CHW Program Assessment and Improvement Matrix

CHW Program Assessment and Improvement Matrix Rebecca Furth, Initiatives Inc. Alison Wittcoff, HCI Project April 28, 2010

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

Activity Action Plan Case Example

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

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 PISAF Program Manager 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 PISAF Program Manager Opportunity for Advancement CHWs have no opportunities for advancement Introduce a post of expert CHW for high-performing CHWs PISAF Program Manager

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

Roleplay Debrief and Discussion

Summary, OR and Concluding Remarks

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

Operational Definition of a Community Health Worker Who Provides (MCH) Services A community health worker is 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.

Applying the AIM Approach in Four Steps Adapt to country context Assessment workshop Validation site visits Action planning Time spent on each step varies according to country context, adaptation and objectives

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

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)

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

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)

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

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

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

Next Steps Finalize the tool One additional field test in HIV/AIDS setting in Africa OR Study with CORE Group members Dissemination of tool

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

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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