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Panelists of Strengthening and Scaling the Community Health Workforce and GHDonline staff

Elsa Haag

Elsa Haag
Panelist

What attributes, skills, and experiences make someone a good CHW candidate?

Posted: 11 Jun, 2017   Recommendations: 7   Replies: 39

At City Health Works in Harlem, New York (New York City), we have developed an intensive screening process for hiring CHWs. We call our workers “health coaches”, but for clarity here, I’ll reference them as community health workers/CHWs. I’ll begin by sharing the hiring process we use and what attributes we look for in candidates. The documents attached offer more insight into our model. I look forward to learning what methods you’re using and discussing ways of addressing challenges that arise in CHW hiring.

We built our recruitment and selection process to identify candidates with what we consider to be the core competencies for health coaching, including: familiarity with the neighborhood the CHW will serve, capacity for motivational interviewing, empathic listening skills, adaptability/flexibility and organizational and time management skills. We require a minimum of a high school diploma/GED.

During the hiring process, we involve many people on staff, including our current CHWs. Our current CHWs have an essential perspective and expertise on the types of skill and personality that are necessary to be successful in the job. Including our CHWs in the process helps build pride, confidence and ownership.

We see value in the rigor of the hiring process as a way to demonstrate to candidates our organizational rigor, expectations of professionalism, and commitment to a positive team culture. At each stage, interviewers rate candidates in defined categories, which helps save time, maintain objectivity, and incorporate feedback from multiple sources.

Our process has four key steps:
1. Recruitment: We reach out to cultivated contacts at local workforce development and job training organizations, community colleges and universities, and community service organizations. Our contacts at these sites have a thorough understanding of the position and our organization, and they circulate the listing and can make personal referrals. We also post to local job boards and ask our current CHWs to share the listing with their networks and peers.

2. Interview 1: The Hiring Manager conducts the first interview to assess key requirements for role and fit with desired culture.

3. Interview 2: The Director of Health Coaching and Health Coach Supervisor conduct a second interview to assess basic math skills and scenarios to assess empathic listening skills and adaptability.

4. Interview 3: Current CHWs, the Director of Health Coaching and Health Coach Supervisor conduct a group interview to assess organizational fit and presentation, learning and communication skills. The group interview includes a brief role-play, and the candidate then has time to speak with current CHWs about the position and organization.

Attached resources:

Replies

 

Esther Lwanga Walgwe Replied at 7:15 AM, 12 Jun 2017

Elsa - thank you for that overview. What has been the level of attrition within this group of CHWs? Relatively low/high? What do you attribute this to?

Abimbola Olaniran Replied at 7:53 AM, 12 Jun 2017

Many thanks for sharing your rich insight on CHW recruitment. My experience conducting a PhD study on CHWs in five countries suggests a need for a paradigm shift in the recruitment of CHWs. Especially, as some CHWs may have certain attributes that make them suitable in certain situations but unsuitable in others:
1. It has been emphasised that CHWs should be community members to ensure availability of, accessibility to and cultural sensitivity of health services. However, service end-users with stigma associated conditions (such as HIV infection) may prefer health workers from outside the community. It is often anticipated that confidentiality is better preserved and they may be less judgmental, unlike fellow community members.
2. Our communities are not homogenous, as community members tend to differ based on social status and demographic characteristics. On the one hand, a CHW who has the same gender and ethnic group as service end-user may be considered suitable for purpose and socially acceptable. On the other hand, the difference in religious beliefs between the CHW and end-user may make her/him unacceptable to the end-user especially when the CHW is not sensitive to the end user's beliefs and values when providing health education. Hence, even though they share the same gender and ethnic group, the difference in religious beliefs may affect the role of CHWs in health education. Should we consider these heterogeneities during recruitment? Or we recruit and provide training to build the capacity of the selected CHWs on cultural competency (including sensitivity to the diverse religious sects in the community)? This is another issue for discussion.

I look forward to reading the experiences of other stakeholders as experiences may vary across contexts. It would also be interesting to read (if) CHW programmes draw from discussions with, and recommendations from service end-users to design the selection criteria. To ‘leave no one behind’, it may be important to engage service end-users when developing selection criteria to identify CHWs who will serve their community/populations.

Evelyne MUKAKABANO Replied at 8:11 AM, 12 Jun 2017

Hi to all of panelists,

A good candidate for CHW demonstrates empathy to others and ability to
analyze and interpret situations.

