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Putting Tigers in CHWs Tanks_Wittcoff_5.3.12
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Putting Tigers in CHWs Tanks_Wittcoff_5.3.12


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  • in Europe, Asia, Africa, Latin America and the Middle East
  • based on WHO’s CHW IMCI treatment manualin certain countries they also provide nutrition screening and newborn care
  • based on WHO’s CHW IMCI treatment manualin certain countries they also provide nutrition screening and newborn care
  • Transcript

    • 2. Introduction to IRC• For over 50 years, IRC has provided health care to the most vulnerable and marginalized communities in over 40 countries• IRC partners with ministries of health, village committees and health facility staff to build capacity in-country and create sustainable programs
    • 3. IR C ’ s C o m m u n it y C a s e Ma na g e me nt P rog ra m- S iz e a n d S c a le• 6 countries• 350 health facilities• 13,000 CHWs• Up to 92,000 treatments/month for fever, diarrhea and pneumonia• 795,000 under five• 4,110,000 total population
    • 4. IRC’s CCM Program- Continued• CHWs chosen by their communities• Initial training lasts 5 to 7 days• CHWs provide case management for malaria, diarrhea and pneumonia• Monthly supervision visits conducted by peer supervisors
    • 5. IRC’s CCM Program- Monitoring & Evaluation CHW Patient Register• CHWs record information in patient and drug registers to document each case• Routine data collected monthly from registers, supervision visits and health facilities and then entered into Excel database CCM Data Flow
    • 6. Assessing Quality of Care (QoC) Delivered by Individual CHWs
    • 7. QoC Methodology• Systematic random sampling of CHWs from a list of those active in area(s) to be assessed• Direct observation of CHWs at their home while managing a child• Prepared case stories used by caregivers at the sites when an actual sick child not available
    • 8. QoC Methodology• Two simple cases with one condition: • Fever for 1 day • Diarrhea for 3 days• One case with two conditions: • Cough and fever for 3 days• Two referral cases: • Diarrhea for 3 weeks • Vomits everything
    • 9. Assessing CHWs• Easy-to-use tools to note if standards for skills were met by CHW during observation• Standards for each skill based on the CHW training manual• Skills often require accomplishment of several tasks to meet the standard
    • 10. Skills Assessed1. Welcoming2. Assessment of the sick child3. Referral decision4. Classification5. Treatment6. Counseling
    • 11. Assessment ofthe sick child• Asks the child’s age• Asks whether the child has fever, diarrhea and cough• Checks for danger signs
    • 12. Referral decision• Takes the correct referral decision (all main danger signs must have be assessed for children not referred)• Gives pre-referral treatment if necessary
    • 13. Treatment ofthe sick child• Prepares and gives the child the first dose• Gives the caregiver the correct treatment according to the child’s age
    • 14. Others skills assessedAssessment of pneumonia2. Uncovers the child’s chest3. Counts respiratory rates correctly4. Knows the cut-off points
    • 15. Example of QoC Tool
    • 16. Multi-Country ResultsEthiopia, Uganda and South Sudan
    • 17. Testing Counting BeadsUganda and South Sudan
    • 18. Counting Beads• CHWs received a short explanation of how to use the beads• CHWs were told NOT to count but move the beads after each breath of the child• CHW’s hand at the sound of the timer had to be within ±3 beads of the gold standard
    • 19. Key Messages• The QoC assessment provides insight into the individual performance of CHWs• The QoC can help identify major gaps/weaknesses in CHW performance that may not be captured through monthly routine data• Counting beads can help CHWs to correctly identify pneumonia cases
    • 20. THANK YOUFor further questions please contact Alison