PHM-Exch> New WHO Guideline on community health workers welcomed at WHA72

Claudio Schuftan cschuftan at phmovement.org
Mon Jun 24 20:31:40 PDT 2019 

From: WHO Watch - PHM <dlegge at phmovement.org>


Overcoming the barriers to realising the promise of CHWs

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New 'guideline' on community health workers welcomed by World Health
Assembly Among the documents prepared for the Astana Conference on Primary
Health Care (PHC) in October 2018 was a new 'guideline' on community health
workers
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=e56687e526&e=916df65fd1>
(CHWs).

A guideline, in WHO practice, is expert-created and evidence-based and is
solely the responsibility of the Secretariat and not (overtly) subject to
the politics of WHO's governing bodies. The decision to cast this material
as a guideline was clearly a strategic choice on the part of the Director
General.

The Guideline was developed through a highly structured process. The
Guideline Development Group undertook a systematic review of published
literature reviews of CHW programs; undertook a stakeholder perception
survey, identified 15 key policy questions; and undertook 15 systematic
reviews corresponding to those questions. The body of the Guideline reports
on the findings and recommendations arising consideration of the findings
of these reviews.

The Guideline, as summarised in A72/13
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=fc8ac37d70&e=916df65fd1>
(paras 10 & 11), concludes that:

   - *10. Evidence across and within countries indicates that support for
   community health workers and their integration into the health system and
   the communities they serve is uneven. Examples of good practices exist, but
   are not necessarily replicable. Policy options for which there is greater
   evidence of effectiveness are known, but not uniformly adopted.
   Accordingly, the performance of community health worker programmes is
   highly variable, hindering the full realization of their potential
   contribution to the implementation of primary health care policies. *
   - *11. Common shortcomings identified across a range of community health
   worker programmes include: poor planning; unclear roles, education and
   career pathways; lack of certification hindering credibility and
   transferability; multiple competing actors with little coordination;
   fragmented, disease-specific training; donor-driven management and funding;
   tenuous linkage with the health system; inadequate coordination,
   supervision, quality control and support; and lack of recognition of the
   contribution of community health workers. These challenges can contribute
   to the inefficient utilization of human capital and financial resources.
   Many community health worker initiatives fail to be properly integrated
   into health systems and remain pilot projects or small-scale initiatives
   that are excessively reliant on donor funding; conversely, uneven
   management and support for community health workers in many contexts may
   result in substandard capacities and performance of the health workers
   concerned.*

The summary of the Guideline in A72/13
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=82e6fb331b&e=916df65fd1>:


   - lists 6 key principles which should be realised in CHW programs;
   - lists 7 policy recommendations (selection, certification, supervision,
   compensation, entitlements, career development, service delivery models);
   - lists key actions for the design and implementation of CHW programmes
   at the national level, and for international organisations (donors and
   IGOs).

CHWs, and the Guideline in particular, were widely supported in the WHA
debate.

   - Togo spoke about involving CHWs in childhood diarrhoea, malaria and
   under-nutrition.
   - Ethiopia spoke about the success of the community health worker
   extension program in dealing with a range of issues. Ethiopia was a
   co-sponsor (with Ecuador) of the resolution that was finally adopted.
   - Angola described the role of CHWs in recent outbreaks of cholera and
   measles.
   - India spoke about the role of its ASHA program (accredited social
   health activists) in the context of its National Rural Health Mission.
   - Thailand commented on the lack of data revealed by the guideline
   development exercise. Thailand was critical of the lack of attention in the
   guideline to the role of CHWs in responding to emergencies.
   - Zimbabwe spoke about the vital role of CHWs in Zimbabwe but emphasised
   the unsustainability of there being seen as volunteers rather than health
   workers.
   - Dominican Republic spoke more positively about voluntary roles
   emphasising recognition and the satisfaction of serving the community.
   - Sri Lanka described CHWs as being the success story of PHC in Sri
   Lanka.
   - Namibia reported a high coverage level of CHWs in the national health
   system and described improvements in MMR, under fives mortality, diarrhoea
   management, and antenatal care but agreed with many of the challenges
   identified in the guideline document.
   - Iran spoke about the risk of overburdening the CHW as many programs
   seek to involve CHWs in their delivery.
   - A number of nonstate actors also spoke in favour of the roles that
   CHWs can play.

The draft resolution, which had been recommended from the Executive Board
in EB 144.R4 was adopted without amendments. The resolution (here
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=6411839479&e=916df65fd1>)
urges member states to implement the recommendations in the guideline;
invites global health agencies and donors to support the principles of the
guideline; and requests the director-general to encourage research; provide
technical advice to member states, and report in three years time.
  More  For full coverage of the WHA consideration of CHWs see the PHM item
page
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=2d7a9858f7&e=916df65fd1>,
which includes: summary of issues in focus at the Assembly; background
notes; PHM commentary and the WHO watchers' notes
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=533a9a2802&e=916df65fd1>
of the debate.

Access all of the documents and debates from the World Health Assembly from
the WHO Tracker at who-track.phmovement.org/wha72
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=02a6f58b5c&e=916df65fd1>.
Review previous Update Reports from WHA72 here
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a940101727&e=916df65fd1>.

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