Regards

Raghupathy Anchala Replied at 8:17 AM, 12 Jun 2017

Local empowered community member who owns the process

Best Regards
Raghu
_____________________________________________________________
Dr. Raghupathy Anchala |MBBS, DTCD, MPH (USA), PhD (Cambridge, UK)
Associate Professor |Department of Epidemiology
Program Coordinator - Masters in Public Health (MPH)
Indian Institute of Public Health, Hyderabad, Public Health Foundation of
India
Research Career Development Fellow (Postdoctoral Fellow), Commonwealth Eye Health Consortium
International Centre for Eye Health, London School of Hygiene & Tropical
Medicine, UK

Felix Ndagije Replied at 8:26 AM, 12 Jun 2017

Interesting discussions!! How can we make CHW sustainable? How can we
standardize their work? How can we make it a pillar in the HRH?

egh Eduardo Gotuzzo Replied at 8:35 AM, 12 Jun 2017

in our ex0erience several of the criteria we need to use but one important
part is dedication
identification with the program
respect for the patient
respect of the human values of the communities are also very important
even you enroll a new health worker we need to manten permanenent
supervision of their work
regards
eduardo gotuzzo

*Dr. Eduardo Gotuzzo*, Director Instituto de Medicina Tropical

Charles Agblanya Replied at 9:05 AM, 12 Jun 2017

A good CHW must exhibit leadership skills which is needed to establish and maintain good interpersonal relationship with clients, volunteers, Community health management team, community and other health workers

BOLATITO AIYENIGBA Replied at 9:56 AM, 12 Jun 2017

How can we improve oversight and supportive supervision among CHWs?

Samuel Kudzawu Replied at 12:15 PM, 12 Jun 2017

The idea of CHWs is a laudable one indeed but the challenges of sustainability can be identified with their being community based, as the name suggest. In sub Saharan Africa, culture and traditional beliefs have a bigger role in healthcare uptake. Every community has stakeholders who see to the health, moral, spiritual and legal needs of it. This runs through traditional leaders, spiritualists, seers and leaders of recognized civil society organizations depending on where you find yourself.
It is therefore necessary to establish the stakeholder that drives each settings to be used as the lead vehicle in community based healthcare deliveries. These are the ones the inhabitants are used to and very comfortable with.

Youssouf Keita Panelist Replied at 12:32 PM, 12 Jun 2017

Le recrutement des CHW est un sujet que porte beaucoup de discussion.
Selon notre expérience l’un des grands succès du recrutement des CHW est de faire participer la communauté à ce processus.
Au Mali les formations sanitaires de base sont gérées par les associations en santé communautaire dont les membres sont exclusivement de la communauté.
Pour le recrutement des CHW, nous mettons en place un comité de présélection composé des membres de l’association, de quelques membres de l’ONG. Des critères de présélection sont définis au préalables avant de commencer le processus qui sont simple : être issue de la communauté que tu dois servir (Il est un important de prendre en compte certains points notamment la question de langue, de conflit inter communauté…), avoir un âge compris entre 18 ans et 45 ans, comprendre la langue couramment parlée dans la communauté (pour pouvoir mener à bien les discussions qui s’imposent), savoir lire et écrire dans la langue du travail pour pouvoir remplir les supports de collectes de données.
Ces critères permettront au potentiels CHW identifiés par le comité (dont le nombre dépasse le nombre souhaité) d’accéder au programme de formation.
A la fin de cette formation, nous procédons à une sélection définitive des CHW par l’équipe de la formation (formateurs et assistants formateurs) sur la base d’une évaluation technique de maîtrise du protocole d’intervention mais surtout de la conduite à tenir de CHW lors de la formation et de ces qualités en matière d’écoute active, de respect pour les autres, de motivation à faire le travail, valeurs qui sont très importantes et pas facile à acquérir et qui sont indispensables pour devenir un bon CHW.
Avec ce processus nous arrivons à la sélection définitive de CHW qui arrive à servir valablement leur communauté en tant que CHW.
C’est un grand plaisir pour l’ONG Muso de partager avec vous ses expériences et de continuer les discussions sur ce sujet très intéressant qui est une base de la réussite des programmes CHW.

