Over the past few decades, many countries have lacked cohesive community health policies, strategies, and guidelines, resulting in systems that are fragmented, poorly integrated with national health systems, and unable to reach scale. For years, countries have had limited access to global data and evidence to inform community health program design and implementation. In 2014, APC launched the Community Health Systems Catalog as a resource for 25 countries deemed priority by USAID’s Office of Population and Reproductive Health. Updated in 2016–2017, the CHS Catalog contains information from community health policies, with a focus on community health workers (CHWs) and over 130 community-based interventions. The CHS Catalog provides an evidence base to inform, strengthen, and harmonize future policy efforts to advance global and national efforts to strengthen community health systems. Specifically, findings help answer key questions about community health policies. For example, which services can CHWs provide? How is community data supposed to be used? What is the community’s role in managing health programs? The CHS Catalog illustrates the breadth and diversity of CHWs – including their various tasks, skills, and characteristics across countries and regions. At the same time, the definition of a CHW still lacks consistency, and greater alignment and clarity of terminology is needed to inform the global conversation on CHWs. Guidance on applying more consistent definitions, such as the forthcoming WHO CHW Guidelines, should provide policymakers, program planners, implementers, and donors with the language to better convey information on best practices, experiences, and lessons in community health. Presented by Kristen Devlin at the Fifth Global Symposium on Health Systems Research in Liverpool this October.

1. Introduction
Selected by
the community
43%
Information
not available
20%
Recruited by national or
subnational authorities
15%
Application
by candidate
2%
Through a
combination
of ways
20%
Both financial and
nonfinancial
60%23%
Information not available
10%
Financial only
Nonfinancial only
7%
The CHS Catalog Includes
Data from 25 Countries
How are CHWs selected?
What incentives do CHWs receive?
The WHO Health
Systems Framework
Building Blocks and
Cross-cutting Areas
Over the past few decades, many countries have lacked
cohesive community health policies, strategies, and
guidelines, resulting in systems that are fragmented, poorly
integrated with national health systems, and unable to reach
scale. For years, countries have had limited access to global
data and evidence to inform community health program
design and implementation.
In 2014, APC launched the Community Health Systems Catalog
as a resource for 25 countries deemed priority by USAID’s
Office of Population and Reproductive Health. Updated in
2016–2017, the CHS Catalog contains information from
community health policies, with a focus on community health
workers (CHWs) and over 130 community-based interventions.
Key Findings
Countries had extensive community health systems guidance,
often spread across a range of policies. The extent to which
policies were clear and comprehensive varied widely across
countries.
LEADERSHIP & GOVERNANCE: Common stakeholders
responsible for community health leadership, management,
and governance included community leaders and commit-
tees; civil society groups; CHWs and other health workers;
and district officers and management teams. While policies
outlined respective roles and responsibilities, there was
often overlap among the stakeholders. In many countries,
details on how a large number of stakeholders should
collaborate were unclear.
FINANCING: Community health programming was financed
through an array of sources and mechanisms (e.g.,
governments, NGOs, donors, out-of-pocket fees), but few
policies had information about long-term financing for
community health programs. Seven countries (28%) had
policies describing specific community-based financing
schemes: Madagascar, Mali, Nepal, the Philippines, Rwanda,
Senegal, and Tanzania.
SERVICE DELIVERY: All countries had policies guiding
community-based interventions across a range of health
areas, but there were certain gaps within individual programs.
For example, some countries had policies covering a wide
range of family planning methods, but many did not have
guidance for natural methods and emergency contraception.
SUPPLY MANAGEMENT: 24 countries (96%) had guidance
for CHW management and resupply of commodities, medi-
cines, and equipment. Only eight countries (32%) included
strategies for how CHWs were to manage stockouts, such as
accessing buffer stock from NGOs or borrowing from other
CHWs. 15 countries (60%) had guidance for how CHWs
should dispose of medical waste.
INFORMATION SYSTEMS: Policies directed CHWs to collect
data on health behaviors and practices, activities conducted,
service delivery, life events, commodity management, and
disease surveillance. 17 countries (68%) had guidance for
data sharing and use by communities. 21 countries (88%)
had policies that mentioned integrating community data
into national health information systems.
HUMAN RESOURCES: There were 60 CHW cadres across
25 countries, with an average of 2–3 per country. Definitions
of CHWs varied greatly. Often, countries with more than
one cadre had a dual or multi-tiered model. Considerable
information was available on many CHW program inputs
(scope, selection, remuneration, training, supervision, etc.),
but was often incomplete or lacked details on the processes
by which they were to take place. Many countries failed to
specify the number of existing or required CHWs in the
country; only 8 countries had both numbers for at least one
of their CHW cadres.
Example CHW policy findings:
- Common selection criteria included selection by
community, residence, age, gender, and education level.
