Table 1

CHW programmes in Cambodia and Tanzania

CharacteristicsCambodia70 71Tanzania29WHO recommendation70
Healthcare workers per populationDoctors/10 000=1.4
Nurses and midwives/10 000=9.5
CHWs/1000 population=0.1
Doctors/10 000=0.3
Nurses and midwives/10 000=4.4
Doctors/10 000≥9
Nurses/10 000≥19
CHWs/10 000≥25
Current health expenditure (% of GDP)307.51%3.75%World average=10.89%
Total number of CHWs2800–3500 VMWs and MMWs16 23 (CHWs specifically trained and deployed for malaria)12 000–17 00029 72
Population17 million64 million
Population density76 per km296 per km2
Area181 035 km²945 087 km²
Healthcare facilitiesCambodia’s public healthcare system consists of a network of 34 national and provincial-municipal level hospitals, 92 operational district referral hospitals, 1222 healthcare centres and 128 healthcare posts738549 healthcare facilities.74 A total of 336 hospitals. Among regions, Dar es Salaam has the largest concentration of hospitals, 53 institutions. The Mwanza and Kilimanjaro regions followed, each with 21 and 20 hospitals, respectively.75
Universal healthcare coverage by social insurance30%7615%–32%77 78
Roles and responsibilitiesFocused on malaria. Cover entire responsibilities related to malaria.11 23 CHWs for malaria are referred to as VMWs and MMWs and are provided with diagnostics and antimalarials. VMWs and MMWs diagnose malaria using RDTs and provide antimalarials if they are non-severe, refer severe and complicated cases of malaria to healthcare centre, report monthly cases and participate in malaria prevention activities. VMWs/MMWs receive case-based incentives.
Village support health group are parallel CHWs for all other health conditions.
Focus on maternal and child health (diarrhoea, pneumonia and malaria), health promotion (nutrition, sanitation and hygiene).29 33 Other may be recruited for vertical programmes such as HIV home-based care, onchocerciasis and lymphatic filariasis elimination programme and trachoma disease.
There are no malaria-specific CHWs. The CHWs are largely responsible for offering advice to all diseases. CHWs mainly offer health education, identify the diseases, refer them to the dispensaries (primary healthcare services) and provide follow-ups. NMCP in support with GFATM and PMI has planned to initiate a community case management (by CHWs) in some priority regions and is being planned to be implemented in selected regions.
  • CHW, community health worker; GDP, Gross Domestic Product; GFATM, Global Fund to Fight Acquired Immune Deficiency Disease Syndrome (AIDS), Tuberculosis and Malaria; MMWs, mobile malaria workers; NMCP, National Malaria Control Programme; PMI, President’s Malaria Initiative; RDT, rapid diagnostic test.