CHW initiative Towards sustainable cadre of CHW 7 January 2015 DPG-Health meeting

Policy Background No clarity on: – Who are the CHWs? – Selection criteria – Training – Role and responsibilities – Supervision systems MMAM – 2 CHWs per village

Background Many different types/names of CHWs and alike mostly trained and funded by partners. – For; HIV, malaria, MNCH, WASH, Social welfare, etc. No standard in ToR and training. Different remuneration.

CBHP policy guideline Developed in collaboration with development partners Stakeholders consultation and participation at all stages Endorsed by the MoHSW, signed as official government policy document The guideline managed to fill the policy gap -Provide policy clarity to operationalize community health programmes -Define explicitly CHWs, package of services, formalization and remuneration, supporting systems for supervision and reporting

CHW scheme Situation assessment and stakeholders consultations National TF for community health initiatives was formed and operational – Coordination of consensus building process for CHW modal to scale Consensus – expand existing ‘Medical Attendant’ cadre to 3-arms Medical Attendant (Health Aids) Community Health Attendant Social Welfare Attendant HF Medical Attendant

CHW scheme... TF wrote proposal on extension of MA cadre to CHA, SWA and HF-MA Proposal presented to and endorsed by MoHSW management meeting Proposal submitted to PO-PSM and agreed, recommended to update MA curriculum to operationalize the 3 arms NACTE led the curriculum development Consultations with relevant MDAs and Devpt partners

CHW Scheme.. Curriculum development; – Final draft submitted to MoHSW HPES – Stakeholders consultation and finalization, re-submission to NACTE for endorsement – Curriculum is expected to: -Operationalize CHW as health cadre with scheme of service -Detail essential skills needed (NACTE), training modalities, roles and responsibilities (JD), and career development

CHW scheme.. Pending work for 2015 – Development of training materials o Facilitator guide and student manuals – Translation of curriculum and training materials into Swahili – Capacity assessment of training centres to deliver quality CHW training – Orientation of tutors on curriculum and training materials – Implementation of the CBHP

DP’s concerns 1) the role of new CHW cadre (Health Aids) for curative services (iCCM/IMCI and others). 2) the relation/implication of existing CHW/VHW (incl RMNCH package with 3 wk training by RCHS) and new Health Aids with 1yr training. Transition/phase out plan? 3) the structure and supervision/reporting of the new Health Aids by health facility and the relation with village government, 4) the relation of three types of Health Aids (training, posting, reporting), 5) costing the CHW strategic plan and analyse the financial implication with other HRH plan is necessary. 6) How does it fit in HSSP IV?

A meeting on 16 Dec. It is meant for standardizing the training and qualification. They can be employed by any organization. Curative aspect is not specific. No clear plan of transition from existing CHW to new ones. No specialization to three types of Health Aids.

Opportunities 1 million CHWs initiative/campaign – advocate for national integrated CBHP Costed strategic plan for implementation of CBHPs Options for financing CHWs – Councils own resources HSSP IV – Incorporate CHWs as HRH cadre

Challenges Government buy-in – Cost associated Training o Large number of CHWs o Duration of training – NACTE requirements for career development o Production of harmonized resource materials o Capacity of training centres Remuneration (salaries, benefits, career ladder – NACTE requirements) – Sustainability Financing the training and remuneration