WHO Guideline on Community Health Worker Programs.

landmark guidance

Pivotal moment for prochw movement.

The World Health Organization (WHO) developed its long-awaited guideline document in 2018, titled WHO guideline on health policy and system support to optimize community health worker programmes.

The release of the document was a landmark moment for the professional community health worker (proCHW) movement.

Not only did the WHO recognize:

“Substantial evidence demonstrating their [CHWs] effectiveness in delivering a range of preventive, promotive and curative services related to reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases, and neglected tropical diseases.”

They also identified CHWs as having a key role to play in achieving the health targets in the Sustainable Development Goals (SDGs). Plus, reinforced their recommendation from the WHO Global Strategy on Human Resources for Health: Workforce 2030 that countries harness the potential of CHWs in interprofessional care teams.

The global dialogue had finally progressed from debating whether CHW programs are required, to how to make them most effective. Rigorous research had demonstrated CHWs could deliver all sorts of complex health tasks, resulting in improved outcomes in child mortality, HIV care management, TB control, and more. But, achieving these positive outcomes reliably, particularly for large-scale CHW programs, had been a challenge.

In 2016, evaluations of national-scale CHW programs remained unfavorable. And it had become apparent that not all CHW programs were equal. Issues like resourcing, recruitment, training, supervision, and integration with existing health systems were clearly linked to the effectiveness of CHW programs, but there was still much to learn about best practices in these areas.

Sensing this as a pivotal moment in CHW history, six community health organizations came together (Integrate Health, Last Mile Health, Living Goods, Muso, Partners In Health, and Possible), with the goal of clarifying the elements of CHW program success.

This collaboration led to the release of a report – Practitioner Expertise to Optimize Community Health Systems – that formed the basis of our shared advocacy around the WHO Guideline. It was also the birth of our Coalition.

our contribution

The purpose of the WHO guideline on health policy and system support to optimize CHW programmes is to:

“Assist national governments and national and international partners to improve the design, implementation, performance, and evaluation of CHW programmes, contributing to the progressive realization of universal health coverage.”

Produced via a systematic review of the literature, and guided by a diverse team of CHW experts, CHWs, associations, and labor union representatives, the guide contains pragmatic recommendations on the selection, training and certification, and management and supervision of CHWs.

It’s a tool for national policymakers and planners, informed by all of the available evidence on what makes CHW programs successful.

The Coalition played a pivotal role in the development of the guideline. While serving as External Review Group Members, CHIC succeeded in getting seven of our eight CHW best practices included in the guideline.

Women standing in line to have their babies weighed by a Community Health Worker

Village Reach

Two women seated on the ground while holding papers

a blueprint for success

CHWs work, but only if they’re set up to succeed.

Too often, CHWs are expected to work with inadequate salary, skills, supervision, and supplies – then the integrity of the profession is questioned when outcomes don’t meet expectations.

For the world to continue making progress toward the SDG of health for all, and to address current and future health workforce challenges, countries must utilize evidence-based best practices in the delivery of CHW programs.

Fortunately, the WHO CHW Guideline provides a comprehensive blueprint for CHW success. It includes detailed recommendations across 15 areas of community health program design that are strongly correlated with positive outcomes. An easy way to begin to adopt these recommendations is by using the CHW AIM Tool.

When these recommendations are adopted, CHWs are treated as the professionals they are. And patients receive the high-quality care they deserve.

Everyone wins.

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