Topic Area

Cross Country Synthesis

Exemplars in Global Health has identified community health worker (CHW) programs in Bangladesh, Brazil, Ethiopia, and Liberia as Exemplars. While each of these national programs is unique, they all share certain strategies and approaches that have helped them achieve and sustain high impact. Our research has identified their common pathways to success. 

Our evidence-based recommendations are intended to help other CHW programs achieve success at scale.

These recommendations do not aim to create a one-size-fits-all approach to designing CHW programs. Rather, they reflect our understanding that what makes CHW programming such a valuable tool is its flexibility to address the needs and context in which it is situated. There exist a variety of program models, each for a different setting, that optimize CHW effectiveness. But there are no ideal settings or programmatic models. In fact, our research indicates that adapting CHW programs to local contexts is critical. At the same time, there are certain policies and strategies that can help leaders design and develop effective CHW programs that suit specific context and address individual health priorities.

Leaders seeking to design or strengthen CHW programing to achieve optimal health outcomes should consider the following five universal recommendations. In this section, context-specific findings, which may – under certain circumstances – provide important guidance to improve program performance and health outcomes, can be found.

Our analysis of the four Exemplar community health worker (CHW) programs in Bangladesh, Brazil, Ethiopia, and Liberia illuminated a number of context-specific best practices that may provide guidance to leaders in similar situations seeking to design, launch, or strengthen CHW programming.

These findings may not be as universally applicable as the recommendations above. But they may still offer powerful guidance in many settings. 

The table below enables comparisons between the four Exemplar community health worker (CHW) programs on key characteristics, including:

  • Priority goals of CHW program
  • Relevant context
  • Key program features
  • Type of CHW cadres
  • Total CHWs and average population covered per CHW
  • Type of health services provided

Mobile phones, tablets, and other technical platforms are increasingly being used for training health workers, patient diagnosis, treatment, and referral, as well as to manage health data in frontline settings around the world.

In many geographies, these digital health tools are improving the delivery of quality healthcare and allowing CHWs to reach larger numbers of patients.

Best practices for when and how to use these tools are still emerging. None of the Exemplar CHW programs had, at the time of this research, fully implemented and assessed the performance of digital tools in their CHW programs, though some have begun using digital tools to improve training and service delivery (like the mobile learning management systems in Liberia and Bangladesh).

While each of the Exemplar community health worker (CHW) programs have maintained scaled impact, they continue to experience challenges. Common, recurring challenges are outlined below.

  • Financing
  • Implementation across all settings
  • Quality of care and productivity
  • Program management and consistent strategy
  • Job satisfaction, CHW selection, and retention

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Cross Country Synthesis Exemplars