1. 1 Improving Community Health Worker Programs

2. USAID HEALTH CARE IMPROVEMENT PROJECT HCI’s CHW Program Improvement Work CHW AIM (The Community Health Worker Assessment and Improvement Matrix) CHW AIM Operations Research Zambia CHW Central 2

3. USAID HEALTH CARE IMPROVEMENT PROJECT Overarching Concerns Respond to global needs to strengthen systems to support CHW programs Contribute to a more strategic approach to CHW program implementation Provide practical tools to disseminate and reinforce best practices Build local capacity to assess and improve CHW programs in relationship to best practices 3

4. USAID HEALTH CARE IMPROVEMENT PROJECT CHW AIM (CHW Program Assessment and Improvement Matrix) A tool and process that guide self-directed assessments of CHW programs and an action planning process. Responds to recognized need to strengthen systems to support CHW programs –Pepfar II: HSS and increase of health workers –GHI: HSS, integration and sustainability –WHO/Global Health Workforce Alliance: country-level support and expansion of CHW programs 4

5. USAID HEALTH CARE IMPROVEMENT PROJECT CHW AIM Objectives Assess program functionality, identify strengths and areas of need, and guide improvement using a simple process and clear criteria that can be applied across projects/programs Assess health service interventions Facilitate action planning to guide improvements 5

6. USAID HEALTH CARE IMPROVEMENT PROJECT CHW AIM Approach Self and group assessment, using criteria consistent with WHO/GHI, of 15 key areas and health service interventions: Recruitment CHW Role Initial Training Continuing Training Equipment and Supplies Supervision CHW Performance Evaluation Incentives Community Involvement Referral System Opportunity for Advancement Documentation, Information Management Linkages to Health System Program Performance Evaluation Country Ownership 6 Health service interventions in MNCH, HIV, TB, Water/Sanitation (TBD), RH (TBD)

7. USAID HEALTH CARE IMPROVEMENT PROJECT CHW AIM Example Section 7

8. USAID HEALTH CARE IMPROVEMENT PROJECT The CHW AIM Field Applications Field tests in Nepal and Benin Salvation Army in Zambia applied the CHW AIM to assess the Chikankata Child Survival Project WHO GHWA 8 country case studies on CHW Programs Save the Children in Ethiopia assessed vCHWs and HEWs CHW AIM OR: 2-year comparative study in Zambia with 5 partners to assess impact of applying CHW AIM as an improvement framework 8

9. WHO Results Country Case Studies CHW-AIM PakistanBangladeshThailandBrazilHaitiEthiopiaUgandaMozambique Recruitment33333333 CHW Role32323322 Initial Training32333333 Ongoing Training23232211 Equipment and Supplies23232212 Supervision33033322 Performance Evaluation32032221 Incentives22233210 Community Involvement23332222 Referral System11133211 Professional Advancement20122202 Documentation, Information System 21033320 Average Score2.11.62.12.82.62.41.6 9 NOTE: For a minimally functional program  a score of at least 2 is required in each of the 12 components

10. Field Test Results CHW-AIM Nepal Kavre Benin Ethiopia vCHW Recruitment333 CHW Role223 Initial Training223 Ongoing Training30 Equipment and Supplies213 Supervision232.6 Performance Evaluation22.3 Incentives221.5 Community Involvement223 Referral System221.3 Professional Advancement00 Documentation, Information System22 Program Performance Linkages to health system Country ownership Average Score2.37522.2 10 NOTE: For a minimally functional program  a score of at least 2 is required

11. USAID HEALTH CARE IMPROVEMENT PROJECT CHW AIM OR Objectives: To test the effectiveness of the CHW AIM toolkit as a capacity building and performance improvement tool. To test the theory that strengthening CHW program functionality leads to improved CHW engagement and performance. To assess the costs associated with implementing the CHW AIM tool and the incremental cost effectiveness associated with its use. 11

12. USAID HEALTH CARE IMPROVEMENT PROJECT CHW AIM OR Timeline: 2 years – July 2010 to June 2012 Partners: World Vision, Salvation Army, ZPCT Project/FHI, CHAZ/Coptic Mission Hospital, mothers2mothers Sample: 5 CHW programs and 130 CHWs, one control (30 CHWs) Tools: CHW AIM, CHW engagement survey, CHW engagement interview, program management interview, performance assessments 12

13. CHW AIM OR Baseline Results CHW-AIM Zambia 1 Zambia 2 Zambia 3Zambia 4 Zambia 5 Recruitment33233 CHW Role23222 Initial Training32133 Ongoing Training21122 Equipment and Supplies21033 Supervision11123 Performance Evaluation10112 Incentives12223 Community Involvement23111 Referral System12121 Professional Advancement10212 Documentation, Information System 22132 Program Performance11232 Linkages to health system12022 Country ownership11121 Average Score1.6 1.22.1 13 NOTE: For a minimally functional program  a score of at least 2 is required

14. CHW AIM OR Baseline Results 14

15. USAID HEALTH CARE IMPROVEMENT PROJECT CHW AIM Advantages Both quantitative (scoring and counting) and qualitative (interviews and discussion) Can be applied at a country level to assess multiple programs or at the individual level Provides clear criteria across programs for multiple partners/implementers Can be complemented by other tools Matrix can be applied without the workshop through interviews and document discovery (eg., GHWA 8 country case studies, Ethiopia) 15

16. USAID HEALTH CARE IMPROVEMENT PROJECT CHW Central Description: A website to house resources related to community health worker programs Rationale: To provide evidence-based resources and a central community for CHW programs Audience: Ministries of health, NGOs, donors, technical support agencies Contents: Training materials, practical tools, guidelines, best practices, blog, virtual learning sessions, interactive discussions, downloadable resources Timeline: To be Launched in early 2011 16

17. USAID HEALTH CARE IMPROVEMENT PROJECT CHW Central Brief Seeking inputs and feedback from the community 17

18. USAID HEALTH CARE IMPROVEMENT PROJECT Other Related Work CHW Productivity Assessment CHW Collaboratives 18

19. USAID HEALTH CARE IMPROVEMENT PROJECT THANK YOU 19