Monalisa Mutimutema Replied at 12:57 PM, 12 Jun 2017

Indeed a good CHW has to have respect for others, sees more of positive traits than negatives, even if negatives are there....to be able to bring out the positive in any situation or in others.....so they can be able to feel at home and open up to share their issues or concerns. Hence need to build trust in others

Ambe Lionel Neba Replied at 1:06 PM, 12 Jun 2017

Despite the often well designed selection process, an added advantage was given to individuals who took part in public health activities at the district level such as SIA, school based deworming and on the fight against NTDS. Considerations was also given to individuals who took part in outreach activities in their respective communities.

Deodatus Ruganuza Replied at 1:14 PM, 12 Jun 2017

Hi everybody, skills required to make a good CHW candidate are basic
education which is for example lower secondary education in Tanzania,
dedication for the job and good communication skills especially to the
local language spoken in that community, trust to the candidate is very
key especially when engaged with issue that are covered with misconception
which is often the case in many rural areas in subs harangue Africa

Elsa Haag Panelist Replied at 1:51 PM, 12 Jun 2017

Thank you all for these thoughtful responses!

I have a few thoughts related to the themes a few people have mentioned about hiring CHWs who can identify with the clients/patients they serve: One of the biggest advantages of CHWs for addressing health and socio-economic needs is that CHWs are typically from the community they serve and can build a trusting relationship with the patient/client based on shared life experience.

As a few people have pointed out, though, not everyone in one community will have the same life experience, or even a similar life experience. Religion, education, experiences with diseases, family structure, etc. can all vary greatly even within one area. To respond to Abimbola Olaniran (and others), I think both are needed: It is very important to educate all CHWs on the cultures and beliefs of the clients they serve, and it's important to screen for CHW capacity to be sensitive to cultural and demographic differences during hiring. That said, we aim to hire workers with a variety of backgrounds that somewhat match the different backgrounds of the clients the CHWs will serve.

To Esther Lwanga Walgwe: We started our program in 2013, so have just a few years to look at attrition. Of 11 CHWs hired, we've had four leave the organization-- one CHW left to advance into a similar position based out of a hospital and one moved away from the city. The other two were let go. Four CHWs have been with the organization for nearly four years, and three have been with the organization for one and a half years.


What recruitment and screening tools help you find the right people? A few people have mentioned the importance of CHWs who are culturally sensitive and demonstrate respect for others. How do you screen for this in particular? What kinds of questions do you ask in the hiring process?

Sidumo Gumbo Replied at 4:54 PM, 12 Jun 2017

Hi all and panelists,
In some of the Southern African states that are facing high burden of dual epidemics of HIV and TB we have witnessed an increase in the involvement of lay cadres or volunteers in the community work force for example the Rural health motivators, Community expert clients, TB active case finders and TB treatment supporters and some of these are supported by other developmental partners in terms of funding and supervision. The recruitment/hiring process is done by the partners and sometimes jointly with the government however after considering the following:
1. basic education qualifications,
2. the CHW should be residing in the same community they are serving,
3.should be someone trusted by other community members, and all these after being engaged are trained on basic HIV and TB concepts and their roles in the community. I have also worked in program where lay cadres were trained on administering injections and DOT to patients on MDR TB treatment in the community.

David Giber Replied at 6:10 PM, 12 Jun 2017

Hi All,

Has anyone had experience using the Motivational Interviewing techniques (Rollnick, Miller and Butler ) with CHW's or CHW supervisors? Their work provides guidelines for how to manage "change talk" and use asking, listening and informing to tap into the motivation of a patient in a "guiding style".

Adugna Kebede Replied at 8:36 PM, 12 Jun 2017

In my experience working with CHWs, these are some additional factors to consider during a recruitment process

1. depending on the health program they are expected to participate, it is good to recruit someone who has gone through the same condition - Example for a Maternal health program, good to have a woman CHW who already experienced giving birth, for infectious diseases such as TB or HIV and AIDS, good to have a person who is a person living with HIV or a former TB patient ( we call them expert clients) etc.

2. CHWs should also be identified by the communities themselves using certain mutually agreed criterion such as (a) the candidate should be from the same community (2) the candidate is a respected member of the community - who is not drunkard, or accused of certain unacceptable behaviors in the past (e.g. running after young girls, or taking drugs etc), speaks the local language, familiar to the traditions/ culture of the community, one who can read and write (depending on the literacy level of the community); previous experience working as a volunteer in a community development work etc

3. In most settings, CHWs are expected to provide a free voluntary service. Unless the volunteers task is made simple and for a very short period, expecting a high quality and long term free service from CHWs is unrealistic. Recruitment of CHWs should take into account a compensation mechanism for their service.

