What are community health workers?

Community health workers (CHWs) are health care workers that extend the reach of primary health care (PHC) systems to communities otherwise underserved or unserved by formal health systems. CHWs accomplish this by delivering a comprehensive set of PHC services, including preventive and curative care, and health education in homes, community institutions, or peripheral health posts. CHWs are typically selected from, serve, and answer to the communities in which they live and work.

There are many CHW program models, each with its own standards for CHW training, supervision, place of service, remuneration, and service package. Training for CHWs can range from a few weeks, to up to two years. Remuneration can range from the standard salary for an entry-level government employee, to pay based on performance and incentives, to volunteer-based work. Place of service also varies by model, with some programs calling for the delivery of services in patients’ own homes (see Brazil), in community settings (see Liberia), or in health posts, while other models rely on mixed approaches (see Bangladesh and Ethiopia). Supervision of CHWs and opportunities for career advancement also vary by program, with some CHWs supervised by clinicians, like nurses, and others supervised by high-performing peer CHWs.

Often, CHWs are village women with secondary education, selected to receive a few months of training. Armed with this training and basic health care supplies (such as antibiotics and modern birth control devices), CHWs provide life-saving care to their neighbors, in communities usually otherwise unreached by the health system. The bias towards hiring women as CHWs serves two functions: empowering women, and ensuring women’s health care, and by extension children’s health care, is prioritized.

The package of services typically offered by CHWs varies across programs, from purely health education and preventive care, to critical curative services, and is often context-specific per a country’s morbidity and mortality profile. The WHO graphic below includes examples of primary health care services often delivered by CHWs, for which there is some evidence of CHW effectiveness.

The “WHO Guideline on Health Policy and System Support to Optimize Community Health Worker Programmes"¹ (on which our definition of CHWs is based) provides a comprehensive set of evidence-based recommendations on the design of CHW programs. As the authors note, and we will explore in-depth here, the evidence for some of their recommendations is still not robust and more research is needed. What is clear, is that CHW programming must be tailored to reflect local health needs, population characteristics, and social norms.