Strengthening the Performance of Community Health Workers in Primary Health Care

This document describes a study that investigated the reasons for the frequent failure of national health systems based on primary health care to make effective use of community health workers. The report assesses different national experiences in order to pinpoint weaknesses, trace key mistakes, and define corrective actions. The report opens with a brief historical overview of problems that have arisen in the use of community health workers and reasons for these problems. Noting that governments frequently fail to decide what community health workers are expected to achieve, the second section proposes an explicit definition of the place, role, and functions of community health workers within the context of a national health system. The report then identifies and explores eight weaknesses, ranging from policy and organizational errors that have built failure into the system to problems of poor selection, insufficient training, inadequate motivation, and lack of reward. Strategies to overcome each problem are proposed. Specific recommendations drawn from national experiences are also included. The final sections condense the contents into a series of conclusions and recommendations intended to guide the reshaping of national programs. Eight references and a 59-item reading list conclude the document. (KC)