Abstract
BackgroundEnsuring that selection processes for Community Health Workers (CHWs) are effective is important due to the scale and scope of modern CHW programmes. However they are relatively understudied. While community involvement in selection should never be eliminated entirely, there are other complementary methods that could be used to help identify those most likely to be high-performing CHWs. This study evaluated the predictive validity of three written tests and two individual sections of a one-to-one interview used for selection into CHW posts in eight areas of Kenya.MethodsA cohort study of CHWs working for Living Goods in eight local areas of Kenya was undertaken. Data on the selection scores, post-training assessment scores and subsequent on-the-job performance (number of household and pregnancy registrations, number of child assessments, proportion of on-time follow-ups and value of goods sold) were obtained for 547 CHWs. Kendall’s tau-b correlations between each selection score and performance outcome were calculated.ResultsNone of the correlations between selection scores and outcomes reached the 0.3 threshold of an “adequate” predictor of performance. Correlations were higher for the written components of the selection process compared to the interview components, with some small negative correlations found for the latter.ConclusionsIf the measures of performance included in this study are considered critical, then further work to develop the CHW selection tools is required. This could include modifying the content of both tools or increasing the length of the written tests to make them more reliable, for if a test is not reliable then it cannot be valid. Other important outcomes not included in this study are retention in post and quality of care. Other CHW programme providers should consider evaluating their own selection tools in partnership with research teams.
Highlights
Ensuring that selection processes for Community Health Workers (CHWs) are effective is important due to the scale and scope of modern CHW programmes
Such a selection process may help potential CHWs make an informed decision about their career path by increasing their knowledge of the role, as the selection process may include a briefing about the role and/or introduce applicants to the nature of the role through the scenarios included in the selection assessments
The results suggest that CHWs aged between 30 and 40 and those with higher levels of education generally had the highest job performance; the authors hypothesise that CHWs in this age range are “energetic and socially settled”
Summary
Ensuring that selection processes for Community Health Workers (CHWs) are effective is important due to the scale and scope of modern CHW programmes. There is growing evidence that Community Health Workers (CHWs) can contribute effectively to addressing preventable burdens of disease, by undertaking specific activities such as surveillance for tuberculosis [1] and case detection and treatment for febrile illness in children [2] This positive evidence, together with task-shifting recommendations to help to alleviate human resources for health crises [3] has led to an increase in the Taylor et al BMC Health Services Research (2018) 18:803 respect, kindness, empathy and diligence [8, 9]. A further explanation for the importance of CHW selection is implied by Nkonki and colleagues, who note that “selection criteria for entry to a Lay Health Worker programme determine the profile of workers it employs” [16], p. 921
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