- More than two-thirds of CHWs received a combination of
financial and nonfinancial incentives. 20 cadres received
salaries, which ranged from $63 to $157 US per month.
- Each CHW provided services to between 275 and
75,000 people
Approach
Discussion
The CHS Catalog provides an evidence base to inform,
strengthen, and harmonize future policy efforts to advance
global and national efforts to strengthen community health
systems. Specifically, findings help answer key questions about
community health policies. For example, which services can
CHWs provide? How is community data supposed to be used?
What is the community’s role in managing health programs?
The CHS Catalog illustrates the breadth and diversity of CHWs
– including their various tasks, skills, and characteristics across
countries and regions. At the same time, the definition of a
CHW still lacks consistency, and greater alignment and clarity
of terminology is needed to inform the global conversation on
Since 2012, Advancing Partners & Communities
(APC) has supported community health programs
globally. APC develops practical tools and
approaches to help global and national level
stakeholders overcome knowledge and
programming gaps to harmonize and scale
community health programs.
In light of renewed dialogue about the importance of strong
and resilient community health systems, APC sought to
understand: 1) the existing landscape of policy guidance for
community health; and 2) common policy gaps that need
attention to better guide planning and implementation of
community health systems strengthening efforts. This information
can support countries as they develop community health policies
and other frameworks to achieve objectives, such as universal
health coverage and the Sustainable Development Goals.
CROSS-CUTTING AREAS: Most policies mentioned
community engagement, gender, and multi-sectoral
engagement.
Examples:
• 15 countries (60%) defined the role of community groups
in health service quality improvement, and 10 (40%)
described how community groups can be incentivized.
• 9 countries (36%) have female-only CHW cadres.
• The most common sectors linked to community health
programs were education, finance, agriculture, and the
private sector.
Leadership &
governance
Health
financing
Human
resources for
health
Service
delivery
Health
information
systems
Supply
management
Community
engagement
Multi-
sectoral
engagement
Gender
How many beneficiaries does each CHW reach?
CHWs. Guidance on applying more consistent definitions, such
as the forthcoming WHO CHW Guidelines, should provide
policymakers, program planners, implementers, and donors with
the language to better convey information on best practices,
experiences, and lessons in community health.
It is clear that community health guidance is often scattered
across documents and is vague and/or incomplete, suggesting
that as early as the design stage, policies and roadmaps for
community health systems often fail to include sufficient detail
to guide optimal program planning and implementation.
Recommendations for policymakers and program planners include:
• More clearly delineate roles and responsibilities for community
health governance, management, and coordination.
Kristen Devlin | Kimberly Farnham Egan | Tanvi Pandit-Rajani | Elizabeth Creel
JSI Research & Training Institute, Inc., 1616 Fort Myer Drive, 16th Floor, Arlington, VA, USA
Community Health Systems Catalog
The One-Stop Shop for Community Health
Information across 25 Countries
The CHS Catalog was informed by a survey comprising 121
open– and closed-response questions, organized by the
WHO health systems building blocks. In-country experts and
APC staff reviewed over 100 community health policies,
strategies, curricula, and other documents to complete the
questionnaire. Country authorities vetted policies when
possible. APC staff performed data quality checks, and
cleaned and analyzed data in Microsoft Excel. Quantitative
responses were tabulated by question, and qualitative
responses were organized by themes, assigned secondary
categories, and
tabulated. Findings
were identified
from selected
questions from
each building block
category and three
cross-cutting
areas: gender, and
community and
multi-sectoral
engagement.
• Provide guidance on linking policy and program inputs to
costed implementation plans, realistic budgets and community-
based financing mechanisms.
• Provide more robust guidance for managing and using data.
• Engage community members and other subnational health
actors in the policy design process to ensure comprehensive
guidance driven by local input.
FURTHER INFORMATION
Explore the full CHS Catalog, including 25 country profiles, a visual document
on cross-country policy trends, a list of key community health policies, and
other content: www.advancingpartners.org/resources/chsc
Number of Countries with Policies that Permit
CHWs to Provide Family Planning Methods
235 1,375 7,500
Min.People Med. Max.
Afghanistan, Bangladesh, Benin, Democratic Republic of the Congo, Ethiopia,
Ghana, Haiti, India, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique,
Nepal, Nigeria, Pakistan, Philippines, Rwanda, Senegal, Sierra Leone, South
Sudan, Tanzania, Uganda, and Zambia
13
12 13
11
1
4
21
10
25 25 25
20
5
21
4
22
3
2
9
14
15
Info on
Standard
Days Method
CycleBeadsInfo on
Lactational
Amenorrhea
Method
Other Fertility
Awareness
Methods
Condoms Oral
Contraceptive
Pills
Injectables Implants IUDsEmergency
Contraceptive
Pills
Permanent
Methods
Yes, policies allow No, policies do not allow Information unavailable or unclear