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

Activity
Roleplay

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

CHW Program Assessment and Improvement Matrix

by jehill3 on May 03, 2010

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CHW Program Assessment and Improvement Matrix — Presentation Transcript