CHW-CRE
Across Borders

In 2021, in the midst of the COVID-19 pandemic, our project was contacted by Prof. Caroline Masquillier of the University of Antwerp in Belgium. Dr. Masquillier, who had previously worked with CHWs in South Africa, supported the development of Belgium’s first nationwide CHW program, which was funded by the Belgian Federal Government and implemented by the National Intermutualistic College to improve access to care. She had read about the CHW Common Indicators and was interested to learn whether they could be adapted for use in Belgium.

Over the next two years, with guidance from CHW-CRE, Dr. Masquillier worked with CHWs, coaches and coordinators of the Belgian CHW program to iteratively adapt the CHW Common Indicators to the Belgian context. By the end of Phase 1 of the project, the Belgian team had developed a registration tool (similar to an encounter form) for daily use by CHWs with several goals: (1) support CHWs in their work; (2) support supervisors in their coaching of CHWs; (3) facilitate research and reporting; and (4) enable program evaluation.

This project reaffirmed the importance of learning from the experiences of CHW programs over time and in other countries and facilitating exchange of these lessons learned. Dr. Masquillier and her colleagues have continued to consult with members of the CHW-CRE team as they have developed subsequent CHW-focused projects. One outcome of the continued collaboration is the project described below.

Inspired by her work with CHWs around the world, Dr. Masquillier organized a reciprocal learning series that included CHWs and allies from five countries: Belgium, South Africa, the UK, Argentina, and Brazil. She invited members of the CHW-CRE team to facilitate a session focused on the role of popular (people’s) education in CHW programs. CHW-CRE staff subsequently invited members of this group to participate in the regular meetings of the CHW-CRE Advisory Group. 
 

Linked by a mutual language and the experience of CHWs in Latin America, CHWs and allies from the province of Chubut in Argentinian Patagonia accepted the invitation and quickly became valued members of the Advisory Group. As Karen Bender, Director of Health Promotion for the Province of Chubut, and Norma Davila, CHW and Coordinator of CHWs for Chubut, began to plan their Second Annual Provincial Health Promotion Conference, it occurred to them to invite CHW-CRE Co-Director Dr. Noelle Wiggins. Noelle had previously expressed interest in attending the conference. CHW-CRE Advisory Group members Teresa Campos-Dominguez and Martin Rivarola enthusiastically joined the team!

 

During a memorable week in October of 2025, Norma and Karen hosted Noelle and Teresa for a series of visits to CHW teams in health centers from Paso de Indios (a 3-hour drive from their base in the city of Trelew) to Dolovan to several other sites. In all these visits, Teresa and Noelle were impressed by the CHWs’ commitment to addressing health issues as diverse as Chagas disease, Hantavirus, and rabies in their communities. (After several visits, they understood why the logo for the Ministry of Health in Chubut includes not just people but dogs!) The CHWs’ extensive record-keeping and detailed community maps demonstrated once again the importance of actively involving CHWs in research and evaluation about public health.

 

Mid-week, Noelle and Teresa traveled with the team from Trelew to the city of Comodoro Rivadavia in southern Chubut where they were joined by Martin. Over the next two days, the CHW-CRE team facilitated three conference presentations that focused on using popular education, building CHWs’ research skills, and sharing lessons learned from a CHW program in the province of Córdoba in central Argentina. Among the exciting outcomes of the visit to Chubut was Karen’s idea to establish a “sede” (site) of CHW-CRE in Argentina. Connections between the teams in Chubut and the team at CHW-CRE have already been extended to the team at the Community Health Impact Coalition, about which more in the next project description!

One of the primary goals of CHW-CRE is to reverse historic exclusion of CHWs from knowledge production by supporting CHWs to develop the skills, knowledge and confidence they need to participate meaningfully in research and evaluation about their own profession. To contribute to this goal, CHW-CRE developed a day-long in-person course to increase CHWs’ skills and meaningful involvement in research and evaluation. 

 

In the current project, CHW-CRE is partnering with the Community Health Impact Coalition (CHIC), which uses research and advocacy to ensure that CHWs worldwide are paid, and Nama Wellness Community Centre (NAWEC), a not-for-profit organization based in Mukono District, Uganda, to adapt the course for a virtual train-the-trainer format appropriate for Ugandan CHWs. The course will be piloted with a group of Ugandan CHWs, who will then facilitate the course in-person with CHWs from their own districts. The Planning Team for the project includes CHW-CRE Co-Director Victoria Adewumi, CHW, MA, MPH, DrPH (c), and CHWs aligned with NAWEC.

 

During this first phase of the project, the partners will measure changes in knowledge, skill and confidence among the participating CHWs; assess the feasibility, acceptability, and scalability of the train-the-trainer course; and identify lessons learned, using a mixed-methods, community-based participatory research approach. Results will be shared in a manuscript co-authored by CHWs and applied to improve the course and achieve the long-term goal of expanding this project to other CHWs around the world.