Initially, international health actors promoted CHWs
as a means to achieve the World Health Organization’s
goal of health access for all by the year 2000 through social
interventions for behaviour change [10,11]. Optimism
about the potential of CHWs led to the increased
desirability of community-based health interventions
[12]. As early as 2000, however, the optimism about
CHW programmes began to fade, as there was little progress
towards the achievement of health goals for the
poor, and CHW programmes showed heterogeneous
outcomes [2,13]. Further, CHW programmes have been
characterized by high levels of attrition through resignations,
terminations and relocations [14,15].