The document summarizes the community health worker (CHW) programs of the International Rescue Committee (IRC) in 6 countries. [1] Over 13,000 CHWs provide case management for conditions like malaria, diarrhea and pneumonia reaching up to 92,000 patients per month. [2] CHWs are chosen by their communities and receive initial 5-7 day training. [3] IRC assesses the quality of care delivered by CHWs through direct observation of their interactions with patients using prepared case studies and standardized evaluation tools.

1. WHAT KIND OF CARE ARE YOUR CHWS
DELIVERING?
CORE SPRING MEETING -MAY 2012

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 Assessed
1. Welcoming
2. Assessment of the sick child
3. Referral decision
4. Classification
5. Treatment
6. Counseling

11. Assessment of
the 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 of
the 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
assessed
Assessment of pneumonia
2. Uncovers the child’s
chest
3. Counts respiratory
rates correctly
4. Knows the cut-off
points

15. Example of QoC Tool

16. Multi-Country Results
Ethiopia, Uganda and South Sudan

20. Testing Counting Beads
Uganda and South Sudan

21. 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

23. 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

24. THANK YOU
For further questions please contact Alison Wittcoff:
awittcoff@rescue.org