Table 5 Suggested improvements for health programmes by CHWs

Low community attendance at health promotion session

Spend time before health promotion sessions informing community members of the importance of the session and the link between ill health and the public health issue

Offer incentives to attract people to group sessions (bar of soap, small snack)

Encourage respected members of the community to promote education sessions, i.e. village chiefs and deputies, monks, school staff

Have repeated health promotion sessions to enable more community members to attend and to help engrain new messages for those with low education levels

Keep all health promotion language simple and consistent

Provide CHWs with a uniform and fully integrate into the health system to increase respect from the community

Behaviour change outcomes

Work in partnership with other providers, for instance, NGOs working on sustainable crop programmes can help community members to grow their own produce to reduce malnutrition in under-five

Follow-up group health promotion sessions with individual home visits and observations

Reinforce messages using TV/radio and other media

Show real-life examples of local people who have made the change and what the benefits are for them

CHW training

Offer training sessions multiple times to increase CHW attendance and offer refresher training regularly

Ensure payment to attend training days is sufficient for CHWs to attend

Resources and ongoing support

Provide full resources to mobilise programmes including equipment, a travel mode, fuel fund and media resources such as leaflets and posters

Local government to raise the importance of health issues and demonstrate their support to local communities

Raise health issues at commune meetings to generate interest and support

Local health officials to recognise CHWs and provide them with an identity

Difficulty in reporting

Include verbal reporting mechanisms to decrease the amount of time spent by CHWs on written reports