Introduction
Community Health Workers (CHWs) are the backbone of HIV prevention, care, and treatment services in many low- and middle-income countries. They bridge gaps between formal health systems and communities, ensuring that vulnerable populations can access testing, counseling, treatment adherence support, and referral services. Despite their critical role, many CHWs operate with limited training, inadequate supervision, insufficient compensation, and a lack of essential tools.
Global guidance from World Health Organization and UNAIDS highlights the importance of strengthening community health systems to achieve universal HIV service coverage and epidemic control. Expanding and professionalizing the CHW workforce improves early diagnosis, retention in care, viral suppression rates, and stigma reduction.
The Strengthening Community Health Worker Capacity for HIV Services Initiative seeks to enhance the skills, resources, supervision, and motivation of CHWs to deliver high-quality, community-based HIV services.
Background and Rationale
- In many regions, CHWs are responsible for:
- HIV education and prevention outreach
- Community-based testing and counseling
- Treatment adherence support
- Tracing patients lost to follow-up
- Referrals to clinics and social services
- Data collection and reporting
- However, common challenges include:
Strengthening CHW capacity improves health outcomes while reducing pressure on overburdened clinical facilities. Well-trained CHWs can detect cases early, reduce stigma, improve treatment adherence, and promote community ownership of HIV responses.
Goal
To improve the quality, accessibility, and effectiveness of community-based HIV services by strengthening the capacity of Community Health Workers.
Objectives
- Train and certify 1,000 CHWs in comprehensive HIV service delivery within three years.
- Improve retention in HIV treatment programs by 25% in target areas.
- Reduce loss-to-follow-up rates by 30%.
- Strengthen supervision systems across 50 health facilities.
- Improve CHW job satisfaction and retention rates.
Target Beneficiaries
- Direct Beneficiaries:
- Community Health Workers
- Supervisory health staff
- Indirect Beneficiaries:
- People living with HIV
- At-risk populations
- Pregnant women and adolescents
- Rural and underserved communities
Estimated direct beneficiaries: 1,200 CHWs and supervisors
Estimated indirect beneficiaries: 100,000+ community members
Key Activities (Components)
- Component 1: Comprehensive Training and Certification
- Standardized HIV service delivery curriculum
- Training on testing, counseling, and adherence support
- Training in stigma reduction and confidentiality
- Gender-sensitive and youth-friendly approaches
- Certification and accreditation system
- Component 2: Supportive Supervision and Mentorship
- Development of supervision guidelines
- Regular field mentorship visits
- Peer learning networks
- Performance review systems
- Digital reporting tools
- Component 3: Equipment and Resource Provision
- HIV rapid testing kits
- Personal protective equipment (PPE)
- Educational materials and job aids
- Mobile phones or tablets for data reporting
- Transportation allowances or bicycles for outreach
- Component 4: Incentives and Motivation Systems
- Stipends or performance-based incentives
- Recognition awards and certification ceremonies
- Career pathway development
- Integration into formal health workforce frameworks
- Component 5: Community Engagement and Outreach Expansion
- Community awareness campaigns
- Home-based care services
- Adolescent-focused outreach programs
- Linkages to social protection and psychosocial services
Timeline (36 Months)
- Phase 1 (Months 1–6):
Baseline assessment, curriculum development, stakeholder coordination. - Phase 2 (Months 7–18):
Training rollout, equipment distribution, supervision framework implementation. - Phase 3 (Months 19–30):
Expanded outreach services, mentorship strengthening, mid-term evaluation. - Phase 4 (Months 31–36):
Performance review, sustainability planning, final evaluation.
Expected Outcomes
- Improved knowledge and skills among CHWs
- Increased HIV testing uptake in communities
- Higher rates of treatment adherence and viral suppression
- Reduced stigma in community settings
- Strengthened linkage between communities and health facilities
- Lower CHW turnover rates
Monitoring & Evaluation
Monitoring tools will include:
- Pre- and post-training assessments
- Treatment adherence and viral load data analysis
- CHW performance scorecards
- Supervision reports
- Community satisfaction surveys
- Mid-term and final evaluations
- Data will be disaggregated by gender, age, and location to ensure equitable service delivery.
Sustainability
Sustainability will be achieved through:
- Integration of CHWs into national health workforce policies
- Collaboration with ministries of health
- Strengthened community ownership
- Ongoing mentorship structures
- Institutionalized certification programs
- Cost-sharing mechanisms with local governments
- Long-term sustainability will depend on formal recognition of CHWs as essential health system actors and sustained investment in community health infrastructure.
Budget (Narrative Form)
- The estimated total budget for the three-year project is approximately USD X.X million.
- Around XX% of the budget will be allocated to training development, facilitation, and certification processes.
- Provision of equipment, digital tools, and outreach materials will account for approximately XX%.
- Supportive supervision and mentorship systems will require about XX% of the total budget.
- CHW stipends and incentive mechanisms will represent XX%.
- Community outreach expansion and engagement activities will account for X%.
- Monitoring and evaluation will require approximately X%.
- Project management and coordination will account for X%.
- Administrative and compliance costs will represent X%.
Conclusion
Community Health Workers are central to achieving equitable and effective HIV service delivery. By investing in training, supervision, equipment, and incentives, this initiative strengthens the foundation of community-based healthcare systems. Empowered and well-supported CHWs not only improve health outcomes but also build trust, resilience, and long-term sustainability within communities affected by HIV.
