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Introduction Community health workers (CHWs) are increasingly being tasked to prevent and manage cardiovascular disease (CVD) and its risk factors in underserved populations in low-income and middle
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-income countries (LMICs); however, little is known about the required training necessary for them to accomplish their role. This review aimed to evaluate the training of CHWs for the prevention and management of CVD and its risk factors in LMICs.
Methods A search strategy was developed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and five electronic databases (Medline, Global Health, ERIC, EMBASE and CINAHL) were searched to identify peer-reviewed studies published until December 2016 on the training of CHWs for prevention or control of CVD and its risk factors in LMICs. Study characteristics were extracted using a Microsoft Excel spreadsheet and quality assessed using Effective Public Health Practice Project’s Quality Assessment Tool. The search, data extraction and quality assessment were performed independently by two researchers.
Results The search generated 928 articles of which 8 were included in the review. One study was a randomised controlled trial, while the remaining were before–after intervention studies. The training methods included classroom lectures, interactive lessons, e-learning and online support and group discussions or a mix of two or more. All the studies showed improved knowledge level post-training, and two studies demonstrated knowledge retention 6 months after the intervention.
Conclusion The results of the eight included studies suggest that CHWs can be trained effectively for CVD prevention and management. However, the effectiveness of CHW trainings would likely vary depending on context given the differences between studies (eg, CHW demographics, settings and training programmes) and the weak quality of six of the eight studies. Well-conducted mixed-methods studies are needed to provide reliable evidence about the effectiveness and cost-effectiveness of training programmes for CHWs.
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The main goal of the National Health Plan (NHP) 2017-2021 is to extend access to a basic Essential Package of Health Services (EPHS) to the entire population while increasing financial protection. In order to extend service delivery to all communities, the NHP calls for all health
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workers (whether community-based, outreach-based or facility-based) involved in the delivery of health promotion, prevention and treatment services to be fully recognised and institutionalized within the health system to ensure efficient use of resources, necessary oversight and quality service provision (regardless of whether the health workers are voluntary or salaried). The first year Annual Operational Plan (AOP) of the NHP 2017-2021 calls for a comprehensive literature review of the situation of all Village Based Health Workers (VBHWs) in the country to inform the development of a comprehensive, institutionalized approach to community health for the country.
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Integrated community case management (ICCM) – an approach where community-based health workers are trained to identify, treat and refer children
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under-five with pneumonia, diarrhoea and malaria – is increasingly being used across sub-Saharan Africa to supplement the gaps in basic healthcare provision. ICCM programmes have been endorsed by major international organisations and donors, and many African Ministries of Health as a key strategy for reducing child mortality.
This learning paper describes Malaria Consortium’s approach to and experience of engaging local communities in integrated community case management (ICCM) in Uganda, Zambia and Mozambique.
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a training course for community health workers, adaptation for high HIV or TB settings: chart booklet
Community-based strategies play a significant role in many health systems in low- and middle-income countries, especially in light of critical shortages in the health workforce. The term community h
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ealth worker has been used to refer to volunteers and salaried, professional or lay health workers with a wide range of training, experience, scope of practice and integration in health systems. In the context of this study, we use the term community-based practitioner (CBPs) to reflect the diverse nature of these cadres of health workers.
CBPs provide preventive, promotive, curative and palliative services across a range of areas, including reproductive, maternal, newborn and child health, HIV, tuberculosis, malaria, control of other endemic diseases, and noncommunicable diseases. Significant evidence has emerged over the past two decades on their effectiveness, which has triggered interest in the potential to use their services to expand access to care, in particular in rural and underserved areas where deployment and retention of more qualified health workers is problematic. Calls have been made to integrate CBP programmes in human resources and health strategies, and to scale up rapidly the extent and coverage of CBP initiatives.
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The harmonized training package for Point-of-use-fortification using micronutrient powders has been developed to guide in training frontline health workers. The micronutrient powders will be distributed at the health facilities where instructions on
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use will be provided by Health Care Providers. Community Health Volunteers will educate, counsel, and mobilize caregivers at the community level to visit health facilities for nutrition assessment and provision of the micronutrient powders.
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Objective To assess the effectiveness of a community-based tuberculosis and leprosy intervention in which village health teams and health workers conduct door-to-door tuberculosis screening, targete
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d screenings and contact tracing.
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Key considerations for the implementation of Community Care Centres
World Health Organization
(2014)
Community Care Centres (CCCs) are small facilities (10 beds maximum), located within the community and run by community health
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workers. CCCs provide isolation facilities for Ebola patients in order to prevent further transmission of the virus within their households and communities. People with Ebola virus can also receive basic curative and palliative care in these centres in an environment supported by their family and communities. This document describes key principles and main considerations for implementation of a community approach.
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Manual for the care and management of patients in Ebola Care Units/ Community Care Centres - Interim emergency guidance, January 2015
recommended
World Health Organization
(2015)
This manual provides guidance on best practices to be followed in Ebola Care Units (ECUs)/Community Care Centres (CCCs). It is intended for health aid workers (including junior nurses and
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community health-care workers) and others providing care for patients in ECUs/CCCs. While the focus is on the care and management of patients with Ebola Virus Disease (EVD), the care of patients with other causes of fever is also described.
