Community health workers at the dawn of a new era: 5. Roles and tasks

Abstract

Background This is the fifth of our 11-paper supplement on “Community Health Workers at the Dawn of a New Era.” When planning new community health worker (CHW) roles or expanding existing roles, programme planners need to analyse global and local research evidence and evidence-based guidance on the effectiveness and safety of relevant tasks performed by CHWs. Methods In this paper, we explore key areas of consideration when selecting roles and tasks; present current knowledge regarding these issues; and suggest how decision-makers could consider these issues when assigning tasks in their setting. This paper draws on the chapter “Community Health Worker Roles and Tasks” in Developing and Strengthening Community Health Worker Programs at Scale: A Reference Guide and Case Studies for Program Managers and Policymakers, as well as on a recently published compendium of 29 case studies of national CHW programmes and on recently published literature pertaining to roles and tasks of CHWs. Results This paper provides a list of questions that aim to help programme planners think about important issues when determining CHW roles and tasks in their setting. Planners need to assess whether the recommended roles and tasks are considered acceptable and appropriate by their target population and by the CHWs themselves and those who support them. Planners also need to think about the practical and organizational implications of each task for their particular setting with regard to training requirements, health systems support, work location, workload, and programme costs. Conclusion When planning CHW roles and tasks, planners, programme implementers, and policy-makers should draw from global guidance and research evidence, but they also need to engage with the experiences, needs, and concerns of local communities and health workers. By drawing from both sources of information, they will stand a better chance of developing programmes that are effective in achieving their goals while remaining acceptable to those affected by them, feasible to implement, and sustainable over time.

Community health workers at the dawn of a new era

“…(2) planning, coordination, and partnerships [28]; (3) programme governance [29]; (4) programme financing [30]; (5) roles and tasks [31]; (6) recruitment, training, and continuing education [32]; (7) supervision [33]; (8) incentives and remuneration [34]; (9) CHWs' relationships with the health system and with the community [35]; (10) programme performance and its assessment [36]; and a concluding article on (11) CHWs leading the way to "Health for All" [37].…”

“…They note that CHWs and their programmes face conflicting needs which are not easily resolved. In their paper on "Roles and Tasks" [31], Glenton et al suggest that planners should address challenges with CHW roles by assessing whether the recommended roles and tasks are considered acceptable and appropriate by their target population, the CHWs themselves, and those who support them. The process of designing roles and tasks should be guided by research evidence and global experience as well as by the experiences, needs, and concerns of local communities and health workers.…”

Domains of Physical and Mental Workload in Health Work and Unpaid Domestic Work by Gender Division: A Study with Primary Health Care Workers in Brazil

“…Female health professionals with high PHC workload scores also had a high unpaid domestic workload, above the levels presented by male professionals. An interesting aspect presented in more recent research highlights that the work developed in the job market, in this case, in primary health care, even if it provides satisfaction, parallels a greater degree of family interference in the work performed by women, which comes from their increased involvement in household chores, including taking care of the house, children and elderly relatives [ 48 ]. In addition, there is still a tendency for the work performed by women in PHC to lead to a greater susceptibility to gender inequities.…”

“…In addition, there is still a tendency for the work performed by women in PHC to lead to a greater susceptibility to gender inequities. This is because female professionals with a partner who also works full-time dedicate more time to unpaid domestic work compared to the male partner [ 48 ]. This can present risks to the health of these PHC workers, and reflects the gender differences that were previously established by women’s susceptibility to anxiety and episodes of depression.…”

Critical interventions for demand generation in Zambia, Nepal, and Senegal with regards to the 5C psychological antecedents of vaccination

“…All three countries relied on trusted, volunteer, CHWs to improve confidence in service delivery by acting as a bridge to connect health staff to the people living in their catchment areas. CHWs are recognized as critical connections to the community, and provide culturally sensitive care and communication [33, 34]. When appropriately trained and supervised, CHWs in both LMIC and HIC contexts have been associated with improved health outcomes and accessibility to services [35].…”