Malawi: Community Health Workers | Liberia: Community Health Promoters | Mexico: Household Model Acompañantes | |
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Start date | 2017 | 2019 | 2019 |
Number Currently Working | 1045 CHWs, 183 SCHWs, and 14 site supervisors | 46 CHPs, 5 CHP-S, and 1 CHN | 70 CHWs (currently being piloted in only 1-2 of 10 target communities) |
Catchment Area Served | 14 rural catchment areas (138,291 people) | 7 peri-urban communities (10,369 people) | 10 rural communities (11,645 people) |
CHW: Household Ratio | 1:20–40 | 1:40–60 | 1:30–40 |
Frequency of Household Visits | Monthly (daily for patients on TB treatment and those on first year of antiretroviral therapy) | Monthly (more often if there are specific patients getting intensive treatment support) | Monthly (monthly, biweekly, or weekly, depending on level of chronic disease control) |
Assigned Tasks | |||
Monthly Home Visits |
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Linkage to Care |
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Additional Visits for Chronic Conditions |
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Outside the Household |
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CHW Selection | Step 1: Mapping of the catchment area (# of households, # of CHWs required). Step 2: Nomination by community leadership and community structures (i.e., chiefs, village health committees, area development committees, village development committees, community-based organizations, and HSAs). Step 3a: Literacy test, and pre- and post-foundational training test. Underperformers are provided with support and mentorship to be effective on their job. Step 3b: SCHWs undergo an extra 2-day training after the 5-day foundational training. | Step 1: Mapping of the catchment area (# of households, # of CHWs required). Step 2: Nomination by community health committee using established selection criteria. Step 3: Literacy and numeracy test, followed by interview to assess for knowledge, skills, and attributes. Step 4: Passing grade (70%) of all training modules and demonstration of a minimum level of core competency, as determined by training facilitators via previously publicized criteria. | Step 1a: Mapping of the catchment area (# of households, # of CHWs required). Step 1b: Existing vertical CHWs given opportunity to remain in household model after consideration of increased workload. Step 1c: Open call for potential CHWs disseminated broadly in target communities. Step 2: Literacy and numeracy test followed by interview and subjective ranking of applicants based on interest, availability, and aptitude. Step 3: Training for twice as many candidates as positions available. Selection of final CHWs based on daily pre- and post-test evaluations, a final practical evaluation, combined with qualitative assessments from multiple team members (supervisors, trainers, CHW coordinator, etc.). Step 4: All remaining candidates that completed the initial training retained as substitute CHWs in case of attrition due to maternity leave, illness, etc. |
Payment for Time Worked | Monthly continuous stipend: -CHWs: US$23 -SCHWs: US$31 (full-time minimum wage about US$26) | Monthly stipend: -CHPs: US$50 for ∼20 hours/week -CHP supervisors: US$70 for ∼30 hours/week -CHNs: US$313 for full-time (full-time minimum wage about US$105) | Monthly stipend for CHWs US$100 for ∼20 hours/week (full-time minimum wage about US$170) |
Training Schedule | 5 days foundational training and quarterly 1-day refresher trainings | 2 months foundational training, regular refresher trainings | 2 weeks of foundational training (theoretical + practical training and mentorship) with monthly continuing education |
Supervision and Mentoring | 1 SCHW assigned to 10 to 15 CHWs
1 site supervisor assigned to 4–19 SCHWs (depending on number of villages in catchment area)
Supervision Tools:
| 1 CHP-S assigned to up to 10 CHPs
1 CHN assigned up to 10 CHP-S
| 1 CHW supervisor assigned to 10 CHWs
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Abbreviations: CHN, community health nurse; CHP, community health promoter; CHP-S, community health promoter supervisor; CHW, community health worker; HSA, health surveillance assistant; SCHW, senior community health worker, NCD, noncommunicable disease.