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Community volunteers occupy a unique position, being at the margins of institutional systems but central to public life in communities. They play a crucial role in forming and maintaining primary-level social order. Through life history interviews that explore the spiritual world of community volunteers, this study proposes a typology of community actors: enthusiasts, devotees, the dissatisfied, and neutrals. The first two types broadly constitute what can be termed "community volunteers." Analyzing the multiple cultural origins that give rise to proactive community actors reveals that the interplay of familial, individual, and danwei (work unit) consciousness is the fundamental driving force behind their engagement in public life. Actors carry the cultural weight of multiple contexts through their life practice, with community an intermediary structure between family and state. This exploration provides a new framework for understanding contemporary Chinese urban community volunteers and community governance, uncovering the consciousness and emotional structures embedded in individual actors by macro-social transformation and highlighting a historical path of primary-level governance modernization in China that is distinct from that of the West. [ABSTRACT FROM AUTHOR]

The United Nations acknowledges that action in one of the 17 Sustainable Development Goals (SDGs) will impact outcomes in others and that development should interact the social, economic, and environmental sustainability. Many countries have prioritized goals and targets based on their current progress and the prosperity of their people. This article focused on SDG 6: Clean water and sanitation, especially the first two (6.1 and 6.2) out of eight targets. The author has considered SDG 6, a critical goal to focus on and achieve in Tirunelveli city municipal corporation. The study area is situated in the Tirunelveli district of Tamil Nadu, India's southernmost state. Citizen science (CS), also known as community science, has emerged as an effective method of collecting data and supporting a wide range of indicators from the SDG targets. The objective of this article is to utilize the benefit of the CS approach for monitoring the targets 6.1 and 6.2 pertained to drinking water and sanitation facilities respectively in the study area. The activities suggested for this SDG 6 CS project were framing the core question, identification of citizen scientists, data analysis, and action plan. College students, ward councilors, and community volunteers, referred to as three categories of citizen scientists, will collect household data for all 55 wards in the study area. The value of the collected data to various government agencies and monitoring organizations is also discussed. [ABSTRACT FROM AUTHOR]

Background: Buruli ulcer (BU) is a debilitating neglected tropical disease which causes disability and mostly affects inhabitants in impoverished settings where access to medical care is challenging. This study aims to determine the effect of training community members as volunteers for or in the detection and referral of people who have Buruli ulcer to the hospital. Methods: The following study is a before and after study in the BU-endemic Local Government Areas (LGA) of Ebonyi State. A cluster random sampling technique was used to select 90 volunteers from three LGAs (30 from each LGA). In each LGA, the volunteers underwent a one-day training and six months field work to identify all those who have any form of ulcer on any part of their bodies. A short questionnaire was used to capture socio-demographic characteristics of the patient, site of the ulcer, duration of the ulcer, initial appearance of the ulcer, referral to hospital, result of laboratory investigation, and treatment received. The data was analysed using the Statistical Package for Social Sciences (SPSS) for Microsoft Windows version 20 software. The Z test statistic was used to compare the number of referred BU patients before and after the intervention by LGA. The Chi square test was used to examine the association between the dependent and independent variables. Results: The mean age of volunteers was 39 ± 9.5 while mean age of the patients was 42.3 ± 17.1. Most of the ulcers were on the legs (79.4%) and lasted 1–5 years (65.6%). There was a significant increase in the proportion of BU suspects identified by the community volunteers in all 3 LGAs (Afikpo north (p = < 0.001), Abakaliki (p = 0.02), Ikwo (p = 0.001). The duration of the ulcer was associated with the detection and referral of the patients with higher levels of detection and referral among those whose ulcer had lasted 1–5 years in two of the LGAs (P < 0.001). Conclusion: We recommend that program managers and stakeholders integrate and scale up the services of trained community health volunteers for the rapid detection of Buruli ulcer cases in rural endemic communities. Awareness and sensitization campaigns on BU preventive measures should be intensified. [ABSTRACT FROM AUTHOR]

