CHW Program Assessment and Improvement Matrix

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CHW Program Assessment and Improvement Matrix

Rebecca Furth, Initiatives Inc.Alison Wittcoff, HCI Project

April 28, 2010

USAID HEALTH CARE IMPROVEMENT PROJECT

Session Agenda

• Welcome and introduction to CHW AIM tool• Case Example: Benin Action Plan• CHW-AIM Roleplay Exercise • Exercise Debrief and Discussion• Summary and CHW AIM operational research

study

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Activity

Action Plan Case Example

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Action Planning Framework

Programmatic Component Problem Action

Person responsible

Needs and resources Timeline Indicators

Equipment and Supplies

Frequent stockouts of CTA, ORS, MILD, FP products in some districts

Performance Evaluation and Incentives

Communities currently are not following through on their commitment to provide incentives and support CHWs

Referral System

Clients are referred, but no formal system exists with standards for referral or methods for tracking referral.

Initial Training

Community has no involvement in initial training

Opportunity for Advancement

CHWs have no opportunities for advancement

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Action Planning Framework

Programmatic Component Problem Action

Person responsible

Needs and Resources Timeline Indicators

Equipment and Supplies

Frequent stockouts of CTA, ORS, MILD, FP products in some districts

Review and modify calculation of average monthly consumption(include needs of the CHW), inc. buffer stock

CHW Supervisor

Security stock

Performance Evaluation and Incentives

Communities currently are not following through on their commitment to provide incentives and support CHWs

Discuss with CHW and the community how to find a way to recognize CHW

PISAF Program Manager

Referral System

Clients are referred, but no formal system exists with standards for referral or methods for tracking referral.

Formalize the referral system by developing referral cards


Document referrals and feedback

Initial Training

Community has no involvement in initial training

Involve community in training role plays and have practicum sessions in the community


Opportunity for Advancement

CHWs have no opportunities for advancement

Introduce a post of expert CHW for high-performing CHWs



Action Planning - Benin

• Referral cards have been distributed to all CHWs• Community has become involved in the last rounds of training • Replenishment of supplies is now centralized and done monthly

by supervisor

More short and medium term actions are planned:• PISAF will re-assess program using AIM tool to monitor progress• Plan to expand interventions to include pneumonia and

vaccination in one pilot area• PISAF proposed using the AIM tool in the national guidelines for

the organization of community-based health services in Benin

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Activity

Roleplay

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Roleplay Debrief and Discussion

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Summary, OR and Concluding Remarks

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CHW Program Assessment and Improvement Matrix (AIM) Objectives

• To assess CHW program functionality and guide improvement in programs delivering services at the community level

• To guide action planning and best practices to assist in strengthening CHW programs

• If needed/required, count the number of “functional” CHWs

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Operational Definition of a Community Health Worker Who Provides (MCH) Services

A community health workeris a health worker who:

• Performs a set of essential evidence-based (MCH) health services;

• Receives standardized training outside the nursing or medical curricula;

• Has a defined role within the community and the larger health system.

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Applying the AIM Approach in Four Steps

1. Adapt to country context

2. Assessment workshop

3. Validation site visits

4. Action planning

Time spent on each step varies according to country context, adaptation and objectives

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Step 1: Adapt to Country Context

• Adapt interventions list based on discussions and review with in-country stakeholders

– Need, epidemiology– Health systems– Evidence-based interventions – Policies that impact CHW activities– NGO or governmental

• Revise and/or translate tool

• High level meeting with in-country partners to share adapted tool

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Step 2: Assessment Workshop

• Overview of AIM

• Review and discussion of programmatic components and interventions

• Rating

• Functionality Assessment

• Gap analysis

• Counting of CHWs (if required)

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Step 3: Validation Site Visits

• Visit 8 to 10 CHWs not involved in workshop

• Interview CHWs to determine validity of workshop findings using a semi structured questionnaire

• Discuss and consider changes to close gaps

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Step 4: Action Planning – Policy level

• Simplicity of matrix encourages improvement discussions and action planning

– Discussions between ministries and other organizations regarding common approach, high impact interventions, sustainability

– Strengthens country ownership through existing committees and management structures using improvement methods - focused on gaps and on linking management structures, health facilities, and community

– Can be used with other tools & approaches (REFLECT, PDQ, COPE, Learning for Performance, Improvement Collaboratives, etc)

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Step 4: Action Planning – Program level

• Several opportunities for improvement discussions and action planning for programs

– During initial discussions with stakeholders during review of interventions: evidence-based vs. policies in place vs. impact in community

– During assessment workshop: identifying gaps or potential improvements in each component

– During field visits: with gaps identified, ‘low-hanging’ improvements are evident

– During action planning workshop

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Benefits of the AIM Approach

• Easily adaptable to multiple settings and applications

• Efficient method to assess programs based on organizational best practices

• Offers a simple framework for improvement with clear steps outlined for action planning

• Allows national stakeholders or organizations to have policy discussions based on a simple strategy and key evidence-based interventions

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Benefits of the AIM Approach (2)

• Easy to implement with accompanying training and facilitation guide

• Encourages rich discussion on actual versus expected state of programs

• Encourages country ownership through ease of use, up-front adaptation to country context, and step-by-step improvement

• Can be combined easily with other tools and approaches

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Next Steps

• Finalize the tool

• One additional field test in HIV/AIDS setting in Africa

• OR Study with CORE Group members

• Dissemination of tool

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Operations Research

HCI is conducing OR with the CHW-AIM tool to :

• Test out the effectiveness of the CHW AIM tool as a capacity building and performance improvement tool.

• Assess common areas of weakness in CHW program functionality

• Assess the links between improvements CHW program functionality and CHW engagement and performance

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• Sites: seeking 4 to 8 programs, preferably in the same country, to test out the tool and process

• Implementation: Apply the tool for a period of 18 months

• Methods:

– CHW AIM assessment, CHW Engagement and CHW performance baseline, mid-term and endline assessments.

– 8 tools: CHW AIM tool, CHW AIM Action plan, CHW engagement survey, CHW engagement interview, CHW performance assessment, CHW program data record review, program managers focus group, cost assessment

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Other Questions or Remarks

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Thank you

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CHW Program Assessment and Improvement Matrix