1 Improving Community Health Worker Programs. USAID HEALTH CARE IMPROVEMENT PROJECT HCI’s CHW Program Improvement Work CHW AIM (The Community Health Worker

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Improving Community

Health Worker Programs

USAID HEALTH CARE IMPROVEMENT PROJECT

HCI’s CHW Program Improvement Work

• CHW AIM (The Community Health Worker Assessment and Improvement Matrix)

• CHW AIM Operations Research Zambia

• CHW Central

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Overarching Concerns

• Respond to global needs to strengthen systems to support CHW programs

• Contribute to a more strategic approach to CHW program implementation

• Provide practical tools to disseminate and reinforce best practices

• Build local capacity to assess and improve CHW programs in relationship to best practices

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CHW AIM (CHW Program Assessment and Improvement Matrix)

A tool and process that guide self-directed assessments of CHW programs and an action

planning process.Responds to recognized need to strengthen systems to support CHW programs

– Pepfar II: HSS and increase of health workers– GHI: HSS, integration and sustainability– WHO/Global Health Workforce Alliance: country-level

support and expansion of CHW programs

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CHW AIM Objectives

• Assess program functionality, identify strengths and areas of need, and guide improvement using a simple process and clear criteria that can be applied across projects/programs

• Assess health service interventions

• Facilitate action planning to guide improvements

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CHW AIM Approach

Self and group assessment, using criteria consistent with WHO/GHI, of 15 key areas and health service interventions:

• Recruitment• CHW Role• Initial Training• Continuing Training• Equipment and Supplies• Supervision• CHW Performance Evaluation• Incentives

• Community Involvement• Referral System• Opportunity for Advancement• Documentation, Information

Management• Linkages to Health System• Program Performance

Evaluation• Country Ownership

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• Health service interventions in MNCH, HIV, TB, Water/Sanitation (TBD), RH (TBD)


CHW AIM Example Section

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Component

Definition

Level of Functionality:

0= non-functional; 1=partly functional; 2= functional; 3 = highly functional

0 1 2 3 (best practice)

1 Recruitment

How and from where a community health worker is identified, selected, and assigned to a community, including selection criteria.

CHW not from community and the community plays no role in recruitment.

No or only a few criteria exist and are not well know or commonly applied.

CHW is not recruited from community and the community is not involved in the recruitment process but approves of final selection.

Few criteria exist and are well known and applied, but are general and/or do not address specific issues such as gender and marital status.

CHW is recruited from community and the community is consulted on the final s election.

Or if due to special circumstances the CHW must be recruited from outside the community the community is consulted on the final selection.

Some criteria exist and are specific on literacy level but do not address gender, marital status, or if the CHW should come from local community or not.

CHW is recruited from community with community participation

Or if the due to special circumstance the CHW is recruited from outside the community, the community participates during the process, agrees on recruitment selection and is consulted on final selection.

All selection criteria – literacy, gender, marital status, local residence – are met when possible.


The CHW AIM Field Applications

• Field tests in Nepal and Benin

• Salvation Army in Zambia applied the CHW AIM to assess the Chikankata Child Survival Project

• WHO GHWA 8 country case studies on CHW Programs

• Save the Children in Ethiopia assessed vCHWs and HEWs

• CHW AIM OR: 2-year comparative study in Zambia with 5 partners to assess impact of applying CHW AIM as an improvement framework

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WHO Results Country Case Studies

CHW-AIM Pakistan Bangladesh Thailand Brazil Haiti Ethiopia Uganda Mozambique

Recruitment 3 3 3 3 3 3 3 3CHW Role 3 2 3 2 3 3 2 2Initial Training 3 2 3 3 3 3 3 3Ongoing Training 2 3 2 3 2 2 1 1Equipment and Supplies 2 3 2 3 2 2 1 2Supervision 3 3 0 3 3 3 2 2Performance Evaluation 3 2 0 3 2 2 2 1Incentives 2 2 2 3 3 2 1 0Community Involvement 2 3 3 3 2 2 2 2Referral System 1 1 1 3 3 2 1 1Professional Advancement 2 0 1 2 2 2 0 2Documentation, Information System

2 1 0 3 3 3 2 0

Average Score 2.1 1.6 2.1 2.8 2.6 2.4 1.6 1.6

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NOTE: For a minimally functional program a score of at least 2 is required in each of the 12 components