Introduction: community volunteers have limited skills but are an important link between the community and health facilities. We determined the effect of a capacity building intervention on knowledge of malaria control and attitudes towards community involvement among female community volunteers as part of a larger community-based intervention study on pregnant women and children under five. Methods: we conducted a before and after intervention study (no randomization or controls) among female community volunteers in Amagu community in Abakaliki Local Government Area. The intervention consisted of training sessions on knowledge of malaria and its control. The training took the form of lectures, role plays and practical demonstrations. Supportive supervision by trained community health extension workers was also provided during their field work. We compared pre-training test and post-training test scores after six months interval and analysed the data using paired t test at 5% level of significance with EPI INFO software version 7.2.3. Results: the mean age of the participants was 28.5(± 6.0) years. All had a minimum level of secondary education. There was significant improvement in the mean scores of their knowledge of malaria signs and symptoms (p < 0.001), preventive measures (p < 0.001) and appropriate drug treatment (p < 0.001) in the post-training test when compared with the pre-training test. The overall mean knowledge scores pre and posttest were 147.8 and 169.8 respectively (p < 0.001) out of a maximum achievable score of 195. Also there was significant improvement in the perception of the participants on community involvement in promoting referral of pregnant women with fever (p = 0.001), the use of intermittent preventive therapy with sulphadoxine-pyrimethamine (p = 0.048) and funding initiatives to sustain activities (p = 0.037). Conclusion: capacity building of female community volunteers coupled with supportive supervision by trained community health workers improved the female community volunteers´ knowledge of malaria, its control and their perception of community involvement in control activities. It is recommended that the use of community volunteers as a low cost health resource can be explored further for incorporation into existing policies on malaria control in resource constrained environments. [ABSTRACT FROM AUTHOR]

The importance of mutual learning between providers and recipients of development assistance has been emphasised for decades. Nevertheless, its practical implementation remains limited, primarily due to organisational issues and unequal power relations in development aid. Using the 'design-thinking' approach, this study demonstrates the possibility of mutual learning utilising the example of the Swiss Red Cross and the Village Health Committees in the Kyrgyz Republic. Based on the related project documentation and interviews with relevant partners, this article provides an insight into the factors enabling mutual learning in practice. It suggests that decentralisation of the organisation, its leadership and response to failures, continuous contact between provider and recipient of development assistance, and emphasis on local expertise contribute to learning. Although context-specific, these findings are essential to understanding the mutual learning in general and taking this phenomenon from theory to practice. [ABSTRACT FROM AUTHOR]

Objective: The WHO and UNICEF recommend home visits to improve health outcomes for mothers and newborns. We evaluated the effect of home visits by community volunteers during pregnancy and postpartum on breast-feeding practices, women's knowledge about benefits, beliefs and myths of breast-feeding, obstetric and neonatal warning signs, preparation for childbirth and initial care for newborns, and diarrhoea and respiratory diseases in children.Design: Community quasi-experimental design. We estimated difference-in-difference models with fixed effects at the community level weighted by propensity score and investigated implementation barriers through focus groups and semi-structured interviews.Setting: Poor rural communities in Mexico; 48 intervention and 29 control.Participants: Baseline and follow-up information were reported from two independent cross-sectional samples of women with babies aged between 6 and 18 months (baseline: 292 control, 320 intervention; follow-up: 292 control, 294 intervention).Results: The intervention increased reports of exclusive breast-feeding in the first 6 months by 24·4 percentage points (pp) (95 % CI: 13·4, 35·4), mothers' knowledge of obstetric warning signs by 23·4 pp (95 % CI: 9·2, 37·5) and neonatal warning signs by 26·2 pp (95 % CI: 15·2, 37·2) compared to the control group. A non-linear dose-response relation with the number of home visits was found. Diarrhoea and respiratory diseases among children decreased in the intervention v. control group but were not statistically significant.Conclusions: Home visits should be implemented as a complementary strategy to the provision of prenatal and postnatal care in rural communities due to their potential positive effects on the health of mothers and their children. [ABSTRACT FROM AUTHOR]

This paper presents an overview of a study which evaluated how well three community-based programmes run by PACE (Prisoners Aid through Community Effort) in the Republic of Ireland (henceforth called Ireland) are assisting convicted perpetrators of sexual harm with desistance and reintegration following custody. The study breaks new ground in highlighting the successes and challenges of assisted desistance across the programmes, as perceived by this offender group and a broad range of stakeholders, including probation officers, gardaí, programme facilitators, policymakers and community volunteers. The results presented in this paper focus on the social aspect of assisting desistance and show that the programmes are working effectively in this area, despite particular external barriers and challenges experienced by this offender group. [ABSTRACT FROM AUTHOR]