4. The CHWs role and contribution in the health system should be recognized by Health workers in the health facilities to ensure a smooth flow of information, referral and feedback systems. Involving the health workers in the recruitment process would help in facilitating their future collaboration.

Ferdousi begum Replied at 11:12 PM, 12 Jun 2017

In an urban setting, getting a health volunteer is comparatively easy, but sustaining their interest is a challenging task. So, to capture that following points need to consider:
a) good compensation package for the time they will volunteer
b) flexible but transparent result based work timing to ensure their given task
c) linkage this voluntarism with their future carrier and educational path
d) arrange exposure visit to a successful program really help to buy their motivation
e) build positive social image for this voluntarism using mass, media and social network
f) last but, not the least- a good on the job training and retraining (refresher) are the key to motivate them

Dr. Ferdousi Begum, Public Health Consultant, Bangladesh

A/Prof. Terry HANNAN Replied at 1:02 AM, 13 Jun 2017

This is a superb discussion and for myself expands the issues behind the philosophy defined by prof William Tierney formerly of the Regenstrief Institute when it comes to end-user e.g. CHW involvement. he stated "we physically and metaphorically sat in the dirt with the end-users to understand there needs". Please keep the discussion going.

Jim Lloyd Panelist Replied at 9:06 AM, 13 Jun 2017

Elsa:

Thanks for this contribution -- the information on recruiting and hiring maps with what a lot of the organizations that we work with do. And thanks for posting those valuable resources!

Our organizations have recognized like you that extending the search into the community, by recruiting through community-based organizations and recognized community leaders -- and even key gathering spots like popular hair salons! -- can help identify the individuals best suited for the position.

One interesting thing we found was how one of our organizations, Mountain-Pacific Quality Health, in Montana, identified a need for CHW services for the population of military veterans in the state (1 in 10 Montanans has served in the armed forces). They recruited two veteran CHWs who had the knowledge of both (i) the geographic community they served, the rural and frontier mountain west; and (ii) the social community of individuals who'd served in the armed forces. It gave them the opportunity to extend services to a population that sometimes is difficult to engage, and in a way that recognized that population's distinct experiences.

With respect to your question about interviewing and identifying the potentially difficult-to-identify qualities the CHWs ought to possess, we found that the organizations with which we worked used more extensive onboarding processes with CHWs than we had expected. They did lots of intensive interviews involving role play -- like you do -- and included trial periods where the organization could determine whether the CHW fit well with the care team they used.

Sarah Lunsford Replied at 1:16 PM, 13 Jun 2017

Thanks to all who have commented thus far - very interesting. My reading of the responses in this and other threads is that the issues of recruitment, training, supervision, and retention/attrition are interconnected. Establishing recruitment criteria is helpful, but can be challenging if it doesn't yield sufficient number. For example, in India, the national level ASHA program has education requirements which are often bent because not enough women meet them. Recruiting people from the community is certainly a good start, but as has been noted, local CHWs can still face socio-cultural barriers that hinder their work. This is where training and supervision comes in - arming CHWs with the skills and compassion to bridge these barriers and continually supporting and mentoring them. This, of course, requires supervisors who are proficient in managing cultural dynamics and mentoring others to do so. However, CHWs can only do so much to overcome cultural barriers within the community as they function within their own cultural norms that dictate how different groups interact. It is incumbent upon program planners to be not just cognizant of the context but aware of how socio-cultural factors may impact recruitment and retention of CHWs as well as service provision and health outcomes.

Allison Squires Replied at 1:34 PM, 13 Jun 2017

Hi All,

This article is useful for thinking about CHW roles and their training:
https://www.ncbi.nlm.nih.gov/pubmed/19896028

It is US specific but offers a good conceptual model that is applicable
anywhere.

