Abstract
BackgroundWhile the evidence supporting the effectiveness of community health worker (CHW) programmes is substantial, there is also considerable evidence that many of these programmes have notable weaknesses that need to be addressed in order for them to reach their full potential. Thus, considerations about CHW programme performance and its assessment must be taken into account as the importance of these programmes is becoming more widely appreciated. In this paper, the tenth in our 11-paper series, “Community health workers at the dawn of a new era”, we address CHW programme performance and how it is assessed from a systems perspective.MethodsThe paper builds on the 2014 CHW Reference Guide, a compendium of case studies of 29 national CHW programmes, the 2018 WHO guideline on health policy and system support to optimize CHW programmes, and scientific studies on CHW programme performance published in the past 5 years.ResultsThe paper provides an overview of existing frameworks that are useful for assessing the performance of CHW programmes, with a specific focus on how individual CHW performance and community-level outcomes can be measured. The paper also reviews approaches that have been taken to assess CHW programme performance, from programme monitoring using the routine health information system to national assessments using quantitative and/or qualitative study designs and assessment checklists. The paper also discusses contextual factors that influence CHW programme performance, and reflects upon gaps and needs for the future with regard to assessment of CHW programme performance.ConclusionAssessments of CHW programme performance can have various approaches and foci according to the programme and its context. Given the fact that CHW programmes are complex entities and part of health systems, their assessment ideally needs to be based on data derived from a mix of reliable sources. Assessments should be focused not only on effectiveness (what works) but also on contextual factors and enablers (how, for whom, under what circumstances). Investment in performance assessment is instrumental for continually innovating, upgrading, and improving CHW programmes at scale. Now is the time for new efforts in implementation research for strengthening CHW programming.
Highlights
Introduction and tensions confronting programsBMC Health Res Policy Syst. 2021. https://doi.org/10.1186/s12961-021-00752-8. 2
We start by defining community health worker (CHW) and CHW programme performance, after which we reflect upon various frameworks that have been developed for considering the performance of CHW programmes
Defining CHW and CHW programme performance Well-performing health workers function in ways that are responsive, fair, and efficient to achieve the best health outcomes possible for clients, given the available resources and circumstances [34]
Summary
Introduction and tensions confronting programsBMC Health Res Policy Syst. 2021. https://doi.org/10.1186/s12961-021-00752-8. 2. Previous papers have provided an overview of national community health worker (CHW) programmes at present and the challenges they face (Paper 1 [1]), approaches to building partnerships, collaborations, and governance (Papers 2 [2] and 3 [3]), financing (Paper 4 [4]), roles and tasks (Paper 5 [5]), recruitment and training (Paper 6 [6]), supervision (Paper 7 [7]), motivation and reimbursement (Paper 8 [8]), and relationships with communities and with health systems (Paper 9 [9]). This series has been produced in recognition that CHW programmes are in a historical moment where the importance of their contribution to health systems and to population health improvement is becoming more widely recognized [10]. The pandemic has led to broad recognition of the importance of CHWs in high-income countries [23, 24]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