Community health volunteers (CHVs) are being used within a growing number of healthcare interventions, and they have become a cornerstone for the delivery of mass drug administration within many neglected tropical disease control programs. However, a greater understanding of the methods used to value the unpaid time CHVs contribute to healthcare programs is needed. We outline the two main approaches used to value CHVs' unpaid time (the opportunity cost and the replacement cost approaches). We found that for mass drug administration programs the estimates of the economic costs relating to the CHVs' unpaid time can be significant, with the averages of the different studies varying between US$0.05 and $0.16 per treatment. We estimated that the time donated by CHVs' to the African Programme for Onchocerciasis Control alone would be valued between US$60 and $90 million. There is a need for greater transparency and consistency in the methods used to value CHVs' unpaid time. [ABSTRACT FROM AUTHOR]

This article discusses the experiences of community volunteers' participation in a community-based participatory research project in Tāmaki, a low socio-economic and ethnically diverse suburban community within greater Auckland City, New Zealand. In the Tāmaki Community Action Research project, community volunteers were recruited and trained to conduct random household surveys (RHS) and asset mapping commissioned by community groups and government agencies in that area. The volunteers were involved in planning, coordination and ongoing governance of the project and ~70 residents and local university students participated at different stages of the 2-year project. Over 600 RHS were completed and the volunteers' experiences were recorded in field notes, informal group discussions, daily team meetings and individual interviews and form the basis of this article. Only their experiences are discussed here, not the survey results which will be presented elsewhere. The project reflected the inherent asset-rich nature of the community via examples of individual volunteer empowerment and collective social/community capacity building. Volunteers increased their interpersonal and organizational skills, their understanding of the complexity of their community's logistics and cultural diversity, and gained an increased sense of community purpose and commitment. There was very strong endorsement of culturally sensitive research practice to recognize cultural differences and to engage productively within their richly ethnically diverse community. Full community volunteer participation in the project's governance (i.e. through design, training, implementation and ongoing consultation/management phases) was considered key to sustaining the life of project. [ABSTRACT FROM AUTHOR]

The increasing vulnerability of children and experiences of childhood violence in many parts of the world have gained traction in academic and policy discourses. In Nigeria, many orphans and vulnerable children (OVC) live in households where they are exploited, violated and potentially dehumanised. Although responses aimed at improving their condition have grown, some interventions are being rendered ineffective. Based on field encounters of project staff, this study explored the sociocultural issues that potentially undermine interventions targeted at OVC in Nigeria. We collected primary qualitative data from 15 organisations drawn from the six geopolitical zones of Nigeria using online interview guides and through one Focus Group Discussion with community volunteers who currently work on OVC projects and regularly interact with vulnerable children and their guardians and parents. The findings show that field staff were confronted by sociocultural barriers, at individual, family and community levels, which affect the ways that interventions are carried out in communities. The study discussed the consequences of these obstacles and concluded that they could impact negatively on project staff across the country. [ABSTRACT FROM PUBLISHER]

Background: Refugees are at risk of psychiatric morbidity because of forced migration, traumatic events and resettlement in unfamiliar environments. Many live in low- and middle-income countries (LAMIC) under stressful conditions contributing to increased suicide risk. Aims: This study assessed the feasibility of regular contact and use of safety planning cards (CASP) by community volunteers (CVs) in reducing suicidal behaviour among Sri Lankan refugees residing in camps in Tamil Nadu, South India. Methods: A household survey was carried out on consenting adults in two refugee camps – one intervention and one control – randomly selected using lottery method. The primary outcome was reduction in suicidal behaviour. Experience of trauma during war and migration, depression, post-traumatic stress and alcohol use were documented. Individuals scoring >16 on Centre for Epidemiological Studies Depression (CESD) or >30 on Post-traumatic Stress Disorder (PTSD) or with active/passive suicidal ideation or a history of previous suicidal attempts were considered as high risk. CVs were trained to deliver CASP intervention to high-risk individuals. Change from baseline to follow-up was computed for intervention and control groups, and the difference between changes in suicide rates was compared using proportion test. Results: In total, 639 refugees from intervention and 664 from control camps participated. Of the 288 high-risk refugees in intervention camp, 139 completed the intervention. In the control camp, 187 were categorised as high risk. Prevalence of suicide attempts was 6.1%. Following intervention, differences between sites in changes in combined suicide (attempted suicides and suicides) rates per 100,000 per year were 519 (95% confidence interval (CI): 136–902; p < .01). Conclusion: CASP, an intervention involving contact by CVs and use of safety planning cards, is feasible to implement and can reduce suicidal behaviour among refugees. Its replication in more settings will enhance validity. [ABSTRACT FROM AUTHOR]

