Prof Cunningham thank you for your posting.
I used 'professional' in the widest sense not restricting it to any strict definition. I am sure that even the CHW would accept that they are paraprofessional. In that sense you are right. Who knows when their scope, role, curriculum and job description rise they may like other cadres in recent memory demand to be called professionals.
But I think that we should not compartmentalise the cadres into such different folios, for that risks failure of attempts at effective multi disciplinary team working. In a recent pilot of a tool that literally binds all cadres in primary health care to work together so long as there is clear delineation of roles and responsibilities: the highly successful PACK Nigeria Programme pilot in 2017 brought CHPs, nurses, midwives and doctors working harmoniously (rare in Nigeria) by being informed of their limits based on their curriculum and training, and referring patients to the next higher cadre in a timely and safe manner.
HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: www.hriwestafrica.com Joseph is a member of the HIFA Steering Group and the HIFGA working group on Community Health Workers: http://www.hifa.org/people/steering-group jneana AT yahoo.co.uk