Table 2.

Community health worker (CHW) programme design and implementation issues to be considered in policy development

Design issues	Implementation issues	Key questions for policy development (from Perry et al6 2014, chapters 8–11)
Recruitment: Align job requirements with job descriptions and skills profile across all cadres. Explore whether there is a pool of people eager to become CHWs and what motivates them. Ensure recruitment processes are transparent, well-thought through and clearly communicated.	Recruitment: The recruitment process and criteria are clearly communicated and understood by communities and pool of potential applicants. Relevant community structures are involved in recruitment and selection. Recruitment criteria and processes are adhered to.	What are the specific recruitment needs for the CHW programme? What are the CHW selection criteria? What is the CHW recruitment process? How do available resources influence CHW recruitment?
Training: Initial and continuing education frameworks, structures and processes are put in place. Relevant and appropriate training materials are developed in the local language. Issues of certification and accreditation are attended to.	Training: Trainers and training materials are available (in the relevant local language). Training is adapted to the needs of trainees locally, their roles and local contexts. Trainees are able to attend training. There are opportunities for continuing education.	What sort of CHW and training programme is being planned? What level of education will be required for entry to the programme? How should the training programme be organised? Who should be responsible for the governance and management of the training programme? How can optimal performance be achieved through training?
Supervision and support: Supervisions requirements are adequately understood and resourced. Supervisors are identified and designated.	Supervision and support: Supervisors are available, trained and aware of their responsibilities. Supervisors have the relevant tools, equipment, infrastructure (eg, transport) and support to fulfil their role. Supervision is considered a priority.	What are the objectives of CHW supervision? Is there a functioning PHC supervision system and can it be adapted/expanded to include CHWs? Are there supervision standards and guidelines for CHW performance? Do the financial resources exist to sustain a CHW supervision system?
Incentives: Incentive structure and mix have been discussed and planned for. Adequate resources for incentives are in place. Mechanisms to make incentives available are in place, whether for financial payments or non-financial incentives. Formalised remuneration.	Incentives: Incentives are understood and accepted by local stakeholders and CHWs. Incentives (whether monetary or other) are regularly, reliably and fairly disbursed. There is no nepotism or corruption in the handling of incentives. Inclusion in the payroll.	What forms of incentives are there? What are the decisions related to incentives that need to be made? What incentives are culturally, socially and financially acceptable among CHWs? What are different stakeholders’ expectations with regard to incentives?
Career pathways: If possible, career paths for different cadres of CHWs are developed to allow for advancement and progression (and thus improving retention).	Agreements between the government, Ministry of Health, professional regulatory bodies and training institutions have been put in place.

PHC, Primary Health Care.