One Million Community Health Workers

This week for our Data for Decision Making Series, Dr. Henry Perry talks to the Campaign about the challenges of CHW scale-up. Dr. Perry is a Senior Scientist in the Health Systems Program of the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. He is the author or co-author of more than 125 scientific articles and other publications, many of which focus on community-based approaches to improving maternal and child health. He has worked as a consultant with UNICEF, the US Agency for International Development, the Gates Foundation, and many others. Dr. Perry has a special interest in community health workers and their capacity to improve access to health services and improve the health of underserved populations.

1. What are the most pressing challenges in the development of scale-up of CHW programs today?

There are many challenges in the development of CHW programs scale-up. Providing adequate and logical support for medicines and supplies have always been pressing challenges for large-scale CHW programs. Some newer challenges that are being recognized include the need for strong monitoring and evaluation systems and for independent transparent evaluations to guide continual strengthening of large-scale CHW programs. Large-scale CHW programs are complex entities, and expansion or development of such programs is a difficult endeavor that requires thorough and careful planning. Planning demands the involvement of multiple stakeholders from the national to the village level. Finally, the need to assure secure long-term funding for these programs is essential so that they don’t become undercut by short-falls in government budgets and other unstable sources of funding.

2. Why is data on frontline health workers, particularly CHWs, important?

We need to have a better quantification of local need for frontline health workers, including CHWs, and the gaps that remain as the numbers of those health workers grow. Additionally, we also need to better understand what the turnover rates are of frontline healthworkers who leave their positions, and why they are leaving their positions. These data are essential for program planning and program improvement. We also need more research on the cost-effectiveness of large-scale CHW programs¬—studies that describe how well those programs are functioning and how they can be improved. These data are essential for continuing to make the case for the importance of CHWs as a fundamental component of the health system.

3. In your opinion, what are the largest gaps in data on frontline health workers, particularly CHWs, right now?

We need to strengthen our understanding of the current programs. Our knowledge base is not as strong as it should be. How do current CHW programs function? What are their strengths and weaknesses? What about cost? To ensure effectiveness in our future CHW programs, it’s necessary to begin with a clear understanding of current programs. Data is required for continuous improvement. To know what is actually happening requires adequate tracking and monitoring on a continual basis that is informed by evidence from the evaluation, from recommendations generated at the local level, and from evidence generated by the global health community.

4. How can we begin to close those gaps?

More funding for research on large-scale CHW programs and for independent evaluations of those large-scale CHW programs is essential to closing the gaps. Large-scale CHW programs themselves also need support and encouragement to help them strengthen their monitoring and evaluation programs, which is crucial to program strengthening.