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CHWs on the Move_Tsuma_5.10.11


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CHWs on the Move_Tsuma_5.10.11

  1. 1. CHWs on the Move CORE Spring Meeting 2011
  2. 2. Background <ul><li>An CHW Technical Advisory Group on CHW performance at scale met in December 2010 and </li></ul><ul><li>reviewed current global CHW initiatives, </li></ul><ul><li>discussed large-scale CHW efforts in several countries, and </li></ul><ul><li>defined knowledge gaps that, if addressed, would further strengthen the global efforts related to CHWs. </li></ul>
  3. 3. Emerging Gaps <ul><li>lack of a clear taxonomy that  distinguishes different types of community health work and provides typologies for selecting appropriate community health agent strategies; </li></ul><ul><li>need for increased consideration of community health systems in achieving scale for community health work; </li></ul><ul><li>a call for practical guidance that program managers and policy makers can utilize to design CHW programs that can operate effectively at scale based in the local cultural context; </li></ul><ul><li>and  a call for mechanisms to facilitate continuous learning on CHW issues. </li></ul>
  4. 4. What is happening Now <ul><li>MCHIP continues to work with a wider group of individuals and organizations to move these recommendations forward and to generate common understanding and develop usable </li></ul><ul><li>assessment tools, </li></ul><ul><li>checklists, </li></ul><ul><li>guidance and </li></ul><ul><li>community of practice </li></ul>
  5. 5. 10. Representative Governance Bodies Other CHVs 3. District 2. Community 11. Other resources, sectors, actors, associations, committees, CBOs, FBOs, NGOs, private & informal sector providers, businesses, schools 1. Household 8. MoH 7. District Health System 6. Health Facility 5. Health Extension Worker 4. Community Health Volunteer 9. Health Sector A B C D E F G H I F “ CHWs”
  6. 6. Who is a CHW? How do they differ? <ul><li>Characteristics/Parameters that can be used to identify several different profiles for CHWs: </li></ul><ul><li>Extent or coverage /country -wide or focused in marginalized or underserved communities </li></ul><ul><li>CHW Programmatic contribution (at national scale) in terms of services provided </li></ul><ul><li>Relationship with MoH, NGO’s, community and other CHW cadres </li></ul><ul><li>Technical scope </li></ul><ul><li>Location of recruitment/ posting </li></ul><ul><li>Selection criteria </li></ul><ul><li>Households covered per CHW </li></ul><ul><li>Where based </li></ul><ul><li>Time worked </li></ul><ul><li>Compensation </li></ul><ul><li>Basic training </li></ul><ul><li>Functions </li></ul><ul><li>Community Context : Presence of local citizen bodies e.g. committees with ongoing responsibility for health </li></ul><ul><li>  </li></ul>
  7. 7. Some suggestions on parameters of CHW typology: <ul><li>where is the nidus of responsibility in the MOH - MNCH/RH or Community Services </li></ul><ul><li>urban vs rural - any differences in typology? </li></ul><ul><li>like to see more on supervision:who, where reside and education, training of supervisor </li></ul><ul><li>financing source </li></ul><ul><li>is there a CHW policy in country and has it been instrumental in facilitating implementation </li></ul><ul><li>CHW standardized drug/commodity kits or diversity in drugs/commodities </li></ul><ul><li>Some of the programs may need to check more than one box, since it is not always either, or but both ... </li></ul>
  8. 8. CHW Typology <ul><li>Benefits </li></ul><ul><li>Helps to classify evolving Evidence </li></ul><ul><li>Easily identifies to who evolving evidence could be easily applied to </li></ul><ul><li>Helpful in Costing </li></ul><ul><li>Caveats </li></ul><ul><li>Classification of CHWs is dynamic and cadres are dynamic </li></ul><ul><li>Multiple CHW Cadres could coexist in a single country </li></ul>
  9. 9. Sample Typology 1 Parameter Definition Example Compensation (C) On Payroll (2) Malawi HSA Not on Payroll (1) Uganda VHT Distance to Household (D) Household visitation via other volunteers (2) Kenya CHEW Work directly with households (1) Mali Relay Education (E) Health Professional (3) Ethiopia HEW Literate but not Health Professional (2) Malawi HSA Illiterate to semi-illiterate (1) Senegal Relay Specialization (S) Specialized Cadre (2) Rwanda CHW Generalized Cadre (1) Tanzania CHW
  10. 10. Sample Typology 1 TYPOLOGY EXAMPLE C 1 D 1 E 1 S 1 Senegal Relay C 1 D 1 E 2 S 1 Liberia gCHV, Mali Relay, Tanzania CHW, Zambia CHW C 1 D 1 E 2 S 2 Rwanda CHW C 1 D 2 E 2 S 1 Uganda VHT, Mozambique Activista C 2 D 1 E 2 S 1 Angola CHW C 2 D 2 E 2 S 1 Malawi HSA C 2 D 2 E 3 S 1 Ethiopia HEW, Ghana CHO, Kenya CHEW
  12. 12. Sample Typology: Professionalized and Paid A. X B. X C. GHANA COMMUNITY HEALTH OFFICER KENYA CHEW MALAWI HSA ETHIOPIA HEW
  13. 13. New Developments <ul><li>Brief Overview of existing literature on the typologies of community-health programs and prominent examples seen at scale (according to Bhutta et al 2010 GHWA report) </li></ul><ul><li>  Typologies [REF: Bhutta 2010] </li></ul><ul><ul><li>Short to intermediate duration versus long duration training programs </li></ul></ul><ul><ul><li>Preventative and promotion tasks to curative tasks </li></ul></ul><ul><ul><li>Weak supervision versus strong supervision </li></ul></ul><ul><ul><li>Weak health system versus strong health system </li></ul></ul><ul><li>Example systems at scale </li></ul><ul><ul><li>Ethiopia Health Extension Program (long training, preventative and basic curative tasks, weak supervision system, weak health system) </li></ul></ul><ul><ul><li>Pakistan LHW system (long training, mixed tasks, strong supervision, weak health systems) </li></ul></ul><ul><ul><li>Brazil FHP system (long training, mixed tasks, strong supervision, strong health system) </li></ul></ul>