Purpose: An estimated 19 million children are visually impaired; of these, 1.4 million are irreversibly blind. A key challenge is to identify them early in life to benefit maximally from visual rehabilitation, and/or treatment. This aggregative review and structured literature analysis summarizes evidence of what it is about the key informant (KI) approach that works to identify children with blindness or severe visual impairment (B/SVI) in the community (for whom, to what extent, in what circumstances, in what respect, how and why). Methods: Peer-reviewed (PubMed, hand search) and grey literature (Google, World Health Organization website, academic theses, direct requests) were included, and methods and criteria used for identification, productivity (number of children referred per KI), accuracy of referrals (positive predictive value, PPV), age of children with B/SVI, KI definition, sex, information about cost and comparisons aggregated. Results: We included 31 documents describing 22 unique KI programs. Mostly KIs identified children with B/SVI in 1–3 weeks, i.e. “campaign mode.” In 60%, KIs were community volunteers, others formal health sector workers (FHSW). Around 0.02–1.56 children per KI (median = 0.25) were successfully recruited. PPV ranged from 12 to 66%. In two studies comparing FHSWs and community KIs, the latter were 8 and 10 times more productive. Conclusion: KIs working in campaign mode may provide an effective approach to identifying children with B/SVI in communities. Including identification of ocular problems and/or other impairments has been recommended. Research on factors that influence effectiveness and on whether KIs continue to contribute could inform programs. [ABSTRACT FROM AUTHOR]

This article focuses on the involvement and management of spontaneous volunteers (SVs). It develops a new theory—which we call the “involvement/exclusion” paradox—about a situation which is frequently manifested when SVs converge in times of disaster. After reviewing research and policy guidance relating to spontaneous volunteering, we present findings from a study of responses to winter flood episodes in England. Taking together the empirical findings and the literature, the article analyzes elements inherent in the involvement/exclusion paradox and develops a conceptual model to illustrate and explain the paradox. Implications for managers and future research are discussed. [ABSTRACT FROM AUTHOR]

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Introduction: The newly established Ipswich regional campus of the University of Queensland School of Medicine experienced difficulty in accessing inpatients for clinical skills teaching during its initial two years of operation. The community patient volunteer (CPV) program was developed to address this problem. Volunteers with significant past medical histories or clinical signs were recruited from the local community and rostered to attend tutorials on campus several times per year. Students practised history taking, physical examination and developed clinical reasoning skills, under the guidance of their clinician tutor. An evaluation of this program was undertaken. Methods: Questionnaires were disseminated to Ipswich students and volunteers from 2010 and 2011. The surveys explored students' views of the program compared with hospital-based bedside teaching, and volunteers reflected on their participation. Student performance on Objective Structured Clinical Examinations (OSCE) was compared between the base and regional cohorts. Results: Students and volunteers reported benefits from participation in the CPV program. The results of the Ipswich students' Year 2 OSCE in 2010 and 2011 were similar to the results of the Brisbane cohort, with a significant positive difference in favour of the Ipswich students in the areas of history taking and communication skills for 2011. Discussion & Conclusions: Student learning was not disadvantaged by the use of the CPV program and may have been enhanced. Volunteers reported personal gains from participation. [ABSTRACT FROM AUTHOR]

