Table 1.

Summary of roles and tasks performed by CHWs in 29 national case studies [19]

Role	Examples of related tasks	Examples of CHW programmes where this is carried out
Community mobilization	Build community awareness for immunization	BRAC’s Shasthya Shebikas mobilize mothers to bring their children to outreach sessions when visiting immunization teams come to the community India’s ASHA workers and Anganwadi workers promote awareness about and participation in national polio immunization days as part of the Global Polio Eradication Initiative CHWs across Africa promote awareness in child health days, at which time immunizations are provided, vitamin A and deworming medicines are given, and commodities such as bed nets are distributed
Health promotion (including health education)	Promotion of healthy household behaviours	Ethiopia’s Women’s Development Army volunteers promote healthy household behaviours Pakistan’s LHWs provide nutrition education
	Family planning education: counselling about birth spacing, family planning, and contraceptives	Afghanistan’s CHWs offer a package of services including health promotion of family planning Bangladesh’s family welfare assistants (FWAs) and BRAC’s Shasthya Shebikas in Bangladesh promote family planning and provide information on how to access services
	Promotion of ANC and PNC	BRAC’s Shasthya Shebikas in Bangladesh; Mozambique’s APEs, Sierra Leone’s CHWs, Zimbabwe’s CHWs
	Promote the utilization of facility-based delivery	India’s ASHAs receive an incentive payment for bringing a woman to a facility for delivery
	Nutrition education: counselling about infant and child feeding (including breastfeeding)	Anganwadi workers in India, Kaders in Indonesia, CHWs in Madagascar
	Promotion of the importance of clean water, sanitation, and hygiene	CHVs in Kenya, CHWs in Sierra Leone
Provision of preventive services	Provision of vitamin A supplementation; oral polio immunization; injectable immunizations; deworming medication; and iron, folate and other vitamins	Shasthya Shebikas and Shasthya Kormis in Bangladesh provide vitamin A supplementation and deworming medication Malawi’s HSAs administer vitamin A supplementation and deworming medication, and they give immunizations as well Nepal’s FCHVs provide deworming medication, vitamin A supplementation, and polio immunization
	Distribute of condoms, insecticide-treated bed nets, oral rehydration salt (ORS) packets	ASCs [community health workers]) in Niger distribute insecticide-treated bed nets Health assistants in Bangladesh distribute ORS packets
Provision of clinical services	Identification of pregnant women and children with warning or danger signs for which treatment should be sought	CHOs in Ghana refer patients needing higher-level care and follow up on those patients who had been referred VHWs in Nigeria refer pregnant women to health facilities
	Management of childhood illness (identification of cases, management of uncomplicated cases, referral of cases with complications)	Integrated management of childhood illness is a common role across CHW programmes, including Ghana’s CHOs, Afghanistan’s CHWs, Niger’s ASCs, and Zimbabwe’s VHWs
	Provision of ANC and PNC	Pakistan’s LHWs coordinate ANC/PNC services
	Provision of basic curative services	Ethiopia’s HEWs provide basic curative services for selected illnesses, including support to people with chronic illness (e.g., HIV/AIDS patients) Zimbabwe’s CHAs provide basic curative care and refer patients to facilities for further treatment, documenting referrals in community health registers Iran’s Behvarzs and Moraghebe-salamats provide management of NCDs such as diabetes and hypertension as well as oral healthcare Programme assistants working with BRAC in Bangladesh evaluate people with eye problems and provide eyeglasses for older patients with presbyopia
	Provision of clinical family planning services: provision of birth control pills, injectable contraceptives, and sometimes placing longer-acting contraceptives such as IUDs and subcutaneous implants	Ethiopia’s HEWs provide a full range of family planning services, including provision of longer-acting contraceptives Ghana’s CHOs provide maternal and reproductive health services as well as management of minor ailments
	Identification of persons with symptoms of TB and referral for further evaluation (or collection of sputum for examination at a TB programme laboratory); provision of directly observed treatment for patients diagnosed with TB	Training packages in Afghanistan have expanded to provide DOT for TB Bangladesh’s Shasthya Shebikas identify suspected TB cases, collect sputum for diagnosis, and provide DOT to diagnosed patients Rwanda’s CHWs support diagnosis and treatment of TB patients
	Provision of first aid for injuries/accidents	Kenya’s CHVs treat common ailments and minor injuries with guidance from the community health extension workers
	Provision of mental health services	Afghanistan’s CHWs provide referral for mental health support, but they are trained to provide direct service provision for those with mental health problems and physical disabilities Indonesia’s Kaders are expanding their roles to include mental health counselling Iran’s Behvarzs and Moraghebe-salamats are trained to manage mental disorders Liberia’s CHAs are trained to identify mental health problems and to identify side effects of mental health medications
Epidemographic surveillance and record-keeping	Household visits for surveillance: maintaining health records and vital event registration, and surveillance of emerging diseases and of disease prevalence	Brazil’s CHAs maintain household registers and visit households monthly Guatemala’s mobile health teams maintain a community census and conduct epidemiological monitoring India’s ASHA workers carry out malaria case identification and screening for NCDs Sierra Leone’s CHWs carry out community-based disease surveillance, making quarterly household visits to promote preventive behaviours, and collect essential demographic information

ANC antenatal care, APE Agents Polivalente Elementare, ASC Agent de Sante Communautaire (Niger), ASHA accredited social health activist, BRAC Building Resources Across Communities, CHA community health agent (in Brazil), CHA community health assistant (in Liberia), CHO community health officer, CHV community health volunteer, CHW community health worker, DOT directly observed therapy, FCHV female community health volunteer, HSA health surveillance assistant, HEW health extension worker, LHW lady health worker, NCD noncommunicable disease, ORS oral rehydration salts, PNC postnatal care, VHW village health worker