.

  • Supervisors have the relevant tools, equipment, infrastructure (eg, transport) and support to fulfil their role.

  • Supervision is considered a priority.

  • What are the objectives of CHW supervision?

  • Is there a functioning PHC supervision system and can it be adapted/expanded to include CHWs?

  • Are there supervision standards and guidelines for CHW performance?

  • Do the financial resources exist to sustain a CHW supervision system?

Incentives:
  • Incentive structure and mix have been discussed and planned for.

  • Adequate resources for incentives are in place.

  • Mechanisms to make incentives available are in place, whether for financial payments or non-financial incentives.

  • Formalised remuneration.

Incentives:
  • Incentives are understood and accepted by local stakeholders and CHWs.

  • Incentives (whether monetary or other) are regularly, reliably and fairly disbursed.

  • There is no nepotism or corruption in the handling of incentives.

  • Inclusion in the payroll.

  • What forms of incentives are there?

  • What are the decisions related to incentives that need to be made?

  • What incentives are culturally, socially and financially acceptable among CHWs?

  • What are different stakeholders’ expectations with regard to incentives?

Career pathways:
  • If possible, career paths for different cadres of CHWs are developed to allow for advancement and progression (and thus improving retention).

  • Agreements between the government, Ministry of Health, professional regulatory bodies and training institutions have been put in place.

  • PHC, Primary Health Care.