Background. Community health workers known as mitanins undertook family-level counseling and mobilized the community to improve coverage of maternal and child health services in the state of Chhattisgarh, India. The Nutrition Security Innovation (NSI) project was launched in selected blocks with additional inputs for promoting appropriate complementary feeding practices and disseminating information on Public Distribution System (PDS) entitlement. Within 3 years of project implementation, all NSI inputs in the project group (PG) were scaled up in the entire state. Objective. To study the impact of interventions on nutritional status in PG and non-NSI comparison group (CG) blocks. Methods. Quasi-experimental mixed methods were used. The sample consisted of 3,626 households with children under 3 years of age and 268 mitanins. Results. A ratio of 1 mitanin per 250 to 500 population was effective. The coverage of exclusive breastfeeding, timely introduction of complementary feeding, DPT immunization, and antenatal care services was more than 70%. The PDS reached almost 90% of beneficiaries. In both the PG and the CG, one-third of children were undernourished, with one-quarter of children undernourished by 6 months of age. The prevalence of low birthweight was over 40%, and half of all women were undernourished. The estimated annual average reduction rate (AARR) for the entire state was estimated to be 4.22% for underweight and 5.64% for stunting. Conclusions. The strategy of Mitanin Programme in the Indian state of Chhattisgarh was unique with the implementation of direct nutrition actions being spearheaded by the health sector and community health volunteers in coordination with the Integrated Child Development Services (ICDS) and the Public Distribution System (PDS). The highest priority was given to interventions in the first 92 weeks of life. This implied ensuring frequent counseling and delivery of services through the entire pregnancy period and continued follow up till the children were at least one year of age. An accelerated decrease in the annual rate of reduction of underweight and stunting was observed. The emerging findings point to the significant contributions that can be made by the National Rural Health Mission (NRHM) in India by involvement of community health volunteers known as Accredited Social Health Activists (ASHAs) towards reducing the persistent problem of undernutrition in the country. [ABSTRACT FROM AUTHOR]

Research Question: Use of community based volunteers, frequently reaching and counseling a selected group of prioritized families, can make a substantial difference in improving maternal and child care practices and in reducing child undernutrition. Setting: Program Rural Uttar Pradesh, India. Study Design: A comparison of baseline and endline surveys following 4 years of community based project intervention Participants: "At risk" undernutrition families comprising mothers of under twos, newlyweds, and severely undernourished children below 6 years. Intervention: Mapping and counseling of "at risk" families. Measuring impact on maternal-child care practices, underweight status. Results: Trained community mobilizers identified and counseled selected "at risk" families. Following 4 years of implementation in 907 villages of 8 blocks of four districts, significant improvement was noted in practices of early initiation of breastfeeding, feeding colostrum, timely introduction of complementary feeding, and washing the hands after defecation. Percentage of mothers exclusively breastfeeding at 6 months was only 2.1% with 78% receiving prelacteal feeds. A small increase in normal and mild malnutrition and a significant reduction of 43% in severe malnutrition was noted. Conclusion: Frequently counseling by accredited social health activists by focusing on selected defined "at risk" families of under twos and those with severe malnourished children could result in increasing acceptability of correct child health, feeding, and care practices and in contributing to improving nutritional status scenario. [ABSTRACT FROM AUTHOR]

To facilitate access to care and to ensure adherence to diagnostic follow-up of positive breast cancer screening or prescribed treatment for confirmed cancer, community volunteers were used as patient navigators (PNs) for a population of low-income, medically under-served women, primarily African Americans. Partnerships were established with local healthcare facilities, residents from the targeted areas were hired as county coordinators, and community volunteers were trained to serve as PNs. Patients who had a suspicious mammogram or confirmed diagnosis of breast cancer were recruited from 23 Alabama counties. For these patients, barriers to diagnostic follow-up or treatment were identified by PNs, who assisted in overcoming these barriers by referring patients to appropriate treatment facilities, guiding them through the healthcare system, and providing the necessary logistical, social, or emotional support. With this intervention, patients kept 93% of their appointments. Thus, for medically under-served patients with breast cancer or a suspicious mammogram, intervention by a network of community volunteers serving as PNs improves adherence to follow-up diagnostic procedures and treatment. PNs can help close the gap between development and delivery of cancer treatments to those who are medically underserved. [ABSTRACT FROM AUTHOR]

