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

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 Crigler community health_workers Presentation Transcript

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