CHWs potentially have two assets: an understanding of the community with which they are working and acceptability to that community. These need to be complemented by training that equips them to engage the community in discussions about change and to act as advocates for that community to external agencies. Some of this is about the acquisition of biomedical knowledge and evidence-based practice, but the CHWs must have space to translate these in ways that are locally acceptable. Their own expertise must be acknowledged and respected. If they are to be effective, they must be able to act as mediators rather than as emissaries or evangelists for an external vision of community development or public health.
CHWs are a huge resource of information on the way health systems impact on the lives of their intended beneficiaries and of ideas about innovation in delivery. We need to treat them as key informants, in the way that an anthropologist or sociologist would, with knowledge that can supplement the quantitative data that tends to dominate in health system management and planning.