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According to the 2006 World Health Report, Working Together for Health, there is an estimated shortage of 4.3 million health workers worldwide. The global shortage of skilled, motivated and supported health workers is a key development challenge and a barrier to strengthening health systems, improving the prospects for universal health coverage and addressing inequity and poverty around the world.
The U.S. Government has a notable history of addressing the challenges of the health workforce in low- to middle-income countries (LMICs). An important dimension of the U.S. Government response has been a resurgence of interest in and attention to community health workers (CHWs). Many countries are increasing their investments and implementing large-scale CHW programs to extend the reach of inadequate health systems to hard-to-reach and underserved populations, and to expand coverage of key interventions. However, more evidence is needed to understand how best to support CHWs to ensure scale up and sustained, optimal performance. Recognizing the need for greater clarity, USAID initiated a year-long evidence review process that culminated into a 2-day Evidence Summit event.
From May 31 to June 1, 2012, approximately 150 participants from LMIC governments and non-governmental organizations, the U.S. Government and non-governmental agencies, bilateral and multilateral agencies, and domestic and international academic institutions assembled in Washington, D.C., to discuss existing evidence and make recommendations for policy, practice and future research.
The following recommendations emerged:
- Develop a strategic research agenda that provides greater clarity on how to enhance CHW performance. The agenda should examine the combined inputs from both community and formal health systems.
- Consider innovative research designs and methodologies to answer complex questions about performance, scale-up and increased capacity building to ensure research is driven by local investigators.
- Invest in research that examines the intended and unintended impact of scaling up CHW programs.
- Develop a robust logic model targeting country policymakers and donors that captures the summit’s key learnings and best practices and lays out ways to improve CHW performance.
- Identify a more coordinated approach to sound stewardship of CHWs at the country and global levels.
Several publications that build on these recommendations and present case studies are being considered for publication.
Evidence Summit Resources:
- Keynote Address by Deputy Administrator Donald Steinberg
Evidence Summit Final Report [PDF, 1.2MB]
- Evidence Review Team 1 (Community Support) Synthesis Paper [PDF, 1MB]
- Evidence Review Team 2 (Formal Health System Support) Synthesis Paper [PDF, 651KB]
- Evidence Review Team 3 (Community and Formal Health System Support) Synthesis Paper [PDF, 600KB]
- CHW Central is an online resource for information and dialogue about CHWs, hosted by USAID’s Health Care Improvement Project.
- Global Health Workforce Alliance Knowledge Center is an online library of resources related to human resources for health crisis in low- and middle-income countries, hosted by the Global Health Workforce Alliance.
Last updated: February 22, 2013