Establishing Career Pathways for Community Health Workers – Models and Key Considerations

CHWs contribute to equitable primary health care by serving as frontline providers for underserved, marginalized, and hard-to-reach populations, supporting referrals, improving continuity of care, and promoting health-seeking behavior in a culturally appropriate manner. Despite their value, CHWs' roles are often loosely codified, inconsistently remunerated, and poorly integrated into formal health systems, with 50% of CHWs in LMICs serving as volunteers and receiving little to no compensation. The World Health Organization (WHO) recommends focusing on career pathways for improved integration and optimization of CHW programs, and the 2023 Monrovia Call to Action emphasizes the need for career progression opportunities as part of professionalizing CHWs. However, few programs exist that integrate CHWs into national health systems and have established career pathways, limiting evidence and learning around designing and operationalizing career progression for CHWs. The USAID Local Health System Sustainability Project (LHSS) is addressing these knowledge gaps through a multi-phased activity, with the aim of providing evidence-based and contextually tailored technical assistance to support CHW career-progression opportunities in three LMICs. A rapid desk review conducted by LHSS identified 171 articles from countries at all levels of socioeconomic development status, which were included in the final analysis. The review found that countries have used various models to establish career pathways for CHWs, including formal education and training programs, job descriptions, supervision and mentoring structures, performance management, and professional and career development. The review also identified systems considerations for CHW career progression, including health workforce education and training, regulation and policy, management, and financing. A convening of experts working in the community health arena was also conducted, with 50 participants representing 10 countries attending the virtual experts convening. Participants discussed LHSS's desk review findings and shared their perspectives on facilitators and barriers, promising practices, and other cross-cutting considerations such as financing and data for designing and implementing career pathways for CHWs. The convening highlighted the importance of addressing the lack of standardized definitions for CHWs and the existence of different CHW typologies across countries. The findings of the desk review and convening of experts are intended to serve as an evidence-based resource for LHSS's technical assistance to partner countries and inform decision makers within LMICs and the broader global health community working on design and implementation for CHW career progression. LHSS plans to publish a series of spotlight briefs on this topic in phase 3 of the activity, which will synthesize learning from its phase 2 technical assistance and explore considerations for CHW career progression in more depth. The LHSS's operational definition of key terms for the purposes of this brief includes community health workers as health care providers who live in the community they serve and receive lower levels of formal education and training than other health care workers. Professionalization refers to processes to formalize CHWs as a health cadre with distinct professional value and roles, including establishing pre-service requirements, job descriptions, supervision and mentoring structures, performance management, and professional and career development. Career pathway refers to a clearly defined and established sequence of positions that align with CHW skills and competencies to guide upskilling and upward career mobility. Career progression refers to advancement or change to a different role with different scope based on set qualifications related to training and years of service.