As the global community aims to fulfill its commitments to the UN Sustainable Development
Goals, and the achievement of universal health coverage, dozens of countries have committed to
the expansion of community health workers (CHWs) as the front line of their healthcare systems. Robust research demonstrates CHWs improve access to care, reduce maternal, newborn,
and child mortality, improve clinical outcomes for chronic diseases, and prevent disease
outbreaks.
But there remains an important opportunity to improve the status quo approach to
implementing national-scale CHW programs. While ample, high-quality evidence exists that
small-scale CHW programs can reduce morbidity and mortality, three studies of CHW scale-up
conducted in Burkina Faso, Ethiopia, and Malawi in 2016 documented limited access, quality, and
mortality impact. The impact of these programs, and those of the dozens of other countries
currently revamping their own national CHW programs, could be optimized if the most recent
evidence and global best practices were incorporated into design and implementation.
To support the operationalization of quality CHW program design and implementation, USAID,
UNICEF, the Community Health Impact Coalition, and Initiatives Inc. have updated and adapted
the Community Health Worker Assessment and Improvement Matrix (CHW AIM) Program
Functionality Matrix. This tool can be used to identify design and implementation gaps in
both small- and national-scale CHW programs, and close gaps in policy and practice.
