By Joanna Raven and Kate Hawkins*
Working with community health workers (CHWs) is seen as a good solution to the problem of a shortage of formal health workers and the push to scale up of programmes to meet universal health coverage.
But how do you attract, retain and support CHWs? Who manages CHWS and how do they support them in their vital role of serving their communities?
We set out to explore human resource management practices used for supporting and managing health workers, considering the views from CHWs, community members, and formal health workers in Ghana, Democratic Republic of Congo, Senegal, Uganda and Zimbabwe.
Who manages CHWs?
Frontline supervisors, such as health centre nurses, and senior CHWs play a major role in the management of CHWs and are central to the implementation of human resource management practices. Some support from the community is provided through health centre committees – such as helping select CHWs, discussion of health issues and planning CHW activities. However, in some contexts such as DRC, Uganda and Zimbabwe this support is minimal.
What do CHWs expect from their role in health care?
CHWs’ expectations from the role ranged from serving the community, enhancing their knowledge and skills, receiving financial benefits, being recognized in the community as a health worker, having social status and prestige in the community, and their role fitting in with other work such as family, home and other paid work.
How well do current human resource management practices meet these expectations?
CHW expectations are not always met through human resource management practices. For example help with farming to free up the time to carry out healthcare work did not materialise in Ghana. Incentives for carrying out health campaigns in DRC were too small and too late and therefore not sufficient to achieve the desired performance. Human resource management practice by managers had not sufficiently controlled the workload to enable CHWS to carry out their personal tasks such as farming, causing some CHWs wanting to leave.
What could be done?
Managing CHW programmes is complex if the aim is to foster ownership by the communities being served as well as delivering quality services. What is therefore needed is a coordinated human resource management approach which is designed to not only address CHW expectations but also to ensure that the programme meets its goals. There is a need to work with all management actors (programme managers, supervisors, community level managers and others involved) to put this in place and implement it.
This would include:
Getting a better understanding of the expectations of CHWs so that human resource practices meet their needs
Increasing clarity at the recruitment stage about which CHW expectations can and cannot be met
Joint use of human resource management practices by community and health sector representatives, monitoring the effects and making necessary adjustments to these practices for CHWs
Documenting what works, under what circumstances to increase learning about supporting CHWs to improve the health of their communities.
Learn more about our findings in this short brief. A journal article was published in September 2015 as part of a special collection on community health workers which is supported by the Thematic Working Group on Supporting and Strengthening the role of Community Health Workers in Health System Development.
Or chat with us about how to support CHWs on twitter @joanna_raven or by e-mail: Joanna.Raven(at)lstmed.ac.uk
* Dr Joanna Raven is a Lecturer in Health Systems at the Liverpool School of Tropical Medicine and a member of Health Systems Global.
Kate Hawkins is the Director of Pamoja Communications.
Photo credit: UNICEF / Nesbitt