Transcript Russia - MCHIP - Maternal and Child Integrated Program

Improving
Community
Health Worker
Programs
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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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USAID HEALTH CARE IMPROVEMENT PROJECT
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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USAID HEALTH CARE IMPROVEMENT PROJECT
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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USAID HEALTH CARE IMPROVEMENT PROJECT
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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USAID HEALTH CARE IMPROVEMENT PROJECT
CHW AIM Approach
Self and group assessment, using criteria consistent with WHO/GHI,
of 15 key areas and health service interventions:
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Recruitment
CHW Role
Initial Training
Continuing Training
Equipment and Supplies
Supervision
CHW Performance
Evaluation
• Incentives
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•
•
•
Community Involvement
Referral System
Opportunity for Advancement
Documentation, Information
Management
• Linkages to Health System
• Program Performance
Evaluation
• Country Ownership
• Health service interventions in MNCH, HIV, TB, Water/Sanitation
(TBD), RH (TBD)
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USAID HEALTH CARE IMPROVEMENT PROJECT
CHW AIM Example Section
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Component
Level of Functionality:
Definition
0= non-functional;
1=partly functional;
0
1
2
3 (best practice)
CHW not from
community and
the community
plays no role in
recruitment.
CHW is not
recruited from
community and the
community is not
involved in the
recruitment process
but approves of
final selection.
CHW is recruited
from community
and the community
is consulted on the
final s election.
CHW is recruited from
community with
community
participation
Recruitment
How and from where
a community health
worker is identified,
selected, and
assigned to a
community, including
selection criteria.
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No or only a few
criteria exist and
are not well know
or commonly
applied.
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.
2= functional;
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.
3 = highly functional
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.
USAID HEALTH CARE IMPROVEMENT PROJECT
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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USAID HEALTH CARE IMPROVEMENT PROJECT
WHO Results
Country Case Studies
CHW-AIM
Recruitment
CHW Role
Initial Training
Ongoing Training
Equipment and Supplies
Supervision
Performance Evaluation
Incentives
Community Involvement
Referral System
Professional Advancement
Documentation,
Information System
Average Score
Pakistan Bangladesh
Thailand
Brazil
Haiti
Ethiopia
Uganda
Mozambique
3
3
3
2
2
3
3
2
2
1
2
2
3
2
2
3
3
3
2
2
3
1
0
1
3
3
3
2
2
0
0
2
3
1
1
0
3
2
3
3
3
3
3
3
3
3
2
3
3
3
3
2
2
3
2
3
2
3
2
3
3
3
3
2
2
3
2
2
2
2
2
3
3
2
3
1
1
2
2
1
2
1
0
2
3
2
3
1
2
2
1
0
2
1
2
0
2.1
1.6
2.1
2.8
2.6
2.4
1.6
1.6
NOTE: For a minimally functional program  a score of at least 2 is required in each of
the 12 components
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Field Test Results
CHW-AIM
Recruitment
CHW Role
Initial Training
Ongoing Training
Equipment and Supplies
Supervision
Performance Evaluation
Incentives
Community Involvement
Referral System
Professional Advancement
Documentation, Information System
Program Performance
Linkages to health system
Country ownership
Average Score
Nepal
Kavre
Benin
Ethiopia
vCHW
3
2
2
3
2
2
3
1
3
2
2
2
2
0
2
3
3
3
0
3
2.6
2.3
1.5
3
1.3
0
2
2
2.2
2
2
2
2
2
2.375
NOTE: For a minimally functional program  a score of at least 2 is required
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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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USAID HEALTH CARE IMPROVEMENT PROJECT
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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USAID HEALTH CARE IMPROVEMENT PROJECT
CHW AIM OR Baseline Results
CHW-AIM
Recruitment
CHW Role
Initial Training
Ongoing Training
Equipment and Supplies
Supervision
Performance Evaluation
Incentives
Community Involvement
Referral System
Professional Advancement
Documentation, Information
System
Program Performance
Linkages to health system
Country ownership
Average Score
Zambia
1
Zambia 2
Zambia 3
Zambia
4
Zambia
5
3
2
3
2
2
1
1
1
2
1
1
2
3
3
2
1
1
1
0
2
3
2
0
2
2
2
1
1
0
1
1
2
1
1
2
1
3
2
3
2
3
2
1
2
1
2
1
3
3
2
3
2
3
3
2
3
1
1
2
2
1
1
1
1.6
1
2
1
1.6
2
0
1
1.2
3
2
2
2.1
2
2
1
2.1
NOTE: For a minimally functional program  a score of at least 2 is required
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CHW AIM OR Baseline Results
1
3
2
8
12
5
13
4
6
9
10
14
11
15
7
14
Site 3
Site 5
Site 1
Site 4
Site 2
Recruitment
2
3
3
3
3
14
93%
Initial Training
1
3
3
3
2
12
80%
CHW Role
2
2
2
2
3
11
73%
Incentives
2
3
1
2
2
10
67%
Documentation, Information Management
1
2
2
3
2
10
67%
Equipment and Supplies
0
3
2
3
1
9
60%
Linkages to Health System
2
2
1
3
1
9
60%
Continuing Training
1
2
2
2
1
8
53%
Supervision
1
3
1
2
1
8
53%
Community Involvement
1
1
2
1
3
8
53%
Referral System
1
1
1
2
2
7
47%
Program Performance Evaluation
0
2
1
2
2
7
47%
Opportunity for Advancement
2
2
1
1
0
6
40%
Country Ownership
1
1
1
2
1
6
40%
Individual Performance Evaluation
1
2
1
1
0
5
33%
Common Strengths and Weaknesses
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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USAID HEALTH CARE IMPROVEMENT PROJECT
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 2011
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USAID HEALTH CARE IMPROVEMENT PROJECT
CHW Central
• Brief
• Seeking inputs and feedback from the
community
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USAID HEALTH CARE IMPROVEMENT PROJECT
Other Related Work
• CHW Productivity Assessment
• CHW Collaboratives
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USAID HEALTH CARE IMPROVEMENT PROJECT
THANK YOU
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USAID HEALTH CARE IMPROVEMENT PROJECT