This document outlines a program to empower and support community health workers in Nigeria. It proposes developing checklists to standardize care delivery and measuring outcomes. Community health workers would be trained to design, implement, and evaluate programs using simple checklists. Their performance would be tracked using weekly scorecards measuring public health metrics. The goal is to professionalize community health work and improve health outcomes in Nigeria.

1. Title Page
Empowerment and Ownership:
A checklist to Sustain Community
Health Workers
Dr. Chidi Ukandu Dr. Elvira Beracochea
MIDEGO-Nigeria MIDEGO, Inc.
Director President
chidi@midego.com elvira@midego.com

2. Opportunity in Nigeria
• Population: Est. 170 million
• Physician Density: 0.4/1000 people
• Nurses & Midwives Density: 1.6/1000 people
• Community Health Workers Density: 0.1/1000
people
• Life expectancy: 52 years
• Infant Mortality Rate: 74/1000 live births
• Maternal mortality: 630 deaths/100,000 live
births
• Health system ranked 187 out of 191 countries
by WHO in 2000

3. Community Health Workers &
Healthcare Systems
• The use of CHW has been identified as one strategy to
address the growing shortage of health workers in
low income countries
• Robust evidence exists that CHWs can undertake
actions that lead to improved health outcomes
• Although they can implement effective interventions
the quality of health services they provide is
sometimes poor
• For CHWs to make an effective contribution they must
be carefully selected and appropriately trained and
supervised and linked to supporting facility and made
to feel “proud of their contribution” to the community
and competent

4. Creating Empowerment and
Ownerrship
• Participate in the design,
implementation and evaluation of the
programs they implement
• Participate in the tracking of their
own improvement and help them to
account for their own achievements

5. Community Health Workers in
Nigeria
• CHO
• CHEW
• CBHV
• TBAs
• CDIs
• Home based HIV care givers
• Ward and Village Development
Committees and Local Leaders

6. Country led development
programme starting with 10 items
1. Hand washing
2. Antenatal, delivery/Postnatal Care
3. Use of bednets
4. Exclusive breast feeding
5. Appropriate nutrition
6. Routine immunization
7. Birth spacing and family planning
8. Malaria prevention
9. Diarrhea and ORS
10. Smoking cessation

7. Empowering CHWs to take action
using a simple tool: the checklist
• A simple list of tasks to achieve a defined
quality objective
• Can be carried around by CHWs
• Allows for consistency in delivery of care
• Prevents “action paralysis” due to
overwhelming challenges
• Participatory and requires minimal training
• Can be deployed rapidly

8. Sample checklist for hand
washing
1. Smile and greet “guest”
2. Introduce yourself
3. Explain to guest why hand washing is important – very powerful for
preventing diseases
4. Ask if guest can easily get access to clean water and soap
5. If no, explore possible sources for getting access to clean water
with guest
6. If yes, now explain the process the guest shall take to start
implementing hand washing immediately
7. Demonstrate correct hand washing
8. Have guest repeat procedure,
9. Have guest invite others in HH to wash hands
10.Set another date to meet with guest to evaluate progress
11.Thank guest for his/her time

9. Steps to be Developed
by the CHW
1. Find a source of clean water for washing near the bathroom
and kitchen at home. At work, have a source of clean water
near every patient examination area. If you do not have a
faucet, use a plastic bottle or bucket with a ladle to save water
2. Find soap and a clean cloth or towel to dry your hands
3. Pour water on both hands
4. Use soap to form a good amount of foam and rub palms, back
of hands and in between fingers while counting slowly up to
20.
5. Rinse both hands with water
6. Inspect your hands and the hand of children after washing to
ensure hands are clean and whether you need cut nails if long
or there is dirt underneath.
7. Repeat if not clean.

10. Measuring Effectiveness:
The Weekly Scorecard
1. Number of children born
2. Number of children who are exclusively
breastfed
3. Number of children with adequate weight for age
4. Number of pregnant women
5. Number of pregnant women who have at least
had one ANC visit
6. Number of immunized children
7. Number of people diagnosed with Malaria
8. Number of cases of diarrhea
9. Number of people who smoke

11. Next Steps
• Raise U$100,000 to implement and
evaluate the project
• Scale up the project into a statewide
and national program

12. Visit us at www.midego.com
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