Best, Allison

*Allison Squires, PhD, RN, FAAN*
Associate Professor, NYU Rory Meyers College of Nursing
Research Assistant Professor, NYU School of Medicine
Webpage: https://nursing.nyu.edu/directory/faculty/allison-squires

Ferdousi begum Replied at 2:08 PM, 13 Jun 2017

Following attributes, skills, and experiences make someone a good CHW candidate:
Attributes:
1) CHWs should be trusted and respected community members
2) Community health workers should be members of the communities where they work, should be selected by the communities, should be answerable to the communities for their activities, should be supported by the health system but not necessarily a part of its organization, and have shorter training than professional workers.
3)Personal Attributes are essential for the success of a CHW as they are an inherent part of the individual and often a reflection of their life experience. Personal attributes are a very important part of what the CHW brings to their role as a CHW; essential to building trusting relationship with the community they serve

Skills:
1) motivational skill is the key asset to be a good CHW
2) Communication Skills
Ability to use Active Listening
Ability to communicate in writing
Ability to communicate verbally
CHWs will communicate with varied populations, individuals, other community health workers, and professionals in a manner that is appropriate for the audience.Good interpersonal skill
3) Interpersonal skills

Ability to build relationships
Ability to work as part of a team
Ability to understand and work within cultural dynamics
CHWs work with a diverse group of individuals including community members and professionals. They must be able to develop and maintain relationships at all levels. They must be able to work as part of a team, and consider, understand, and respect various perspectives to meet the needs of others
4) Capacity Building

Understanding of and ability to apply leadership
Ability to develop additional skills
Ability to develop and manage resources
Ability to use planning skills
Ability to produce complete, accurate reports
Understanding of needs assessments

CHWs will increase the capability of their community to be empowered to care for themselves. They will also work collectively with community members and stakeholders to develop plans to increase resources in the community and to expand public awareness of community needs.
5) Organizational Skills

Ability to develop plans and set goals
Ability to manage time and determine priorities
Ability to manage a budget
Ability to report and evaluate in community settings
5) Teaching Skills

Ability to teach one-on-one and/or in group settings
Ability and willingness to learn and be proficient with information being presented
Ability to lead classes or educational sessions
Recognize need to continue education
Ability to adapt teaching style to audience needs
6) Advocacy Skills

Ability to be assertive and respectful
Ability to listen and ask questions
Ability to advocate at different professional levels
Ability to identify and manage risky situations
Ability to strengthen social support networks

Experience:
1) Knowing the community norms and value
2) Knowledge of the community culture and languages spoken, personality traits that encourage trust and respect, gender, previous experience providing healthcare, and educational qualification
3)

Elsa Haag Panelist Replied at 3:39 PM, 13 Jun 2017

Thanks for bringing up motivational interviewing (MI), David. MI is central to our approach.

I've attached a great introductory article about what the theory/technique for anyone who is unfamiliar.

Attached resource:

Minal Rahimtoola Replied at 12:47 PM, 14 Jun 2017

Thank you, colleagues for a robust and rich dialogue. The recommendations and cautions presented here are all very valid. CHWs need to be respected in their community, humble, able, capable, willing to learn and grow. Good candidates may not automatically mean good CHWs. Which is why we must remember that recruitment is only part of the journey. For someone to be a good CHW candidate they need the health system or program to support them. Especially as primary / essential health packages in the community become more integrated - strong supervisors, fair wages, security of self, available supplies and equipment to support their credibility, and opportunities to grow and learn. Otherwise they will stagnate, be overworked, succumb to vertical programs to more funding, and we will face the same failures we have experienced in the past.

Celia Taylor Replied at 3:18 PM, 14 Jun 2017

This is a fascinating thread - thank you. It is particularly pertinent for me as we are starting a project to develop selection tools for use as part of the selection process for CHWs in sub-Saharan Africa later this year.
Involving existing CHWs in selection seems a really good idea and is something we do successfully at our medical school as our current students run one station of our multiple mini interview.
I was interested that relatively few of the key requirements noted on the thread relate to baseline skills/knowledge or trainability. Has anyone had field experience of CHWs who don't successfully complete their initial training and, if so, what were the reasons for this?

Amy Madore Replied at 11:34 PM, 14 Jun 2017

That's an interesting question, Celia: How might you test or screen for "trainability" during the recruitment phase?

Following up on motivational interviewing (MI), I wanted to share a 35-minute video introduction to MI by Keri Bolton Oetzel, PhD, at the University of New Mexico. She created the video in collaboration with Project ECHO, which has developed several different CHW training models for various health conditions. They offer three different modes of training: face-to-face and hands-on training, weekly videoconferences with patient case presentations and didactic lectures from experts, and video modules for material that doesn't require interactive discussion. Their community health worker programs manager, Venice Ceballos, is a CHW who still actively sees patients as a part of her role.

