Topics: Community health workers, Maternal, Newborn and Child Health, Supervision

Region and Country: Bangladesh

This paper describes a large-scale community-based efficacy trial of chlorhexidine for cleansing the umbilical cord conducted in rural north-eastern Bangladesh. The trial established a two-tiered system of community-based workers: paid community health workers (CHWs) and volunteer village health workers (VHWs). The community-based workers delivered a package of essential maternal and newborn care interventions and one of three umbilical cord-care regimens. At any given time, the trial employed approximately 133 CHWs, each responsible for 4-5 village health workers and a population of approximately 4,000. The paper describes the study’s approaches to recruitment, training, and supervision. Key lessons included the importance of supportive processes for community-based workers, including a strong training and field supervisory system, community acceptance of the study, consideration of the setting, study objectives and human resources available.