There is growing evidence that physical activity (PA) can improve quality of life (QOL) and reduce fatigue in cancer survivors. Research staff or healthcare providers have delivered PA interventions to cancer populations. As a first step to dissemination of a previously tested PA intervention, seven American Cancer Society Reach to Recovery volunteers (mean age = 57.4 years) were trained to deliver the telephone-based intervention to 25 breast cancer survivors (mean age = 52.9 years, 56% Stage 2 cancer, mean of 3.3 years since diagnosis). A single group design was used. The theory-based intervention consisted of 12 weekly calls to encourage participants to adopt moderate-intensity PA. Participants' PA, QOL, mood, and fatigue were assessed at baseline, 12, and 24 weeks. Data on intervention feasibility and preliminary effects were collected. The intervention was feasible (mean of 10.7 out of 12 calls were delivered) and acceptable to the volunteers. At 12 weeks, there were significant increases in participants' PA and improvements in fatigue, QOL, and vigor. Effects were maintained at 24 weeks. This pilot study demonstrated that it was feasible for trained volunteers to deliver a telephone-based PA intervention to breast cancer survivors, and there were positive effects on survivors' PA behavior and psychological outcomes. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Although Turkish society has traditionally valued volunteering, it has not fully utilized the potential of such contributions. This is because the country lacks professional volunteer organizations, and limited research has evaluated Turkish volunteers. The main aims of the current study were to describe the personal characteristics of Turkey's community volunteers and to determine the influence of various motivational factors on their decision to serve in the Community Volunteer Foundation. The participants were a randomly selected sample of 175 community volunteers from different regions of Turkey. Findings showed that the average community volunteer was a 22-year-old, male college student pursuing a career in engineering, economics, or business. The most important motivational factors for volunteering were altruism, a filiation, and personal improvement (in that order). Completing an orientation course before working as a volunteer was considered useful. Recognition, by contrast, was not considered to be a vital factor. [ABSTRACT FROM AUTHOR]

The Dalhousie Health Mentors Program builds on a long history of interprofessional health education initiatives by introducing students in health and social care professions to chronic conditions and disabilities, patient/client-centredness, interprofessional learning, and team functioning. This large interprofessional education program (16 participating programs, 650 students) connects interprofessional student teams with Health Mentors, who are adult volunteers with chronic conditions, for a learning experience that extends over one academic year. Students explore their mentor's life story and chronic condition journey, the impact the condition has had on her/his life, and her/his experience with health care in general and interprofessional collaboration in particular. All aspects of the program planning, management, implementation, and evaluation have been interprofessional in nature. Lessons have been learned regarding [ABSTRACT FROM AUTHOR]

Background: Globally, eye care provision is currently insufficient to meet the requirement for eye care services. Lack of access and awareness are key barriers to specialist services; in addition, specialist services are over-utilised by people with conditions that could be managed in the community or primary care. In combination, these lead to a large unmet need for eye health provision. We have developed a validated smartphone-based screening algorithm (Peek Community Screening App). The application (App) is part of the Peek Community Eye Health system (Peek CEH) that enables Community Volunteers (CV) to make referral decisions about patients with eye problems. It generates referrals, automated short messages service (SMS) notifications to patients or guardians and has a program dashboard for visualising service delivery. We hypothesise that a greater proportion of people with eye problems will be identified using the Peek CEH system and that there will be increased uptake of referrals, compared to those identified and referred using the current community screening approaches.Study Design: A single masked, cluster randomised controlled trial design will be used. The unit of randomisation will be the 'community unit', defined as a dispensary or health centre with its catchment population. The community units will be allocated to receive either the intervention (Peek CEH system) or the current care (periodic health centre-based outreach clinics with onward referral for further treatment). In both arms, a triage clinic will be held at the link health facility four weeks from sensitisation, where attendance will be ascertained. During triage, participants will be assessed and treated and, if necessary, referred onwards to Kitale Eye Unit.Discussion: We aim to evaluate a M-health system (Peek CEH) geared towards reducing avoidable blindness through early identification and improved adherence to referral for those with eye problems and reducing demand at secondary care for conditions that can be managed effectively at primary care level.Trial Registration: The Pan African Clinical Trials Registry (PACTR), 201807329096632 . Registered on 8 June 2018. [ABSTRACT FROM AUTHOR]

Community-based research on child survival in sub-Saharan Africa has focussed on the increased provision of curative health services by a formalised cadre of lay community health workers (CHWs), but we have identified a particular configuration, that deserves closer scrutiny. We identified a two-tiered CHW system, with the first tier being the lessor known or 'hidden' community/village level volunteers and the second tier being formal, paid CHWs, in Ethiopia, Mali, and Niger. Whilst the disease-focussed tasks of the formal CHW tier may be more amenable to classic epidemiological surveillance, we postulate that understanding the relationship between formalised CHWs and volunteer cadres, in terms of scope, location of practice and ratio to population, would be important for a comprehensive evaluation of child survival in these countries. We report on the findings from our joint qualitative and quantitative investigations, highlighting the need to recognise the 'hidden' contribution of volunteers. We need to better characterize the volunteers' interaction with community-based and primary care services and to better understand ways to improve the volunteer systems with the right type of investments. This is particularly important for considering the models for scale-up of CHWs in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]