Project ECHO is working with the state of New Mexico to develop CHW certification criteria and processes. They've collaborated closely with indigenous communities to develop culturally responsive CHW programs and tools. I've provided a link to their website for anyone interested in learning more.

Attached resources:

Leonard Masele Replied at 9:43 AM, 15 Jun 2017

The requirements based on Experience and Education background deprive other community members who are willing to volunteer especially those who did not attend schools, what should be done especially for the developing Countries like Tanzania?

Elsa Haag Panelist Replied at 1:21 PM, 15 Jun 2017

Some great points raised here.

In response to Sarah Lunsford's point-- I agree wholeheartedly. You can have the most rigorous, evidence-based screening and recruitment process, but without ongoing support and training for CHWs, even the most skilled worker will struggle to succeed long term.

While some minimum education requirements do make sense, Leonard Masele's point about who such requirements can exclude is important. One thing we have thought about: like many CHWs, ours teach and work with people who often have minimal formal education. Teaching in a way that is appropriate/matched to the client's education level is core to CHW work. In many contexts, if a client can learn the material, then a CHW can learn to teach it. This does not address programmatic/reporting requirements around reading and writing, but it can be a helpful frame in the conversation about minimum requirements. Many of the characteristics that we've discussed so far are ones that a candidate could develop with or without formal education.

On the topic of screening for trainability-- that's a key question. Role plays can be one tool for this, as the interviewer(s) can give feedback and see how the candidate is able to incorporate that. Additionally, you could try teaching a candidate a short lesson and then ask him/her to teach it back to a group. I'd love to hear other people's ideas about screening for trainability.

Tinashe Goronga Replied at 4:23 PM, 15 Jun 2017

Leonard raises a valid point about the minimum educational requirement in resource poor settings where some people might not have access to education. Most Community Health Workers tend to be volunteers who will be working without compensation. I think as much as some level of education is ideal i think basic literacy and experience may be essential. I once witnessed a Community health worker without a high school education accurately diagnose, manage and counsel a patient with malaria through following basic algorithms.
Then i wanted to raise a point that we often neglect the needs of people with disabilities when designing community projects and identifying community health workers. Community Health Workers may help improve access to care for people with disabilities .

Carissa McGee Replied at 2:06 PM, 16 Jun 2017

My name is Carissa and I work with Project ECHO Community Health Worker Department and I am a Training Support Analyst. I believe that a good CHW candidate is a person that has lived the lifestyle, or lived among the population lifestyle, that they are trying to help. The reason I believe this is because I feel that a person can only truly help what they themselves understand. The ability to empathize only comes when an experience has taken place that is directly related to the issue. Empathy isn't a recommendation for a CHW to have, it's a necessity. CHW deal with persons, not theories. CHW must relate and be relatable to their population and clients. This is a great attribute for a CHW to have.

Believe Dhliwayo Replied at 3:21 PM, 16 Jun 2017

This certainly has been an interesting discussion. I totally agree with
Carrissa inputs as a former CHW issues to do with being client centered and
being relatable to are crucial as they meet Community based Responsiveness
approach of in ensuring access to Healthcare services in the communities

Kenneth Maes Replied at 4:07 PM, 16 Jun 2017

This is a great conversation. I appreciate the introduction, and points raised by Abimbola Olaniran and Monalisa Mutimutema, particularlys the point that “communities” are made up of heterogenous people with some shared and some divergent interests, values, concerns, and priorities; and the important of being able to build trust. And Elsa Haag’s response about this issues. I would like to build on your points.

As you mentioned, there is often interest in ensuring that CHWs and the people they serve trust one another—in fact this is a core part of common definitions of CHW. Organizations and health systems thus seek CHWs who will be trusted by others in “the community.” Intent on ensuring this trust, some seek to construct culture-specific community health worker programs, so that there is some matching on certain cultural characteristics or identities between CHWs and the people they serve. These characteristics or identities can be and sometimes are specified as relating to race/ethnicity, national origin, faith, sexuality, gender, citizenship/immigration status, and/or intersections between these.

I believe it is important to think critically about balancing a goal of ensuring this trust through matching CHWs to communities, versus a goal of creating trust and social relationships between people and communities that do not identify themselves in the same way. That is, creating bridges of understanding, trust, and respect between people of different race/ethnicity, national origin, faith, sexuality, gender, and/or citizenship/immigration status. Thinking about this goal is important because such relationships are potentially powerful social determinants of health; better relationships across social dividing lines can lead to improved wellbeing in probably a multitude of ways at multiple levels.

