Towards sustainable cadre of CHW
7 January 2015
• No clarity on:
– Who are the CHWs?
– Selection criteria
– Role and responsibilities
– Supervision systems
• Many different types/names of CHWs and
alike mostly trained and funded by partners.
– For; HIV, malaria, MNCH, WASH, Social welfare,
• No standard in ToR and training.
• Different remuneration.
CBHP policy guideline
• Developed in collaboration with development partners
• Stakeholders consultation and participation at all stages
• Endorsed by the MoHSW, signed as official government
• The guideline managed to fill the policy gap
- Provide policy clarity to operationalize community health
- Define explicitly CHWs, package of services, formalization
and remuneration, supporting systems for supervision
• Situation assessment and stakeholders consultations
• National TF for community health initiatives was
formed and operational
– Coordination of consensus building process for CHW
modal to scale
• Consensus – expand existing ‘Medical Attendant’
cadre to 3-arms
Community Health Attendant
Social Welfare Attendant
HF Medical Attendant
TF wrote proposal on extension of
MA cadre to CHA, SWA and HF-MA
Proposal presented to and
endorsed by MoHSW management
Proposal submitted to PO-PSM and
agreed, recommended to update
MA curriculum to operationalize
the 3 arms
NACTE led the
relevant MDAs and
• Curriculum development;
– Final draft submitted to MoHSW HPES
– Stakeholders consultation and finalization, re-submission to
NACTE for endorsement
– Curriculum is expected to:
- Operationalize CHW as health cadre with scheme of
- Detail essential skills needed (NACTE), training
modalities, roles and responsibilities (JD), and career
• Pending work for 2015
– Development of training materials
o Facilitator guide and student manuals
– Translation of curriculum and training materials into
– Capacity assessment of training centres to deliver quality
– Orientation of tutors on curriculum and training
– Implementation of the CBHP
1) the role of new CHW cadre (Health Aids) for curative
services (iCCM/IMCI and others).
2) the relation/implication of existing CHW/VHW (incl RMNCH
package with 3 wk training by RCHS) and new Health Aids with
1yr training. Transition/phase out plan?
3) the structure and supervision/reporting of the new Health
Aids by health facility and the relation with village
4) the relation of three types of Health Aids (training, posting,
5) costing the CHW strategic plan and analyse the financial
implication with other HRH plan is necessary.
6) How does it fit in HSSP IV?
A meeting on 16 Dec.
• It is meant for standardizing the training and
• They can be employed by any organization.
• Curative aspect is not specific.
• No clear plan of transition from existing CHW
to new ones.
• No specialization to three types of Health
• 1 million CHWs initiative/campaign
– advocate for national integrated CBHP
• Costed strategic plan for implementation of CBHPs
• Options for financing CHWs
– Councils own resources
• HSSP IV
– Incorporate CHWs as HRH cadre
• Government buy-in
– Cost associated
o Large number of CHWs
o Duration of training – NACTE requirements for
o Production of harmonized resource materials
o Capacity of training centres
• Remuneration (salaries, benefits, career ladder
– NACTE requirements)
• Financing the training and remuneration