Crigler community health_workers

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CORE Group Fall Meeting 2010. Global Trends in Community Health Worker Programs - Lauren Crigler, USAID

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  • Production: # of CHWs working currently / # of CHWs deployed at the start of program^^^Thailand= Free health services for themselves and for family members. And Educational grants for further studies * Uganda = T shirts, boots, rain coats, bi cycle, transport and lunch allowances in some areas * Mozambique = USD 50/month still under consideration
  • Crigler community health_workers

    1. 1. Global Trends in Community Health Worker ProgramsLauren CriglerDirector, Health Workforce DevelopmentUSAID Health Care Improvement Project<br />
    2. 2. Global Context<br />The health workforce is in crisis while demand is skyrocketing<br />High disease burdens for infectious and non-communicable conditions<br />Overburdened health workers and health systems<br />Endorsement of MDG Goals in 2000<br />Meeting MDGs requires a productive, stable workforce in facilities as well as shifting some tasks to community health workers and volunteers<br />Increasing evidence of high impact interventions at community level<br />2<br />
    3. 3. USAID: Health Systems Strengthening Focus<br />FY2008 USAID MCH Priority<br />Increase functional CHWs by 100,000<br />PEPFAR II<br />Health systems strengthening <br />Specific target to increase health workers by 140,000<br />Global Health Initiative<br />Health systems strengthening <br />3<br />
    4. 4. WHO and Multilateral (G8) Focus<br />Encouraging global health partners to take the following directions: <br />More synergy between disease-oriented approaches (vertical) and strengthening of health systems (horizontal) <br />Three major building blocks identified for health system strengthening (HSS): workforce, financing, and information<br />Revitalization of primary healthcare (PHC) through human security approach<br />
    5. 5. Human security as the core concept for global actions<br />Health is the vital core of human lives and offers a concrete field for developing strategies for human security<br />Strategies<br />Empowerment <br />enable people to develop capacity to cope with or prevent difficult conditions<br />Protection<br />set up by states, international agencies, NGOs, and the private sector to shield people from critical and pervasive threats and enable people to protect themselves<br />
    6. 6. Human security approach to CHW<br />Central government<br />Top-down approach<br />Protection<br />Local government<br />training, supervision & oversight, authorization, financing , logistics<br />Community Health Committee<br />selection of CHWs, identification of priorities <br />Bottom-up approach<br />Empowerment<br />management, supervision & oversight<br />participation<br />OWNERSHIP<br />motivation<br />career advancement<br />training<br />mobilization<br />Communities<br />
    7. 7. Assessing of CHW programs according to global priorities <br />
    8. 8. The CHW Assessment and Improvement Matrix (CHW AIM) Approach<br />A recent approach developed by the HCI Project to assess and improve CHW programs applies criteria for the following 15 components as a way to measure functionality:<br />Recruitment<br />The CHW Role<br />Initial Training<br />Continuing Training<br />Equipment and Supplies<br />Supervision<br />Performance Evaluation<br />Incentives<br />Community Involvement<br />Referral System<br />Opportunity for Advancement<br />Documentation, Information Management<br />Linkages to Health System<br />Program Performance Evaluation<br />Country Ownership<br />8<br />
    9. 9. The CHW AIM Field Applications <br />First field tests in Nepal and Benin<br />Salvation Army in Zambia applied the CHW AIM to assess the Chikankata Child Survival Project<br />Save the Children in Ethiopia to assess vCHWs and HEWs<br />2-year comparative study in Zambia with 5 partners to assess impact of applying CHW AIM as an improvement framework:<br />Nyimba (Salvation Army Zambia)<br />Chongwe (World Vision Zambia)<br />Lusaka (CHAZ and Coptic Hospital)<br />Chipembi (CHAZ and Chipembi Clinic)<br />Kabwe (ZPCT Project/FHI)<br />Choma (mothers2mothers)<br />9<br />