Importantly, some if not all CHWs are capable and very talented when it comes to creating these kinds of relationships across social dividing lines. Not every CHW must have this goal as part of their job description. However, perhaps some should, and we should encourage this, through careful recruitment, training, support, and engagement. Screening tools for recruitment and finding the right questions to ask in the hiring process will be important in this endeavor. Collaboration with community-based organizations will also often be essential. Yet consider that it should not be CHWs and community-based organizations by themselves trying to create healthier societies that thrive on diversity rather than fear and attack it. I think that’s on all of us. If we (non-CHW policy makers, supervisors, program leaders, researchers, etc.) are engaged in this kind of work, then we are in a better place to recruit, train and support CHWs who are also engaged in it.

Finally, I think a helpful document to consult is a 2016 report by the Community Health Worker (CHW) Core Consensus (C3) Project, which is focused primarily on the U.S. context, but which could be a helpful document for people outside the U.S. Report details the core roles of CHWs, and the skills and qualities they need to be successful in those roles. It’s attached.

Thank you!
Kenny Maes
http://liberalarts.oregonstate.edu/users/kenneth-maes

Attached resource:

Elsa Haag Panelist Replied at 4:39 PM, 16 Jun 2017

Thank you all for your thoughtful contributions to this discussion. It's
great to know so many good minds are at work on growing CHW programs
globally.

Dinesh Koirala Replied at 6:12 AM, 17 Jun 2017

Its informative. The role of CHW in health system will always carry a special position.

Dinesh Koirala Replied at 6:14 AM, 17 Jun 2017

Its informative. The role of CHW in health system will always carry a special position.

Allan Tomas Replied at 4:36 AM, 20 Jun 2017

Good day,

It's been an interesting discussion despite the fact that couldn't go through all the comments. I would like to have a little of your experience regarding the level of formal education among the trainees. How difficult it is to make them follow certain guideline, follow procedures and keep them with the right mindset?
I ask this because in most low-income countries where basic education is still a big, this program might struggle to create a passion driven working environment which I think is one of the core aspects that would dictate the the success and effectiveness in terms of quality of service delivered either in rural and urban areas.
What could we do to "use" younger generations, guide them and make them aspire as CHW in health systems.

Abdi Isaak Replied at 4:42 PM, 8 Jul 2017

Being "closer to community" and ideally working with people of same gender identities would be ideal. Closer to community helps with sustainability in that people from same neighborhood or village trust each other more, stay together more and understand each other more. when CHW programs closeout closer to community remains in the village and help in some ways, until someone else come with different programs. When polio drive ended recently, WASH (hand washing) program came to my village and so recalled the same CHWs to do the tasks. I live in the N/America but come from E/Africa so I know my neighbors here don't trust each other a lot but my parent's neighbors in Africa trust each other more. With Gender identity concordance, pregnant women for example may prefers a female CHW aspiring to be a nurse/midwife etc, some CSW would prefer same gender identity CHWs too. In sum, both closer to community and gender parity is context specific but somewhat important consideration. In Kenya a primary school (8 grade equivalent) can do some of the community health work but ideally HS diploma holders with strong leadership skills can be an ideal candidate. what do others think?

Neil Pakenham-Walsh Replied at 6:21 AM, 9 Jul 2017

Dear Abdi, Thank you for your interesting post. This corresponds with our experience on HIFA Community Health Workers project:
http://www.hifa.org/projects/community-health-workers
HIFA has >16,000 members and I invite GHD members to join (free): www.hifa.org/joinhifa
We hosted a major thematic discussion on CHWs in the runup to the Internationa Sysmposium on CHWs in Kampala (Fef 2017). Many HIFA members noted the importance of:
1. CHWs being appointed and working by, and in, their own local community
2. CHWs having the potential for career progression to 'higher' level cadres.
Thanks again for sharing.

Best wishes, Neil

Let's build a future where people are no longer dying for lack of healthcare information - Join HIFA: www.hifa.org

HIFA profile: Neil Pakenham-Walsh is the coordinator of the HIFA campaign (Healthcare Information For All - www.hifa.org ) and current chair of the Dgroups Foundation (www.dgroups.info), which supports 700 communities of practice for international development, social justice and global health. Twitter: @hifa_org FB: facebook.com/HIFAdotORG

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