26 October 2018 – The new WHO guideline on health policy and system support to optimize community health worker programmes was launched at the Global Conference on Primary Health Care, in Astana. The guideline uses state-of-the-art evidence to identify effective policy options to strengthen community health worker (CHW) programme performance through their proper integration in health systems and communities.
In 1978, the Declaration of Alma-Ata recognised community health workers as part of a diverse, sustainable team that responds effectively to the health needs of communities. Forty years on, in Astana, the global health community gathers to affirm and reinvigorate its commitment to primary health care as fundamental to ensuring that everyone everywhere is able to enjoy the highest possible attainable standard of health. The health workforce agenda remains as relevant today as it was in 1978: addressing health workforce shortage, maldistribution and performance challenges is essential for progress towards all health-related goals, including universal health coverage. Further, the health sector has the potential to be a driver of economic growth through the creation of qualified employment opportunities, in particular for women.
Effective health workforce strategies include the education and deployment of a diverse and sustainable skills mix, harnessing in some contexts the potential of community health workers operating in inter-professional primary care teams. Successful delivery of services through CHWs requires evidence-based models for education, deployment and management of these health workers. The guideline is intended as a tool for national policy makers and planners and their international partners to use in the design, implementation, performance and evaluation of effective community health worker programmes. It contains pragmatic recommendations on selection, training and certification; management and supervision: and integration into health systems and community engagement.
The development of this guideline followed the standardized WHO approach. This entailed a critical analysis of the available evidence, including 16 systematic reviews of the evidence, a stakeholder perception survey to assess feasibility and acceptability of the policy options under consideration, and the deliberations of a Guideline Development Group which comprised representation from policy makers and planners from Member States, experts, labour unions, professional associations and CHWs.
Critical to the success of these efforts will be ensuring appropriate labour conditions and opportunities for professional development, as well as creating a health ecosystem in which workers at different levels collaborate to meet health needs. Adapted to context, the guideline is a tool that supports optimizing health policies and systems to achieve significant gains to meet the ambition of universal access to primary health care services.