Training and supervision of Community Health Workers conducting population-based, noninvasive screening for CVD in LMIC

Background: Community health workers (CHWs) can screen for cardiovascular disease (CVD) risk as well as health professionals using a non-invasive screening tool (data unpublished). However, this demonstrated success does not guarantee effective scaling of the intervention to a population level.

Objectives: To report lessons learned from supervisors’ experiences monitoring CHWs and perceptions of other stakeholders regarding features for successful scaling of interventions which incorporate task-sharing with CHWs.

Methods: We conducted a qualitative analysis of in-depth interviews to explore stakeholder perceptions. Data was collected through interviews of 36 supervisors and administrators at non-governmental organizations contracted to deliver and manage primary care services using CHWs, directors and staff at the government health care clinics, and officials from the departments of health responsible for the implementation of health policy.

Results: CHWs are recognized for their value in offsetting severe human resource shortages and for their expert community knowledge. There is a lack of clear definitions for roles, expectations, and career paths for CHWs. Formal evaluation and supervisory systems are highly desirable but nonexistent or poorly implemented, creating a critical deficit for effective implementation of programs utilizing task sharing. There is acknowledgement of environmental challenges (e.g. safety) and systemic challenges (e.g. respect from trained health professionals) that hamper the effectiveness of CHWs. The government-community relationships presumed to form the basis of redesigned health care services have to be supported more explicitly and consistently on both sides in order to increase the acceptability of CHWs and their effectiveness.

Conclusions: The criteria critical for successful scaling of CHW led screening are consistent with evidence for scaling up communicable disease programs. Policy makers have to commit appropriate levels of resources and political will to ensure successful scaling of this intervention.