Table 2.

Evolution of BRAC’s CHW programme over 60 years (1970–2019)

Characteristic	Evolution over time
Time period	1970–1979	1980–1999	2000–2009	2010–2019	2020–2029
Socioeconomic environment	Extremely poor, with a low literacy level and poor communications infrastructure	Poor but literacy and communication improving	Poor with acceptable literacy and communication networks	Low-income country but developing and urbanizing, with increased access to digital networks	Developing country that has achieved status as a lower middle-income country in process to become an upper middle-income country, population better educated, older, more urbanized, and well connected to digital communications
Stage of development of CHW programme	Experimental, pilot	Embryonic	Expanding	Maturing	Entrepreneurial
Type of CHW envisioned	Empowered woman	Educator and mobilizer	Healthcare service provider	Healthcare service provider who is sustained through cost recovery	Business women who is a service provider who earns the money herself needed to sustain herself
Objective of CHW programme	Empowerment of women (CHWs with access to knowledge, social recognition, and financial inclusion)	Improved child health	Improved access to health services and health information	Improved resilience of community in meeting its health needs	Improved access to quality healthcare through a digitally enabled community-based healthcare system
Nomenclature for CHW cadres	Paramedic, lady family planning officer	Oral therapy extension worker, shebok shebika	Shasthya shebika, shasthya kormi, nutrition promoter	Shasthya shebika, shasthya kormi, programme assistant, mid-level ophthalmic paramedic, midwife, skilled birth attendant	Shasthya shebika, shasthya kormi, programme assistant, mid-level ophthalmic paramedic, midwife, para-psychosocial counsellor
Tasks	Provision of over-the-counter drugs and family planning commodities at the home	Education and mobilization for diarrhoea prevention and treatment, immunization, vitamin A, demand creation for public health services, maternal and adolescent health, and communicable diseases	Promotion of positive health behavior, creation of demand for public and BRAC services, provision of services free of cost at households and outreach points, paper-based data collection	Promotion and demand creation, service provision with service fees, health centre-based service provision, introduction of digital data collection	Promotion, demand creation, service provision, psychosocial counselling, digital real-time recording of demographic and management data
Scope of services	Provision of family planning commodities, treatment of common ailments	Child health (prevention and treatment of diarrhoea, child survival interventions); WASH interventions; ANC, safe delivery, and PNC; adolescent family life education, nutrition supplementation	RMNCH; communicable diseases (TB, malaria); child feeding, dietary diversification, and micronutrient supplementation), eye care	RMNCH, NCDs, nutrition, eye care	RMNCH, NCDs, nutrition, eye care, mental health, early childhood development, food safety, climate change mitigation
Training duration	2 months for basic training with monthly refresher training	1 month of basic training with monthly refresher training	18 days of basic training with monthly refresher training, provision of new knowledge periodically	Basic training over a 2-year period (initial 3 weeks of basic training followed by 3 days of basic training every 3 months for 2 years, and then monthly problem-based refresher training)	Same as in 2010–2019
Training content	Family planning, common ailments	Child health (prevention and treatment of diarrhoea, child survival interventions); WASH interventions; ANC, safe delivery, and PNC; adolescent family life education, nutrition supplementation	RMNCH, communicable diseases (TB, malaria), nutrition and IYCF (promotion of appropriate infant and young child feeding), dietary diversification, and micronutrients; eye care	RMNCH, NCDs, nutrition, eye care	RMNCH, NCDs, nutrition, eye care, mental health, early childhood development, food safety, climate change mitigation
Training methodology	Pedagogy (face-to-face lecture-type learning)	Pedagogy (face-to-face, lecture-type learning) using printed materials, flip charts, and posters	Combination of pedagogy with participatory adult learning using audiovisual aids, simulation games, field placements, and clinical training in health facilities	Subject-based training with lengthy courses of up to 1 year in not duration; specialized training institutes are contracted to give courses	After in-person basic training, digital training is provided depending on skill needs; self-learning provided through a digital platform
Impact	Public health orientation started in the country	Reduced numbers of diarrhoea deaths, reduced night blindness, improved child vaccination coverage, improved ANC coverage	Improved CPR, reduced number of child and maternal deaths, increased case identification and treatment completion of TB, reduced severe malnutrition among children	Use of clinical contraception improved, reduced number of child and maternal deaths, stunting reduced, improved access to treatment for communicable diseases and NCDs, improved access to eye glasses to correct refractive errors and to cataract surgery	Access to quality services improved

ANC antenatal care, CPR contraceptive prevalence rate,IYCF infant and young child feeding, NCDs noncommunicable diseases, PNC postnatal care, RMNCH reproductive, maternal, neonatal, and child health, WASH water, sanitation and hygiene