Health workforce

Online public hearing to help inform the scope of the forthcoming WHO guidelines on health policy and system support to optimize community based health worker programmes

Consultation deadline: 31 August 2016

Background

In the last few years, there has been growing interest and attention in the potential of various types of community health workers (CHWs) in reducing inequities in access to essential health services, particularly in under-served or excluded, vulnerable populations. The WHO Global Strategy on HRH: Workforce 2030 encourages countries to adopt a diverse, sustainable skills mix, harnessing the potential of community-based and mid-level health workers in inter-professional primary care teams.

Several systematic reviews and other studies have demonstrated the effectiveness of various types of CHWs in delivering a range of preventive, promotive and curative services related to reproductive, maternal, newborn and child health, i,ii,iii infectious diseases, iv non-communicable diseases,v,vi and neglected tropical diseases.vii In parallel, other systematic reviews have identified the most effective policy approaches for a successful integration of health workers in health systems: these include, among others, providing CHWs with predictable financial and non-financial incentives, frequent supervision, continuous training, embedment of CHWs in health systems, with clear roles and communication channels for CHWs.viii,ix,x,xi There is also significant evidence through systematic reviews and economic evaluations that delivering essential health services through CHWs may represent a cost-effective approach in some contexts.xii,xiii

Rationale

The support for community health workers and their integration into the health system, however, remain uneven across and within countries. This is hindering the full realization of their potential contribution to the implementation of health policies based on primary health care.

Although they should be considered as an integral part of the health system, CHW programmes are often fraught with challenges, including: poor planning; unclear roles and education pathways; multiple competing actors with little coordination; fragmented, disease-specific training; donor-driven management and funding; tenuous linkage with the health system; poor coordination, supervision, quality control and support; and under-recognition of CHWs’ contribution. These challenges can contribute to wastage of both human capital and financial resources: many well-intentioned and performing CHW initiatives fail to be properly integrated in health systems, and remain pilot projects or small scale initiatives that are excessively reliant on donor funding.

Existing WHO guidelines encourage the delegation of certain tasks relating to prevention, diagnosis, treatment and care, for example for HIV, and a range of reproductive, maternal, newborn and child health services. However, successful implementation of these recommendations requires an evidence-based model for educating, deploying, remunerating and managing CHWs to optimize their performance and contribution to the health system across various health service areas.

Scope of the guidelines and objective of the consultation

WHO has therefore decided to develop guidelines to assist national governments, as well as national and international partners, to improve the design, implementation, performance and evaluation of CHW programmes, contributing to the attainment of universal health coverage and the health SDG targets.

WHO guidelines are based on a rigorous and impartial process to assess the evidence to respond to priority policy questions. Defining the scope of the guidelines therefore entails identifying the most relevant and significant policy issues, and translating them into research questions – structured according to the Population, Intervention, Control, Outcome (PICO) framework . Evidence will be then collected and synthesized through systematic reviews to answer the research questions identified. Through this consultation, we are asking you to assist in the identification of policy issues and research questions to define the scope of the guidelines. This consultation is open to everyone, and inputs will be accepted until 31st August 2016. Consolidated / collective submissions are highly encouraged.

The primary target audience for these guidelines will be policy-makers, planners and managers responsible for health workforce policy and planning at national and local levels that rely on CHWs for the delivery of health services. Secondary target audiences include development partners, funding agencies, global health initiatives, donor contractors, NGOs and activists who fund, support, implement, and/ or advocate for the greater and more efficient involvement of CHWs in the delivery of health services.
Secondary target audiences include development partners, funding agencies, global health initiatives, donor contractors, NGOs and activists who fund, support, implement, and/ or advocate for the greater and more efficient involvement of CHWs in the delivery of health services.

How your inputs will be used

The Guideline Development Group (GDG) , which includes health workforce and CHW experts from the academia and research community, as well as end-users of the guidelines from Government and other constituencies, has the role of finalizing the scope of the guidelines and prioritizing and refining the key questions in the PICO format. The results of this online consultation will be consolidated by the WHO Secretariat and presented to the first meeting of the Guideline Development Group to inform its proceedings and deliberations.

References


i Gilmore B, McAuliffe E. Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review. BMC Public Health. 2013;13(1):847. PubMed PMID: doi:10.1186/1471-2458-13-847
iiGlenton C, Scheel IB, Lewin S, Swingler GH. Can lay health workers increase the uptake of childhood immunisation? Systematic review and typology. Tropical Medicine & International Health. 2011;16(9):1044-53
iiiLewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database of Systematic Reviews. 2010;3
ivMwai GW, Mburu G, Torpey K, Frost P, Ford N, Seeley J. Role and outcomes of community health workers in HIV care in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2013 Sep 10;16:18586
vvan Ginneken N, Tharyan P, Lewin S, Rao GN, Meera S, Pian J, et al. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database of Systematic Reviews. 2013;11
viRaphael JL, Rueda A, Lion KC, Giordano TP. The role of lay health workers in pediatric chronic disease: a systematic review. Acad Pediatr. 2013 Sep-Oct;13(5):408-20
viiVouking MZ, Takougang I, Mbam LM, Mbuagbaw L, Tadenfok CN, Tamo CV The contribution of community health workers to the control of Buruli ulcer in the Ngoantet area, Cameroon. Pan Afr Med J. 2013 Oct 22;16:63
viiiGlobal Health Workforce Alliance (2010). Global Experience of Community Health Workers for Delivery of Health Related Millennium Development Goals - A Systematic Review, Country Case Studies, and Recommendations for Integration into National Health Systems. Geneva, Switzerland. http://www.who.int/workforcealliance/knowledge/themes/community/en/index.html Accessed 10 March 2016
ixPerry H, Zulliger R. How effective are community health workers? An overview of current evidence with recommendations for strengthening community health worker programs to accelerate progress in achieving the health-related Millennium Development Goals. 2012.
xKok MC, Kane S, Tulloch O et al How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature. Health Res Policy Syst. 2015;13:13
xiKok MC, Dieleman M, Taegtmeyer M, Broerse JE, Kane SS, Ormel H, Tijm MM, de Koning KA Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review. Health Policy Plan. 2015 Nov;30(9):1207-27
xiiMcPake B, Edoka I, Witter S, Kielmann K, Taegtmeyer M, Dieleman M, Vaughan K, Gama E, Kok M, Datiko D, Otiso L, Ahmed R, Squires N, Suraratdecha C, Cometto G. Cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya.. Bull World Health Organ. 2015 Sep 1;93(9):631-639 xiiiVaughan K, Kok MC, Witter S, Dieleman M Costs and cost-effectiveness of community health workers: evidence from a literature review. Hum Resour Health. 2015 Sep 1;13:71
xivTulenko K et al. Community health workers for universal health-care coverage: from fragmentation to synergy Bulletin of the World Health Organization 2013;91:847-852

Results of the online public consultation