REACHOUT Definitions
REACHOUT definition of close-to-community providers
A close-to-community provider is a health worker who carries out promotional, preventive and/or curative health services and who is first point of contact at community level. A close-to-community provider can be based in the community or in a basic primary facility. A close-to-community provider has at least a minimum level of training in the context of the intervention that they carry out and not more than two to three years para-professional training.
Some considerations and clarifications
Close-to-community providers include a broad variety of health workers, including community health workers. We will use the Lewin et al. (2010) definition of lay health workers which refers to community health workers,
“Any health workers carrying out functions related to health care delivery; trained in some way in the context of the intervention, and having no formal professional or paraprofessional certificate or degree in tertiary education."
We will not use the term lay health workers as they may be regarded by some as having no training in the intervention.Other names that are used for community health workers include for example: village health workers, health promoters, etc.
Close-to-community providers also include auxiliary health workers. For auxiliary workers we use definitions proposed by the World Health Organization (WHO) (2012),
“Have some training in secondary school. A period of on-the job training may be included, and sometimes formalised in apprenticeships. An auxiliary nurse has basic nursing skills and no training in nursing decision-making. However, in different countries the level of training may vary between few months to 2-3 years. Different names for this cadre are: auxiliary nurse, nurse assistant, enrolled nurse (also called nurse technicians or associate nurses)."
In REACHOUT, the focus is to improve the performance of close-to-community providers that have a link with either the government or a non governmental organisation programme. For Mozambique, Malawi, and Kenya these are community health workers and for Ethiopia these are the health extension workers. The latter cadre has a one year para-professional education and is employed by the government health services and therefore could be regarded to fall within the WHO definition of an auxiliary worker.
For the purpose of the international literature review, it was necessary to develop the definition of close-to-community provider with clear limits (mainly regarding educational level). Informal providers are considered within the definition of close-to-community providers when they have a link with a government or non governmental organisation programme and when they are trained. This is relevant for Bangladesh. Village midwives in Indonesia have a full midwifery education and don’t fall into the close-to-community provider definition.
The close-to-community provider definition of REACHOUT excludes informal cadres, like community pharmacists, informal private practitioners, traditional healers and traditional birth attendants who are not trained for an intervention or who don’t collaborate with other actors in the health system. The definition also excludes cadres with tertiary education. This doesn’t mean that they are completely excluded from the REACHOUT literature review or processes; we will address the interactions between close-to-community providers and these cadres. Nor are they excluded from the 'improvement cycles'.
What we include in the international literature review
In the international literature review we will particularly focus on the broad categories of community health workers and auxiliary health workers. When it comes to other providers (doctors, midwives and nurses with tertiary education who form a first contact with the community) and informal cadres, we will include the interactions of community health workers and auxiliary health workers with these cadres.
The table below contains some information on the cadres being included in the international literature review:
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Auxiliary health workers
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Community health workers |
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Examples of cadres and nomenclature |
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Characteristics |
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Residence |
Often not living in community (as catchment area often consists of more than one community) |
Often living in community, but not always the case (catchment area may consist of more communities) |
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Selection |
Not selected by community (mostly) |
Selected by community (ideally) and, in principle, accountable to community |
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Origin |
Not necessarily coming from the community |
Coming from the community (mostly) |
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Organisational setup |
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Level of training
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Remuneration |
Paid/employed |
Paid/employed or volunteer |
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REACHOUT countries and their close-to-community providers included in the research |
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Ethiopia |
Health extension workers |
Volunteer community health promoters |
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Indonesia |
Village/community midwives* |
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Kenya |
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Mozambique |
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Community health workers |
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Malawi |
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Bangladesh |
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Community health workers |
*This cadre does not officially fall in the auxiliary cadre.
References
Global Health Workforce Alliance (2013) Synergy among partners’ actions. Concept note (draft 1) Identifying knowledge gaps and defining a need based Global Research Agenda by 2015 on CHWs. GHWA, Geneva, Switzerland.
Lewin S, Babigumira S, Bosch-Capblanch X, Aja G van Wyk B, Glenton C, Scheel I, Zwarenstein M, Daniels K (2006) Lay health workers in primary and community health care. Cochrane Database of Systematic Reviews 2005, 1(CD004015).
WHO (2012) WHO recommendations: optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting. WHO, Geneva, Switzerland.
This project is funded by the European Union.