Community health workers (CHWs) are individuals with an in-depth understanding of the community culture and language and have received standardised job-related training in order to provide culturally appropriate health services and basic medical care to the community. They are usually members of that community and have been chosen by other community members, government or non-governmental organizations. Unlike health professionals who have relative clarity in the length of their education and training, CHWs are often described in non-specific terms. Consequently, global stakeholders continue to recommend generic but expanded roles for CHWs without acknowledging the diversities in their education, length of pre-service training and whether they are facility- or community-based.
To address this gap in knowledge, researchers from the Centre for Maternal and Newborn Health (CMNH) reviewed 23 policy documents, 36 focus group discussions and 131 key informant interviews to explore the scope of practice of 10 CHW cadres providing maternal and newborn health (MNH) services in Bangladesh, India, Kenya, Malawi and Nigeria. Their findings have been published in BMJ Global Health: The roles of community health workers who provide maternal and newborn health services: case studies from Africa and Asia.
This study showed that irrespective of the length of CHW training and whether they are facility- or community-based, all CHWs’ roles include identifying pregnant women, providing health education and screening for maternal health conditions. However, therapeutic care, skilled antenatal care, birth attendance and provision of long-acting reversible contraceptives are only provided by CHWs with more than three months of training. In contrast, community mobilisation and patient tracking are often done by CHWs with less than three months of training. Across the 5 study countries, CHWs were under pressure to provide MNH services beyond their scope of practice. There was also a tendency for CHWs in some settings to take on a healthcare facility-based role at the expense of a more traditional community-based role.
Dr Abimbola Olaniran, lead author of this study and recent PhD graduate from CMNH:
“CHWs are geographically and socially well positioned to provide MNH services to communities. To fully harness their potential, we need to categorise CHWs based on the level of education and duration of pre-service training. These categories should inform their roles in provision (or not) of aspects of MNH services. Local policymakers may consider reviewing and revising existing CHW scope of practice to reflect their varied training and education while responding to local health needs and priorities.”