Community health workers (CHWs) are vital to country strategies to achieve universal health coverage (UHC). As health systems come to rely on CHWs to deliver a growing number of interventions and activities, the potential for overburdening them with unrealistic expectations increases. Limited human and financial resources, combined with a lack of tools to operationalize context-specific considerations for planning CHW workload, can lead to wishful thinking when it comes to defining CHW scopes of work, how many CHWs to engage, and expectations for population-level impact.
In terms of how many CHWs to deploy relative to the population size, global benchmarks are difficult to identify, given variability in context and the number and types of services that CHWs may offer. The World Health Organization (WHO) Global Health Worker Alliance’s 2017 review of evidence concluded that the “estimation for an optimal population size would depend on various factors including the number and type of services and the actual time required for CHWs to complete their assigned tasks.”1 The resulting WHO Guideline on Health Policy and System Support to Optimize Community Health Worker Programmes2 suggests that most countries use the criteria outlined below to determine target population size……more