The current enthusiasm for large-scale community health workers (CHWs) needs to be tempered with a sobering reflection on the disappointments that followed a similar wave of enthusiasm in the 1970s and 1980s, noting challenges in scaling up and sustaining large-scale public sector CHW programs.

Large-scale public sector CHW programs are complex entities that require adapting a systems perspective to the national and local contexts.

CHWs are a diverse group of community-level workers. This guide distinguishes between two levels of CHWs: 1) full-time, paid, with formal pre-service training, and 2) volunteer, part-time workers.

The guide attempts to avoid categorical recommendations, but rather offers suggested issues and principles to consider and, when possible, brings in relevant program experience.