Speaking Technically: Analyzing the Gap Between Policy and Practice for Community Health Workers

Around the world, community health workers play an essential role in providing access to the healthcare and information people need to live healthy lives. A new three-part research series, co-authored by a team from Helen Keller Intl, aims to deepen our understanding of community health workers’ responsibilities and capacities, their role in providing lifesaving nutrition interventions, and how they can be better supported and trained.

Following the publication of the first paper in the series, we spoke with Djeinam Toure, Helen Keller’s Global Monitoring, Evaluation, and Research Advisor, and one of the study’s co-authors, to unpack the latest findings.

What is the role of community health workers within a health system?

In much of the world, community health workers are an essential liaison between people and the health system. Globally, there’s a shortage of healthcare providers and limited access to health services. Community health workers are the bridge. They typically live in the areas where they provide services, making them accessible and trusted members of the community. They often offer vital, lifesaving services, such as immunization and nutrition supplementation, and they serve as counselors and sources of trusted information.

What did you learn about community health workers’ activities on the ground from this research?

One of the key questions of the paper was: What services are community health workers providing, and how are they trained? Each country has its own definition of community health workers’ responsibilities and the standards for training and services. Our research looked at policy documents in six countries to compare these to what they are doing on the ground.

We found considerable variability across countries between the actual work performed and their job descriptions. In Kenya and Côte d’Ivoire, for example, the governments have developed specific curricula and criteria for community health workers. But in other countries, like Niger, there’s more ambiguity, meaning community health workers may be operating without a consistent standard.

What does this finding mean for the people we serve?

The question I always ask myself is: How are we going to put ourselves out of business? How do we get to a point where there is no longer a need for development institutions like us? How do we help health systems in Africa and Asia be sustainable without so much outside intervention and ensure people have access to the care they need to live healthy lives filled with potential? Our findings signal a weakness in the current health systems.

Our research suggests that community health workers’ efforts might be dictated, not by national priorities but by the activities of a nongovernmental organization or donors. The inconsistencies we found suggest that Ministries of Health do not have enough oversight and vision to ensure families receive all the needed interventions. Without this central view, health workers can become overloaded, and families can miss out on essential services.

What sets this study apart from other research on community health workers?

We spend a lot of time trying to find ways to make our programs more effective and economical. Yet, community health workers cut across all of our work because they provide the services. That means we need to better understand what they’re doing and what support they need.

The value of this study is being able to compare policy documents in depth. That enabled us to get a bird’s-eye view of what we are asking of these folks and what they do. This first paper in the series needed to answer that question before we could examine community health workers’ roles in providing specific interventions or the training and support needed for their work.

The African Union has pledged to support 2 million community health workers by 2030. What is the significance of that commitment, and how does our research fit within those broader sector efforts?

We already have solutions for many of the key drivers of death and disability in the world. Simple, cost-effective interventions like vitamin A supplementation, comprehensive prenatal vitamins, breastfeeding support, or growing nutritious crops can make a world of difference in improving health and wellbeing. Our creed as humans working in development is to bridge the gap – to ensure these health interventions are implemented at scale, so more people can live better lives.

The African Union’s commitment to investing in community health workers is tremendously significant because they are the platform to deliver the solutions. Our next step is to understand how to make the platform operational. Our research will help us understand what health workers need to do their jobs and improve access to services.

How will Helen Keller use these findings to inform our advocacy or programmatic priorities?

Institutionally, we’re taking a step back to think about health systems strengthening more deliberately to become less siloed. We sometimes think of nutrition versus neglected tropical disease work as very different. But for the person receiving the services – whether that’s vitamin A or trachoma treatment – they’re interfacing with one human being: the community health worker.

Our goal is to generate useful evidence to help us consider how we can impact and build health systems through our interventions. At the end of the day, it’s about leaving the health systems stronger, so that 35 years from now, our kids are not trying to fix the exact same problems.