    10. 10. Systematic review of 8 country programs – Global Health Workforce Alliance<br />Reviewed reports on country experiences with CHWs for target 8 countries and programs (Pakistan, Bangladesh, Thailand, Ethiopia, Uganda, Mozambique, Brazil, Haiti)<br />Applied the CHW Assessment and Improvement Matrix (CHW - AIM) to assess functionality<br />Country visits to interview key personnel overseeing the program<br />Information was compiled and reviewed on programs (description, job descriptions, role of CHWs) including evaluation reports and outcome assessments<br />
    11. 11. Selected Key Results<br />
    12. 12. Selected Key Results<br />12<br />
    13. 13. Overall Results<br />Factors limiting the range and quality of CHWs included:<br />Insufficient initial and continuing education<br />Inadequate and irregular supervision<br />Shortage of basic drugs and irregular supplies of vaccines and commodities (e.g. condoms)<br />Lack of equipment and non functional equipment<br />Low social status and remuneration levels of CHWs adversely affect motivation<br />Inadequate linkages with health system <br />13<br />
    14. 14. Global Consultation on Community Health WorkersMontreux, Switzerland, 29 -30 April 2010<br />Meeting objective:<br />Program managers, policy makers and experts review the recommendations of the global review, share experiences, and develop a broad agreement on key messages for countries to integrate CHWs into their national health workforce.<br />
    15. 15. Global Health Workforce Alliance Key Messages<br />Planning, Production and Deployment<br />Attraction and Retention<br />Performance Management<br />
    16. 16. PLANNING, PRODUCTION AND DEPLOYMENT<br />Integrate CHWs fully into national HRH plans and health systems.<br />Involve key HRH stakeholders in the decision-making process.<br />Ensure effective and robust monitoring and evaluation throughout the policy and implementation process or the scale-up of CWs.<br />Any scale-up of CHWs has adequate support (including training, supervision, equipment and supplies, transport).<br />Existing health system should provide enabling environment for CHW policies and planned interventions.<br />
    17. 17. ATTRACTION AND RETENTION<br />Prepare and engage the community throughout the process.<br />Ensure a regular and sustainable stipend and, if possible, complement it with other rewards.<br />Ensure a positive practice environment.<br />Establish selection criteria, training duration, and scope of tasks that are clearly stated, publicized and respected by all stakeholders.<br />Provide an ongoing continuing education for CHWs and, where possible, support opportunities for career advancement.<br />
    18. 18. PERFORMANCE MANAGEMENT<br />Governments should take responsibility for the quality assurance of CHWs, even if CHWs are trained and managed by civil society or private-not-for-profit groups.<br />Performance management should be based on a minimum set of needs-based skills.<br />The management and supervision of CHWs should be team-based and development focused, and integrated with that of other health workers.<br />
    19. 19. Summary and Key Points<br />Community health workers are integral to health systems strengthening and overall global health;<br />Increasing services considered to be effective at the community level<br />Global Health Initiative emphasizes linking CHWs to overall health system; and <br />Pressure is on governments and non-governmental organizations to provide support to CHWs in key areas, including incentives, supervision, standardized training, supplies.<br />
    20. 20. Thank you<br />The HCI Project<br />www.hciproject.org<br />lcrigler@initiativesinc.com<br />
    21. 21. Working Group Questions:<br />Group 1: <br />Given the trend to integrate CHWs into national health systems and support CHWs as part of that system:<br />How can NGOs play a role in advancing this agenda?<br />What impact will this have on locally implemented programs currently not linked to the health system?<br />
    22. 22. Working Group Questions:<br />Group 2: <br />Providing incentives and offering career progression or advancement opportunities to CHWs surface repeatedly as both important and controversial: <br />If CHWs are to be considered as part of the health system, should they also be rewarded and consider their work as a ‘job’ with a career path?<br />How does the increasing role and numbers of tasks assigned (shifted) to CHWs affect traditional volunteerism?<br />
    23. 23. The preceding slides were presented at the<br />CORE Group 2010 Fall Meeting<br />Washington, DC<br />To see similar presentations, please visit:<br />www.coregroup.org/resources/meetingreports<br />

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