The table below compares key characteristics of the four Exemplar community health worker (CHW) programs:
Program overviews
| Bangladesh | Brazil | Ethiopia | Liberia |
|---|---|---|---|
|
Increase coverage of key interventions requiring behavior change (family planning, use of oral rehydration therapy for treatment of childhood diarrhea, immunization, etc.) |
Ensure appropriate use of primary health care (PHC) services
Help population navigate health and welfare systems
Support healthy behaviors |
Increase geographic access to PHC services
Address high burden of preventable diseases |
Provide PHC services in remote and rural communities
Increase resilience of health system |
| Bangladesh | Brazil | Ethiopia | Liberia |
|---|---|---|---|
|
Health system with multiple actors and large private sector
Low government health expenditure per capita |
Significant health system reform to ensure universal access to healthcare, with focus on equity
High burden of non-communicable diseases |
Highly centralized, mostly public PHC system
Highly constrained human resources for health |
Post-Ebola epidemic, with a range of NGOs working in community health
Large rural population living in remote areas |
| Bangladesh | Brazil | Ethiopia | Liberia |
|---|---|---|---|
|
Diverse ecosystem of government and NGO CHWs, with different training and service packages
Mix of paid, full-time CHWs and part-time volunteer cadres with income-generation activities
Developing since the 1970s, to respond to evolving health priorities (e.g. family planning in the 1970s, child health in the 1980s, etc.)
BRAC is the largest NGO program in Bangladesh, with ~50 percent of all CHWs in country |
Full-time CHWs integrated into PHC teams in context of national PHC reform
Home visits and community activities to support demand for and utilization of PHC services, as well as uptake of other welfare services
Focus on maternal, newborn, and child health (MNCH) (e.g. ANC, immunization), chronic diseases (e.g. ensuring proper follow-up), identification of other family needs |
Full-time, female CHWs extending geographical reach of PHC services
12-month training (5-10x longer than other programs), with range of curative and prevention/promotion services
Services delivered both at community/homes and health posts
Manage Health Development Army Volunteers, ~three million women providing role model to peers on prevention/promotion practices |
Part-time CHWs providing curative and prevention/promotion services in hard-to- reach areas
Dedicated nurse supervises CHWs and provides link to facility-based PHC
Services provided at community and home level Program managed by government, in partnership with NGOs |
| Bangladesh | Brazil | Ethiopia | Liberia |
|---|---|---|---|
|
Government Cadres:
BRAC Cadres:
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Types of health services provided
| Bangladesh | Brazil | Ethiopia | Liberia |
|---|---|---|---|
|
Only CHCPs and SKs: treatment of pneumonia, diarrhea and malaria; TB DOTS; some CHCPs conduct safe deliveries |
None |
Only HEWs: treatment of pneumonia, diarrhea and malaria; TB DOTS; some HEWs conduct safe deliveries |
Treatment of pneumonia, |
| Bangladesh | Brazil | Ethiopia | Liberia |
|---|---|---|---|
|
Provide childhood illness education to mothers, nutrition, and water, sanitation and hygiene (WASH) education |
Check immunization cards and recommend appropriate immunization, design, organize, and deliver group education meetings and counseling for individuals with chronic disease, pregnant women and women with newborns, provide information on services available at PHC center and refer as needed |
Provide childhood illness education to mothers, nutrition and WASH education |
Provide childhood illness education to mothers, nutrition education |
| Bangladesh | Brazil | Ethiopia | Liberia |
|---|---|---|---|
|
Prevent neonatal sepsis, administer immunizations, identify and manage malnutrition, identify pregnant mothers, provide antenatal and postnatal care (ANC/PNC) - only CHCP/SK, preventive education on neglected tropical diseases (NTDS), non-communicable diseases (NCDs), HIV, tuberculosis (TB), and provide family planning (FP) distribution |
Identify risk factors in the home, measure blood pressure/glycemia, provide 1:1 counseling on cancer and other NCDs, HIV, TB healthy behaviors and FP, schedule ANC/PNC and general PHC appointments, follow up to ensure attendance and support and adherence to medication (e.g. for diabetes) |
Prevention of neonatal sepsis, administer immunizations, identify and manage malnutrition, identify pregnant mothers, provide ANC/PNC (only HEW), deliver preventive education on NTDS, NCDs, HIV, TB, and provide FP distribution |
Identify danger signs and provide referrals for pregnant women and children, identify pregnant mothers and provide them with referrals for ANC/PNC and facility-based deliveries, identify and manage malnutrition, vaccination dropout tracing, preventive education on NTDS, NCDs, HIV, TB, provide FP distribution, and basic first aid response |
| Bangladesh | Brazil | Ethiopia | Liberia |
|---|---|---|---|
|
National vitamin A, immunization and campaigns, family planning satellite mobile clinics |
Determine health needs, conduct advocacy, promote and mobilize on identified health needs |
Determine health needs, conduct advocacy, promote and mobilize on identified health needs |
Determine health needs, events-based surveillance for infectious diseases, immunization and campaigns, mobilize on identified health needs |
| Bangladesh | Brazil | Ethiopia | Liberia |
|---|---|---|---|
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