Field Test Results

CHW-AIM NepalKavre

Benin EthiopiavCHW

Recruitment 3 3 3CHW Role 2 2 3Initial Training 2 2 3Ongoing Training 3 0Equipment and Supplies 2 1 3Supervision 2 3 2.6Performance Evaluation 2 2.3Incentives 2 2 1.5Community Involvement 2 2 3Referral System 2 2 1.3Professional Advancement 0 0Documentation, Information System 2 2Program Performance Linkages to health systemCountry ownershipAverage Score 2.375 2 2.2

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NOTE: For a minimally functional program a score of at least 2 is required


CHW AIM OR

Objectives:

• To test the effectiveness of the CHW AIM toolkit as a capacity building and performance improvement tool.

• To test the theory that strengthening CHW program functionality leads to improved CHW engagement and performance.

• To assess the costs associated with implementing the CHW AIM tool and the incremental cost effectiveness associated with its use.

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CHW AIM OR

Timeline: 2 years – July 2010 to June 2012

Partners: World Vision, Salvation Army, ZPCT Project/FHI, CHAZ/Coptic Mission Hospital, mothers2mothers

Sample: 5 CHW programs and 130 CHWs, one control (30 CHWs)

Tools: CHW AIM, CHW engagement survey, CHW engagement interview, program management interview, performance assessments

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CHW AIM OR Baseline Results

CHW-AIM Zambia1

Zambia 2 Zambia 3 Zambia 4

Zambia5

Recruitment 3 3 2 3 3CHW Role 2 3 2 2 2Initial Training 3 2 1 3 3Ongoing Training 2 1 1 2 2Equipment and Supplies 2 1 0 3 3Supervision 1 1 1 2 3Performance Evaluation 1 0 1 1 2Incentives 1 2 2 2 3Community Involvement 2 3 1 1 1Referral System 1 2 1 2 1Professional Advancement 1 0 2 1 2Documentation, Information System

2 2 1 3 2

Program Performance 1 1 2 3 2Linkages to health system 1 2 0 2 2Country ownership 1 1 1 2 1Average Score 1.6 1.6 1.2 2.1 2.1

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NOTE: For a minimally functional program a score of at least 2 is required

CHW AIM OR Baseline Results

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Site 3 Site 5 Site 1 Site 4 Site 2 Common Strengths and Weaknesses

1 Recruitment 2 3 3 3 3 14 93%

3 Initial Training 1 3 3 3 2 12 80%

2 CHW Role 2 2 2 2 3 11 73%

8 Incentives 2 3 1 2 2 10 67%

12 Documentation, Information Management 1 2 2 3 2 10 67%

5 Equipment and Supplies 0 3 2 3 1 9 60%

13 Linkages to Health System 2 2 1 3 1 9 60%

4 Continuing Training 1 2 2 2 1 8 53%

6 Supervision 1 3 1 2 1 8 53%

9 Community Involvement 1 1 2 1 3 8 53%

10 Referral System 1 1 1 2 2 7 47%

14 Program Performance Evaluation 0 2 1 2 2 7 47%

11 Opportunity for Advancement 2 2 1 1 0 6 40%

15 Country Ownership 1 1 1 2 1 6 40%

7 Individual Performance Evaluation 1 2 1 1 0 5 33%


CHW AIM Advantages

• Both quantitative (scoring and counting) and qualitative (interviews and discussion)

• Can be applied at a country level to assess multiple programs or at the individual level

• Provides clear criteria across programs for multiple partners/implementers

• Can be complemented by other tools

• Matrix can be applied without the workshop through interviews and document discovery (eg., GHWA 8 country case studies, Ethiopia)

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CHW Central

Description: A website to house resources related to community health worker programs

Rationale: To provide evidence-based resources and a central community for CHW programs

Audience: Ministries of health, NGOs, donors, technical support agencies

Contents: Training materials, practical tools, guidelines, best practices, blog, virtual learning sessions, interactive discussions, downloadable resources

Timeline: To be Launched in early 201116


CHW Central

• Brief

• Seeking inputs and feedback from the community

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Other Related Work

• CHW Productivity Assessment

• CHW Collaboratives

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THANK YOU

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Documents

1 Improving Community Health Worker Programs. USAID HEALTH CARE IMPROVEMENT PROJECT HCI’s CHW Program Improvement Work CHW AIM (The Community Health Worker