Limited access to veterinary services significantly impacts both animal and public health, especially in rural and remote areas worldwide where service availability is even lower (1). Addressing this issue requires ensuring adequate education and training for key stakeholders of the veterinary workforce, particularly community-based animal health workers (CAHW), who are essential contributors to a robust One Health workforce along with veterinarians and veterinary paraprofessionals (VPP) (2).

A CAHW, also referred to as village animal health worker (1, 3, 4), is “a person selected from or by their own community and provided with short, initial or recurring vocational training to perform basic animal health and animal husbandry-related services, in line with national animal welfare standards. CAHWs operate on a fee-for-service basis or some other means, are accountable to a registered veterinarian, a registered veterinary paraprofessional or an appropriate official and are active in their community” (5). Mostly found in low- and middle-income countries (LMIC) of Africa and Asia, their functions might include providing basic veterinary care, organizing vaccination campaigns, advising livestock keepers on husbandry practices, diagnostic sample collection, assisting in disease reporting and control, and conducting food inspection (1, 4). Through these functions, CAHWs are valuable contributors to a One Health workforce, particularly at the community level, raising awareness of intersectional health problems and applying comprehensive solutions to prevent zoonotic diseases, promote food security, and ensure sustainable production management practices that preserve the health of animals and the people who depend on them.

While there are several entities dedicated to training CAHWs, from non-governmental organizations (e.g., Agronomes et Vétérinaires Sans Frontières (AVSF), Action Contre la Faim (ACF), Heifer International, International Committee of the Red Cross (ICRC)) to intergovernmental organizations (e.g., Food and Agriculture Organization of the United Nations (FAO), United Nations Children’s Fund (UNICEF), African Union Inter-African Bureau for Animal Resources (AU-IBAR)) and government agencies (e.g., Agriculture Skill Council of India, Government of Chad), there is little consensus regarding the logistical structure and content of such trainings. For example, training durations can vary significantly, from a few days to close to 1 year in total length (1, 3). Similarly, neither trainee profiles nor cohort sizes seem to be standardized between trainings; trainees have different baseline experience and levels of literacy, creating variable dynamics within and among training programs (1, 3). Instructional approaches also add variability, with varying time spent utilizing theoretical-based pedagogy vs. implementing hands-on activities (1). The lack of agreement and coordination between training programs may limit the effectiveness of CAHWs and exacerbate existing dysfunction in animal health services (1).

Although standardizing such trainings is complex, the recognition of their important contribution to the veterinary and One Health workforce led to the development of Competency and Curriculum Guidelines for CAHWs by the World Organization for Animal Health (WOAH) (5). With the availability of these Guidelines, it is imperative to consider curriculum and training assessment methodologies to allow existing CAHW trainings to determine whether their content meets the established recommendations. Moreover, regular training assessments are needed to ensure that competencies are effectively and consistently transferred to CAHWs. Only by supplementing the guidelines with a framework for curriculum and training assessment is it possible to fully support the preparation of proficient CAHWs who can strengthen veterinary services and expand One Health efforts.

To contribute to the development of such a framework, a literature review was conducted to offer a succinct summary of current assessment practices in CAHW training systems. The present article highlights common practices and gaps identified to guide the creation of an assessment tool for CAHW training programs, helping organizations and regulatory bodies to optimize CAHWs’ potential.

Publications were gathered from multiple databases, namely PubMed, CABI: Cab abstracts, CABI: Global Health, Scopus, CGIAR, and Google Scholar, using a modified PICO question, with no comparison (C) term, as follows:

(P) Population: “community-based animal health worker” OR “Village animal health worker” OR “CAHW” OR “VAHW” OR “para-veterinarian” OR “basic veterinary worker” OR “village veterinary promoter” OR “village livestock promoter” OR “village vaccinator” OR “livestock correspondent” OR “barefoot vet” AND.

(I) Intervention: “training” AND (“assessment” OR “evaluation”) AND.

(O) Outcome: (“competencies” OR “competency” OR “proficiency” OR “knowledge” OR “skills” OR “learning” OR “reaction” OR “satisfaction” OR “behavior” OR “behaviour” OR “results” OR “impact”). Additionally, we searched for literature produced by organizations that train or work with CAHWs including WOAH, VSF International, FAO, African Union, Heifer international, and Global Alliance for Livestock Veterinary Medicines (GALVmed) by reviewing available public reports and resources. No restrictions were applied for year of publication and geographic location, but only published documents written in English were considered.

The present research followed PRISMA guidelines (6) and utilized the online tool Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia, to facilitate collaboration among the researchers (AM, AB). Initially, all results were screened by reading the abstracts or executive summaries, and papers not related to veterinary workforce development were excluded. Papers that received “yes” from both reviewers and those that had conflicting votes on the screening step were selected for full review to determine their eligibility. At full review stage, reviewers included only studies focusing on training for CAHWs in which assessment of the curriculum or training was performed. Papers solely addressing project operational processes (design, implementation, and evaluation), characteristics or sustainability of CAHWs systems, service capacity, value chain, and knowledge or practices of livestock producers were excluded. After creating a preliminary list of eligible papers, relevant articles cited in each included study and other publications by the same authors were screened to ensure comprehensive coverage. The new papers from the backward “snowball” search (7) underwent full review using the inclusion and exclusion criteria previously described.

All studies deemed eligible were thoroughly reviewed, and relevant information was extracted into an Excel file for subsequent organization and synthesis. Papers were scrutinized to collect information systematically, including the focus of the assessment (i.e., curriculum or training) and training effectiveness level according to the Kirkpatrick Model (a framework for training evaluation that considers four levels - reaction, learning, behavior, and results) (8), based on reviewers’ interpretation. When sufficient information was available, data collection methods were analyzed using a competency-based education (CBE) framework to identify which types of competencies, as defined in the Guidelines (knowledge, skill, and personal, social, and methodological abilities) (5), were assessed with each method. Other extracted information included the stakeholders involved and the use of results to improve training.

