Strategic partnering to improve community health worker programming and performance: features of a community-health system integrated approach.

Joseph F Naimoli,James A Mccaffery,Henry B Perry,John W Townsend,Diana E Frymus

doi:10.1186/s12960-015-0041-3

Abstract

BackgroundThere is robust evidence that community health workers (CHWs) in low- and middle-income (LMIC) countries can improve their clients’ health and well-being. The evidence on proven strategies to enhance and sustain CHW performance at scale, however, is limited. Nevertheless, CHW stakeholders need guidance and new ideas, which can emerge from the recognition that CHWs function at the intersection of two dynamic, overlapping systems – the formal health system and the community. Although each typically supports CHWs, their support is not necessarily strategic, collaborative or coordinated.MethodsWe explore a strategic community health system partnership as one approach to improving CHW programming and performance in countries with or intending to mount large-scale CHW programmes. To identify the components of the approach, we drew on a year-long evidence synthesis exercise on CHW performance, synthesis records, author consultations, documentation on large-scale CHW programmes published after the synthesis and other relevant literature. We also established inclusion and exclusion criteria for the components we considered. We examined as well the challenges and opportunities associated with implementing each component.ResultsWe identified a minimum package of four strategies that provide opportunities for increased cooperation between communities and health systems and address traditional weaknesses in large-scale CHW programmes, and for which implementation is feasible at sub-national levels over large geographic areas and among vulnerable populations in the greatest need of care. We postulate that the CHW performance benefits resulting from the simultaneous implementation of all four strategies could outweigh those that either the health system or community could produce independently. The strategies are (1) joint ownership and design of CHW programmes, (2) collaborative supervision and constructive feedback, (3) a balanced package of incentives, and (4) a practical monitoring system incorporating data from communities and the health system.ConclusionsWe believe that strategic partnership between communities and health systems on a minimum package of simultaneously implemented strategies offers the potential for accelerating progress in improving CHW performance at scale. Comparative, retrospective and prospective research can confirm the potential of these strategies. More experience and evidence on strategic partnership can contribute to our understanding of how to achieve sustainable progress in health with equity.

Highlights

There is robust evidence that community health workers (CHWs) in low- and middle-income (LMIC) countries can improve their clients’ health and well-being
The collaborative partnership in support of CHWs that we propose is consistent with observations on the rapid spread of child survival, maternal health and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) interventions in participatory democracies [7, 25, 26]
Our identification of a minimum package of simultaneously implemented essential strategies arose primarily from a sequential process that drew upon three key events: (1) a year-long (2012–2013) exercise to synthesize the evidence on strategies to enhance CHW performance in large-scale, national programmes [14]; (2) a review of evidence synthesis records; and (3) a series of author consultations

Summary

Introduction

There is robust evidence that community health workers (CHWs) in low- and middle-income (LMIC) countries can improve their clients’ health and well-being. Large-scale, national community health worker (CHW) programmes in low- and middle-income (LMIC) countries have the potential to extend the reach of inadequately resourced health systems to vulnerable and under-served populations and thereby improve service access with equity by 2030. In light of this potential, CHWs and CHW programmes are experiencing a resurgence of interest and are likely to continue to attract national and international attention and investment in the decade and beyond [3]. There is robust evidence that CHWs, a heterogeneous cadre of frontline health workers operating in a diverse set of countries and contexts, can improve people’s health and well-being [9]

Methods

Results

Conclusion