<div dir="ltr"><div class="gmail_default" style="font-size:large"><br></div>From: <b class="gmail_sendername" dir="auto">WHO Watch - PHM</b> <span dir="auto"><<a href="mailto:dlegge@phmovement.org">dlegge@phmovement.org</a>></span><br><div class="gmail_quote"><br><br><u></u>

    
        
        
        
        
        
        

    
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                            <div style="text-align:center"><a href="https://mailchi.mp/a4fe4b3618d2/new-who-guideline-on-community-health-workers-welcomed-at-wha72?e=916df65fd1" style="color:#656565;font-weight:normal;text-decoration:underline" target="_blank">View this email in your browser</a></div>

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                            <h1 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:26px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">New 'guideline' on community health workers welcomed by World Health Assembly</h1>
Among the documents prepared for the Astana Conference on Primary Health Care (PHC) in October 2018 was a new <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=e56687e526&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">'guideline' on community health workers</a> (CHWs).<br>
<br>
A guideline<span class="gmail_default" style="font-size:large">,</span> in WHO practice<span class="gmail_default" style="font-size:large">,</span> is expert<span class="gmail_default" style="font-size:large">-</span>created and evidence<span class="gmail_default" style="font-size:large">-</span>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.<br>
<br>
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.<br>
<br>
The Guideline, as summarised in <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=fc8ac37d70&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">A72/13</a> (paras 10 & 11), concludes that:

<ul>
        <li><i>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<span class="gmail_default" style="font-size:large">,</span> but are not necessarily replica<span class="gmail_default" style="font-size:large">ble</span>. Policy options for which there is greater evidence of effectiveness are known<span class="gmail_default" style="font-size:large">,</span> 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. </i></li>
        <li><i>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.</i></li>
</ul>
The summary of the Guideline in <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=82e6fb331b&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">A72/13</a>:

<ul>
        <li>lists 6 key principles which should be realised in CHW programs;</li>
        <li>lists 7 policy recommendations (selection, certification, supervision, compensation, entitlements, career development, service delivery models);</li>
        <li>lists key actions for the design and implementation of CHW program<span class="gmail_default" style="font-size:large">mes</span> at the national level, and for international organisations (donors and IGOs).</li>
</ul>
CHWs<span class="gmail_default" style="font-size:large">,</span> and the Guideline in particular<span class="gmail_default" style="font-size:large">,</span> were widely supported in the WHA debate.

<ul>
        <li>Togo spoke about involving CHWs in childhood diarrhoea, malaria and under-nutrition.</li>
        <li>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.</li>
        <li>Angola described the role of CHWs in recent outbreaks of cholera and measles.</li>
        <li>India spoke about the role of its ASHA program (accredited social health activists) in the context of its National Rural Health Mission.</li>
        <li>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.</li>
        <li>Zimbabwe spoke about the vital role of CHWs in Zimbabwe but emphasised the unsustainability of there being seen as volunteers rather than health workers.</li>
        <li>Dominican Republic spoke more positively about voluntary roles emphasising recognition and the satisfaction of serving the community.</li>
        <li>Sri Lanka described CHWs as being the success story of PHC in Sri Lanka.</li>
        <li>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.</li>
        <li>Iran spoke about the risk of overburdening the CHW as many programs seek to involve CHWs in their delivery.</li>
        <li>A number of nonstate actors also spoke in favour of the roles that CHWs can play.</li>
</ul>
The draft resolution, which had been recommended from the Executive Board in EB 144.R4 was adopted without amendments. The resolution (<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=6411839479&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">here</a>) 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.<br>
 
<h2 class="m_-9050566860021240538null" style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:22px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">More </h2>
For full coverage of the WHA consideration of CHWs see the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=2d7a9858f7&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">PHM item page</a>, which includes: summary of issues in focus at the Assembly; background notes; PHM commentary and the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=533a9a2802&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">WHO watchers' notes</a> of the debate.<br>
<br>
Access all of the documents and debates from the World Health Assembly from the WHO Tracker at <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=02a6f58b5c&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">who-track.phmovement.org/wha72</a>. Review previous Update Reports from WHA72 <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a940101727&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">here</a>.

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Spread the word</h2>
The purpose of WHO Watch is to contribute to democratising global health governance, through new alliances and new information flows. You can help by forwarding our updates, disseminating on social media and inviting others to <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=bee4a60b72&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">subscribe to the Updater</a>.<br>
<br>
WHO Watch is a project of the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=8a0e844b5e&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">People's Health Movement</a> in cooperation with <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=08e234805b&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Medicus Mundi International</a>, <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=d699443f1d&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Third World Network</a> and a number of other civil society networks.

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                                        WHO Tracker / People's Health Movement · P.O. 13698, St. Peter's Square, Mowbray · Cape Town, Western Cape 7705 · South Africa
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