The global policy of providing primary level care was initiated with the declaration of Alma-Ata in 1978s. The countries signatory to Alma Ata declaration considered the establishment of CHW program as synonym with Primary Health Care approach (Mburu, 1994; Sringernyuang, Hongvivatana, & Pradabmuk, 1995). Thus, in many developing countries PHC approach was seen as a mass production activity for training CHWs in 1980s (Matomora, 1989). During these processes the voluntary health workers or CHWs were identified as the third workforce of “Human resource for Health” (Sein, 2006). Following this approach CHWs introduced to provide PHC in 1980s are still providing care in the remote and inaccessible parts of the world (WHO, 2006a). In this paper, we attempt to provide an overview of the concepts and practice of Community Health Workers (CHWs) from across a range of (developing and developed) countries, and draw some insights into policy challenges that remain in designing effective CHW schemes, particularly in the Indian context. In the subsequent sections, we provide a review of the various ways in which community health workers have been deployed in different settings. To arrive at this we adopted a systematic search of literature on CHWs, using key words such as community health worker, primary health care worker, community based health care worker, lay health worker, we also used the inclusion criteria that WHO adopted for describing CHWs (WHO, 2006a), in Pub-Med, Science Direct, WHO and World Bank sources. A total of 110 studies (including Journal articles, Reports etc are mentioned in the tables) were identified for this purpose. 

Prasad BM, Muraleedharan; August 2007