Table 4 Summary of findings on CHW training

Link between CHW training and performance (knowledge, skills, and motivation)

All nine studies in one review that described CHW training reported improvements in CHWs knowledge or skills [25]. TBA training was found to be associated with significant increases in TBA knowledge, improved attitude, behavior and advice for antenatal care, and improved pregnancy outcomes [22, 82]. Training and supervision are vital for high-quality performance in integrated community case management programs [27]. Although no studies included in Kok et al.’s review examined the impact of CHW training on health outcomes, training was found to influence CHW motivation, job satisfaction, and performance in the following ways [15]:

• Training generally resulted in expanded CHW knowledge and performance

• Training linked to allowances and favoritism could lead to demotivation

• Continuous training increased job satisfaction/motivation

• Training should include counseling and communication skills

• Training can increase community confidence in CHWs

Beneficial approaches to training (e.g., continuous education and mixing of training components)

For CHW training to improve CHW performance it must include a mix of approaches (knowledge- and skills-based) [15, 21, 48], be complemented by ongoing field-based mentoring and back-up support, [15, 20, 21] and enable CHWs to have an increased sense of self-efficacy, mastery of the tasks, and self-esteem [15, 48]. In CHW programs for common peripartum mental disorders in women in LMICs, continuous supervision was found to be more effective than one-off training [73]. However, the frequency of refresher training had no effect on guideline adherence [15] and training duration had no consistent effect on the effectiveness of the intervention [24, 42]. CHW technical competency tends to drop after training, necessitating follow-up and regular supervised practice opportunities [40, 131].