The flow chart (Figure 1) outlines the review process and summarizes the results. From the primary research, 213 documents were screened, of which 79 were considered for full review.

Of those, 31 did not cover CAHWs curriculum or training program assessment, instead most were about services capacity (n = 18) or project operational procedures (n = 13). Additionally, 22 did not concern CAHWs, but rather VPPs, farm workers, livestock producers, or community health workers (CHWs), and 15 were general information on CAHWs systems or had considerable missing information. Importantly, four curriculum or training guidelines were found in the research process. Ultimately, seven papers met the inclusion criteria and are scrutinized in this review.

This mini review highlights a significant research gap that must be addressed to standardize and advance training aimed at optimizing the efficiency and role of CAHWs within the One Health workforce. While the lack of a harmonized technical language across papers was a major challenge in this review, the authors used well-described frameworks to classify and analyze the assessments, allowing for comparison across very diverse papers.

The assessment of level 1 (reaction) alone (14) provides little information about the effectiveness of the training; however, when combined with other levels of assessment, reaction may help identify the root causes of learning gaps as satisfaction (or dissatisfaction) with the training methods and approaches may affect learning outcomes. Assessing knowledge long after training (13) does not reflect learning from the training, as it can be associated with a high risk of recall and maturation biases. In this paper, the authors used a single survey at one point in time to assess participants’ reaction, learning, and results levels. However, given the time elapsed since the training, only results level could be accurately assessed (8).

To assess the learning level, tests should be conducted immediately after training (15, 16) or, ideally, using a pre-/post-test (10) to assess participants’ knowledge gain. Most assessments were classified as behavior level assessments since they aimed at measuring the extent to which learned concepts were being applied in the field. However, because of the large time span between training completion and assessment, with some authors performing the assessment more than 2 years after training completion, we cannot be confident that CAHWs’ performance can be attributed to the training itself, but rather to experience gained over the practice years, being prone to maturation bias. To allow for the transfer of skills and knowledge into actual performance, behavior should be measured at least 90 days after training, but the longer the duration between training and the assessment, the higher the chances for biased results, impacting the validity of the assessment. For example, Bishop recommended using their observation-based assessment tool at least once every 3 months, but as frequently as possible (12). Despite being a resource-intensive approach that may not be feasible for most CAHW training organizations, ensuring timely assessment (e.g., during training and/or up to 90 days after completion to assess learning) and increasing the frequency is strongly recommended. Lastly, although assessing results is associated with high training transfer because it holds participants accountable for applying the training (17) and is useful to show the importance of training CAHWs (13, 15), focusing solely on long-term results provides limited insight into the training itself.

Ideally, assessments should cover all four levels, allowing to build a comprehensive narrative from immediate reaction and learning through on-the-job application and eventual results. If that is not feasible, priority should be given to learning and behavior levels. Learning is directly tied to the training and its curriculum, with minimal risk of bias, and behavior assessments have been linked with higher training transfer (17).

Importantly, most authors utilized multiple assessment methods and data sources enabling triangulation of results. This approach helps mitigate inherent limitations of individual methods, such as recall bias linked to self-assessment surveys.

Berrian et al. (10) suggested that differences in performance on written assessments across education levels may be due to unfamiliarity with the assessment format, limited literacy, or translation errors. While literacy and education level do not necessarily hinder strong performance (16), Berrian et al. (10) findings highlight the importance of designing assessment tools that take literacy into consideration to avoid misleading results.

The overall lack of papers on CAHW curriculum assessment may be due to the absence of national guidelines in some countries and the fact that, until recently, no international guidelines were available for comparison. The general lack of assessments might be due to limited resources and a lack of recognition of their importance. Since most assessments were conducted by a research team, it suggests they were one-time evaluations rather than iterative ones. This is problematic because organizations that frequently evaluate their training programs experience higher rates of training transfer (17). Furthermore, the lack of articles describing the implementation of subsequent trainings with revised curricula makes it challenging to determine the changes that lead to better training outcomes. As the demand for proven impact grows, as noted by Ghimere and Suvedi (13), regular assessments become increasingly important and sharing results can highly benefit other organizations.

The authors acknowledge the heterogeneity of the papers included in the present review. Other limitations include that only English and published research was included, and that some of those included were mostly descriptive, missing relevant elements to assess their rigor. Despite that, this review enabled several key takeaways that appear to be important to increase the validity and feasibility of curriculum and training assessment in the CAHWs settings, such as:

It is also important to consider the use of well-described frameworks (e.g., Kirkpatrick, Kaufman and Keller’s Five Levels of Evaluation, CIRO Model) to improve the validity of assessment results. Their use will facilitate the analysis across curricula and training programs, enabling organizations to easily exchange lessons learned. In choosing a framework, one should consider their limitations; for example, Kirkpatrick fails to capture individual and contextual factors like motivation and support systems, respectively (18).

Future research could be enriched through inclusion of unpublished training manuals, project reports, and non-English literature to better capture the breadth of CAHW programs. As more research becomes available on this topic, a meta-analysis could be beneficial to further support the choice of assessment methods. Despite the limitations, to the best of our knowledge, this is the first review conducted on this topic, being an important step toward the development of a systematic methodology to assess CAHWs’ training and training curricula.

A thorough curriculum assessment is essential to identify gaps in training that prevent CAHWs from performing their core competencies effectively. Therefore, investing in the development and implementation of curriculum and training assessments is key to complementing the recent advancements in improving and harmonizing CAHWs’ proficiency, thereby contributing to increasing the access to quality veterinary care.