Perspectives The Complexity of CHW Training
By Maryse Kok and Miriam Taegtmeyer, 24 March 2014
Having resisted heavy rains and tube strikes in London, more than 30 people met in the afternoon of 6 February to discuss the possibility of developing a core set of standardized learning resources for Community Health Workers (CHWs), a meeting organized by mPowering Frontline Health Workers.
The dizzying diversity of CHW training
Given the diversity of CHWs, existing training materials are available in many forms: pre-service standardized packages that are put together by governments, modules developed by NGOs, distance learning and on the job training on multiple or specific subjects.
A literature review conducted by colleagues from the 1 Million CHW Campaign found out that there is limited information available on training for CHWs: on what works and what doesn’t work well and why? We also came across this in our REACHOUT systematic review on factors influencing performance of close-to-community providers, to be published soon.
In-country coordination of CHW trainings is much needed. In many countries, CHWs receive multiple trainings from different organizations which are sometimes not completely in line with each other. Who sets the priority for what a CHW should minimally know and what competencies a CHW should have? How do we avoid an overload of different trainings offered to the same CHWs, resulting in unmanageable workload, unclear roles and responsibilities, trainings only seen as income-generating activities and CHWs being away from the community for long times? These and other questions were part of the lively debate in the CHW forum.
Many of the issues around lack of co-ordination or standardised approaches raised by fellow participants reflect experiences we hear on the ground. For example, one of the CHWs participating in REACHOUT in Malawi said: “Nowadays there are a lot of activities and services which need volunteers hence there are so many volunteers who receive all kinds of trainings. For example, NGO A will need theirs, NGO B, Ministry of Health will also need theirs as well. However the point is the volunteers are the same people but we just change names, because the organizations have their different needs”.
Another issue with CHW training is that most of the time, content is available (information about diseases, how to diagnose), but CHWs are not taught about how to approach people in their homes, how to give feedback to communities and how to assure confidentiality, all very essential elements of a CHW’s job.
Positive change is possible
There is evidence for combining theory and practical knowledge to make improvements: using interactive methods; using technology, like mobile phones; conducting pre and post-tests to assess CHW knowledge and competencies; certification; and involving CHW in the development of training materials and evaluation.
But training alone is not enough. Training should be followed up with proper supervision and support, both from the health system and at community level. Training cannot be seen as a stand-alone intervention, it is part of a package of support that all CHWs need.
A standardised approach to learning?
Back to the question about the usefulness of a core set of learning materials. It’s obvious that there are a lot of good training materials available. But more coordination is needed to prevent people from re-inventing the wheel and inefficiently producing new content when it is already available. The main question bothering us at the end of the London meeting was: would governments and other major actors use a core set of learning resources if this were available? Sometimes they have reasons to want their own. This is not always because of political considerations; everybody acknowledges that contexts of CHW programmes are so diverse that new development of training content, curricula and pedagogy is justifiable.
A core set of learning resources should therefore be generic, adaptable and presented in modules. It should be attractive to contributors and clients (governments, NGOs), wanting to save time and money. We should give it a try and ensure that major actors, including the WHO, are willing to contribute.
This blog was first published on the mPowering Frontline Health Workers website. We want to thank them for publishing our post.This innovative partnership is designed to improve maternal and child health by accelerating the use of mobile technology by frontline health workers around the world. The founding partners are USAID, UNICEF, Qualcomm, Vodafone, Intel, MDG Health Alliance, GlaxoSmithKline, Praekelt Foundation, Frontline Health Workers Coalition, and Absolute Return for Kids. The USAID-funded MCHIP project serves as the partnership secretariat. As well as supporting financial and human resources management, MCHIP helps to identify potential points of collaboration and areas where working jointly will bring benefits to the aims of both mPowering and MCHIP.
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This project is funded by the European Union.