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This learning paper describes Malaria Consortium’s experience with Integrated Community Case Management (ICCM) in malaria prevention and treatment in Mozambique and Uganda. ICCM is an approach where com
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munity-based health workers are trained to identify, treat, and refer complex cases malaria (and other diseases) in children
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A book of methods, aids, and ideas for instructors at the village level
An indispensable resource for health educators, this book provides hundreds of methods, aids, and learning strategies to make health education engaging and effective, encouraging com
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munity involvement through participatory education.
You can download chapter by chapter free of charge
The previous version (2005) is freely available here
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2nd edition. Known as “Community Case Management of Sick Children” (CCM), this approach sends community-based health workers out to find, diagn
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ose, and successfully treat sick children, in partnership with their families. Inspired by the classic “Immunization Essentials”, this guide methodically documents what is known about CCM and how to make it work. First, health program managers are introduced to the basics. Then, CCM Essentials walks its readers through the process of designing and managing a high-quality CCM program. The ultimate result: lives of newborns, infants and children saved around the world
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WHO guideline on health policy and system support to optimize community health worker programmes
recommended
The guideline uses state-of-the-art evidence to identify effective policy options to strengthen community health worker (CHW) programme performance through their proper integration in health systems and communities.
Successful delivery of services
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through CHWs requires evidence-based models for education, deployment and management of these health workers. The guideline is intended as a tool for national policy makers and planners and their international partners to use in the design, implementation, performance and evaluation of effective community health worker programmes. It contains pragmatic recommendations on selection, training and certification; management and supervision: and integration into health systems and community engagement.
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As the global community aims to fulfill its commitments to the UN Sustainable Development Goals, and the achievement of universal health coverage, dozens of countries have committed to the expansion of com
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munity health workers (CHWs) as the front line of their healthcare systems [1, 2]. Robust research demonstrates CHWs improve access to care, reduce maternal, newborn, and child mortality, improve clinical outcomes for chronic diseases, and prevent disease outbreaks [3].
To support the operationalization of quality CHW program design and implementation, USAID, UNICEF, the Community Health Impact Coalition, and Initiatives Inc. have updated and adapted the Community Health Worker Assessment and Improvement Matrix (CHW AIM) Program Functionality Matrix [12]. This tool can be used to identify design and implementation gaps in both small- and national-scale CHW programs, and close gaps in policy and practice.
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The Community Health Systems (CHS) Catalog is a resource that provides information on community health program workers, and interventions for the
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25 countries deemed priority by USAID’s Of of Population and Reproductive Health. It comprises a compilation of 25 country profiles developed from a desk review of community health policies, strategies, a related documentation.
This document summarizes country trends drawn from the CHS Catalog and highlights interesting and relevant findings
about the global community health policy landscape.
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WHO supports countries in their efforts to: address these structural barriers, ensure human rights for sex workers, and to implement a comprehensive package of HIV and other STI services through community
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-led approaches.
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This policy will serve as a cornerstone from which to address the accessibility of Community Health (CH) services and to encourage its integration with services for HIV/AIDS, maternal and child health, and other development initiatives. This policy
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has been developed at an opportune moment, as Rwanda is embarking on the introduction of community-based provision of family planning and non-communicable disease (NCD) services through Community Health Workers (CHWs). These efforts are anticipated to trigger a paradigm change in the way community health services are provided and accessed in order to contribute towards a healthy and productive Rwanda for all.
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The Kabeho Mwana project (2006–2011) supported the Rwanda Ministry of Health (MOH) in scaling up integrated community case management (iCCM) of childhood illness in 6 of Rwanda’s 30 districts. The project trained and equipped
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community health workers (CHWs) according to national guidelines. In project districts, Kabeho Mwana staff also trained CHWs to conduct household-level health promotion and established supervision and reporting mechanisms through CHW peer support groups (PSGs) and quality improvement systems. The iCCM model implemented by Kabeho Mwana resulted in greater improvements in care-seeking than those seen in the rest of the country. Intensive monitoring, collaborative supervision, community mobilization, and CHW PSGs contributed to this success. The PSGs were a unique contribution of the project, playing a critical role in improving care-seeking in project districts. Effective implementation of iCCM should therefore include CHW management and social support mechanisms. Finally, re-analysis of national survey data improved evaluation findings by providing impact estimates.
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Community health nurses have the potential to make significant contributions to meet the health care needs of various population groups in a variety of community settings. In order to assess the ext
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ent to which CHNs are achieving this potential, WHO conducted a study between 2010 and 2014 that examined the status of community health nursing in 22 countries, 13 of which were experiencing a critical shortage of health care workers. The study revealed that the countries surveyed had the basic and operational framework for optimizing CHN in their health systems as evidenced by the availability of PHC structures to guide interventions. However, challenges were identified related to the education, practice and management of CHNs in these countries. The major challenges identified were: Limited availability of career opportunities; poor worker retention; low recognition for CHNs; inadequate and unsupportive working conditions and environments; absence of educational standards; varying educational entry-level requirements for CHN programmes; and a lack of consensus on the scope of practice for CHNs.
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The Humanitarian Pandemic Preparedness (H2P) Initiative and its many partners have developed ready-to-use training curricula for district- and community-level leaders, and community volunteers and
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workers in order to minimize morbidity and mortality in the event of an influenza pandemic. The time to put these tools into action is now.
The curriculum has separate tracks for district/community leaders and for first responders (community volunteers and workers) at the community level.
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