In November 2020, UDER completed a wide assessment of community health programs in northwest Syria. The assessment was done with the help of 23 NGOs implementing community health projects in northwest Syria, and it lasted for 5 months. The result of this assessment can help organizations and donors looking to improve community health programming in northwest Syria by considering the following recommendations:

CH roles and responsibilities

While there was a common understanding of the CHW role in each organization, participant NGOs demonstrated different understanding and structures of the CH Supervisor and Team Leader roles and responsibilities. All NGOs should be encouraged to follow the structure identified in the CHWG SOPs: CHWs to deliver health-related activities directly to the community and households, CHW Team Leaders for a maximum of 10 CHWs (5 teams) each, and dedicated CH Supervisors. Also, many NGO respondents reported that the CH Working Group is less active now than before. It is recommended that the Group is reactivated and regular meetings should be held to guide and organize all NGO CHW activities.

CHW scope of work

Participant NGOs demonstrated different type of service delivery and scope of work. All NGOs should be encouraged to follow the CHWG SOPs and provide CH services according to all the 6 modules (Basic Module, Family Health Module, Nutrition Module, NCD Module, CD Module, and Healthy Lifestyle Module) instead of focusing only on nutrition and COVID-19, in a community-based setting with well-established linkages to health facilities, instead of providing the CH services from the facilities only. As clarified in the CHWG SOPs, the community members should receive community health services through outreach visits by CHWs to reduce accessibility obstacle due to transportation and travel distance and to maximize the coverage of the health system by active community engagement. As for the services that the CHWs provide, the collected data specifically identified a lower reporting of follow-up visits for the same households. All NGOs should focus more on these follow-up visits, and guide their CHW teams to revisit the household as recommended in the SOPs (at least once every 2 or 3 months).

CHW selection and recruitment

The dissatisfied community members mentioned that CHWs are not from the same community, and the responses of other participants and CHWs confirmed this. The first criteria for selecting community health workers in the CHWG SOPs is being a member of the targeted community and being recruited from within his/her community. All NGOs reported that they do the recruitment process independently and they should consider this aspect in their future CHW recruitment processes.

CHW Training

According to the CHWG SOPs, each CHW must complete a training and successfully pass the evaluation by the end of it, then undergo a refresher training every three months. Around half of the CHWs working in northwestern Syria are not trained on the comprehensive package and the six-module training curriculum and many respondents reported the lack of qualified trainers and the necessity to review the contents and update its information, especially with relation to COVID-19 materials. The CH Working Group is encouraged to consider updating the package and reviewing its contents according to the suggestions mentioned in the report. ToT training covering COVID-19 and all the 6 modules (Basic Module, Family Health Module, Nutrition Module, NCD Module, CD Module, and Healthy Lifestyle Module) should be reconducted to qualify more trainers who can visit Syria and provide the training for the CHWs.

CH Supervision

According to the CHWG SOPs, CHWs should be supervised through field visits and on the job coaching, with weekly meetings or visits to discuss and evaluate the work plans. The participant NGOs reported conducting supervision or regular evaluation to CHWs, but they are encouraged to follow the CHWG SOPs in this aspect, especially regarding conducting the supervision visits on weekly-basis and coordinating with local community representatives. 

CHW data collection and reporting

Data collection and reporting is an essential part of the CHWs work, with a detailed process flow clarified in the CHWG SOPs. The participant NGOs confirmed submitting the required reports, but data collection and reporting tools varied significantly between NGOs, although most of them expressed their interest to change to an electronic system. However, donors have strict rules about procuring tablets and tools required to do this upgrade. The key informants requested from the donors to provide solutions and make it easier to procure electronic tools. The CH Working Group should also work on developing a standardized electronic system, which could enhance the reporting from all NGOs managing CH projects.

CHW linkages with the health system

According to the CHWG SOPs, one of the main objectives of CHWs is to maximize the coverage of the health system. Since not all NGO CHWs are linked to health facilities, there is an area for improvement in this aspect. First, a comprehensive map of services should be developed to identify all types of services in northwestern Syria. Second, the coordination between CHWs and health facilities in the area they cover should be enhanced, with more focus on follow-up visits to referred community members.

Community coverage and feedback

The general community feedback about CHWs was found to be satisfactory and positive, with a significant exception related to low follow-up visits by CHWs. A high percentage of community members and leaders recognized CHWs as helpful, considered their information and services to be useful, and requested to continue supporting these projects and increase their coverage. As recommended in a previous section, more focus on follow-up visits is important as well.

The full report can be found here: