A conceptual framework for measuring community health workforce performance within primary health care systems

Agarwal, Smisha; Sripad, Pooja; Johnson, Caroline; Kirk, Karen; Bellows, Benjamin; Ana, Joseph; Blaser, Vince; Kumar, Meghan Bruce; K, Buchholz; Casseus, Alain; Chen, Nan; Dini, Hannah Sarah; Deussom, Rachel; Jacobstein, David; Kintu, Richard; Kureshy, Nazo; Meoli, Lory; Otiso, Lilian; Pakenham-Walsh, Neil; Zambruni, Jérôme Pfaffmann; Raghavan, Mallika; Schwarz, Ryan; Townsend, John W.; Varpilah, Brittney; Weiss, William; Warren, Charlotte E.

doi:10.1186/s12960-019-0422-0

Cited by 74 publications

(76 citation statements)

References 42 publications

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“…No assessment of methodological quality of the studies was conducted as a part of methodological tailoring to expedite review process. 4 We adapted an existing conceptual framework for assessment of CHW performance in primary healthcare 6 to guide data extraction and narrative synthesis. The framework looks at inputs, programmatic processes, CHW-level and community-level outputs to improve health outcomes in the context of economic evaluation and equity, gender and accountability.…”

Section: Screening Data Collection and Analysismentioning

confidence: 99%

“…The key findings from the included studies are presented as per the elements of the conceptual framework. 6 Input in CHW programmes during pandemic responses Myriad inputs and planning were required to ensure effective pandemic response through CHWs. These are summarised in subdomains below: ► Policies related to CHW task/roles.…”

Section: Summary Of Findings On Role Issues Enablers and Barriers Fmentioning

confidence: 99%

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Community health workers for pandemic response: a rapid evidence synthesis

et al. 2020

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IntroductionCoronavirus disease (COVID-19), affects 213 countries or territories globally. We received a request from National Health Systems Resource Centre, a public agency in India, to conduct rapid evidence synthesis (RES) on community health workers (CHWs) for COVID-19 prevention and control in 3 days.MethodsWe searched PubMed, websites of ministries (n=3), public agencies (n=6), multilateral institutions (n=3), COVID-19 resource aggregators (n=5) and preprints (n=1) (without language restrictions) for articles on CHWs in pandemics. Two reviewers screened the records independently with a third reviewer resolving disagreements. One reviewer extracted data with another reviewer cross-checking it. A framework on CHW performance in primary healthcare not specific to pandemic was used to guide data extraction and narrative analysis.ResultsWe retrieved 211 records and finally included 36 articles. Most of the evidence was from low-and middle-income countries with well-established CHW programmes. Evidence from CHW programmes initiated during pandemics and for CHW involvement in pandemic response in high-income countries was scant. CHW roles and tasks change substantially during pandemics. Clear guidance, training for changed roles and definition of what constitutes essential activities (ie, those that must to be sustained) is required. Most common additional activities during pandemics were community awareness, engagement and sensitisation (including for countering stigma) and contact tracing. CHWs were reported to be involved in all aspects of contact tracing - this was reported to affect routine service delivery. CHWs have often been stigmatised or been socially ostracised during pandemics. Providing PPE, housing allowance, equal training opportunities, transportation allowance, improving salaries (paid on time and for a broad range of services) and awards in high-profile public events contributed to better recruitment and retention. We also created inventories of resources with guiding notes on guidelines for health workers (n=24), self-isolation in the community (n=10) and information, education and counselling materials on COVID-19 (n=16).ConclusionsCHWs play a critical role in pandemics. It is important to ensure role clarity, training, supportive supervision, as well as their work satisfaction, health and well-being. More implementation research on CHWs in pandemics is required.

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Section: Screening Data Collection and Analysismentioning

confidence: 99%

Section: Summary Of Findings On Role Issues Enablers and Barriers Fmentioning

confidence: 99%

Community health workers for pandemic response: a rapid evidence synthesis

et al. 2020

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“…Performance appraisal of the health workforce is fraught with challenges, however, there is a consensus that the ultimate goal should be to improve motivation and performance of workers for better health outcomes [40,41]. A recent study proposed a framework for CHW performance measurement and some of the domains include; CHW incentives, supervision and performance appraisal, data use, data reporting, service delivery, quality of services, CHW absenteeism and attrition, community use of services, experience of services, referrals, and trust [42]. Closely linked to supervision is the quality of reported data.…”

Section: Discussionmentioning

confidence: 99%

An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan.

Lutwama

Kok

Jacobs

2021

Preprint

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Background: Community health workers (CHWs) are crucial for increasing access to health services to communities. Due to decades of conflict and under-funding, access to health care in South Sudan remains severely limited. To improve equitable access to healthcare, the government has introduced “the Boma Health Initiative (BHI)”, a strategy to harmonise community health programmes across the country. In order to scale up the BHI, it is necessary to assess the recent CHW programmes and draw lessons for future implementation. This study aimed to explore the characteristics, barriers, and facilitators to the implementation of CHW interventions in South Sudan between 2011 and 2019.Methods: The study used a qualitative approach drawing from 26 key informant interviews and a scoping review of 21 Health Pooled Fund (HPF) programme reports from October 2016 to June 2018 and policy documents from 2011 to 2019. The results were thematically analysed based on a conceptual framework on factors influencing the performance of CHWs.Results: Funding of CHW programmes has come from international donors, channelled through non-governmental organisations (NGOs) that have implemented a variety of CHW programmes. Communities have been participating in the selection of voluntary CHWs, intervention areas, and occasionally in the supervision of activities performed by CHWs. The coordination mechanisms among stakeholders have been weak, leading to wastage and duplication of resources. Although training of CHWs is done, training duration was short, and refresher-trainings were rare. There were and still are disparities in the type of incentives provided to CHWs. Monitoring and supportive supervision activities have been insufficient; drug misuse and stock-outs were common. Conclusion: Despite their challenges, CHW programmes can be implemented in conflict-affected South Sudan if the local human capital is leveraged and engaged by NGOs as implementing partners. Robust coordination efforts are required to build synergies among stakeholders for the effective implementation of the BHI strategy.

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“…Studies conducted in low-and middle-income countries have shown that focusing on provision of health services at the community level not only leads to more efficient and equitable use of health resources and better health outcomes but also is a consistent component of strong, effective health systems. 5,6 Considerable progress has been made in improving health and well-being over the past 40 years, with dramatic reductions in maternal, neonatal, and child deaths. [7][8][9][10][11][12][13][14][15] A systematic analysis found a significant impact of community case management with antibiotics: 32% (RR: 0.68, 95%CI: 0.53, 0.88) reduction in acute respiratory infections mortality and 20% (RR: 0.80, 95%CI: 0.77, 0.83) reduction in all-cause mortality among children aged 1-4 years.…”

Section: Introductionmentioning

confidence: 99%

Galvanizing Action on Primary Health Care: Analyzing Bottlenecks and Strategies to Strengthen Community Health Systems in West and Central Africa

Simen-Kapeu

Reserva

Ekpini

2021

Glob Health Sci Pract

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Challenges with health financing, essential medical products and technology, and community ownership and partnerships emerged as the severe or very severe health system bottlenecks that hampered the strengthening of community health systems, irrespective of mortality context. n Country-led progress is possible. Potential strategies to overcome bottlenecks include increasing domestic allocation and leveraging innovative funding mechanisms for primary health care (PHC), integrating supply chain systems, and strengthening policy implementation with communities and local governments. n Countries with high child mortality rates should improve service delivery through better integration.

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A conceptual framework for measuring community health workforce performance within primary health care systems

Cited by 74 publications

References 42 publications

Community health workers for pandemic response: a rapid evidence synthesis

Community health workers for pandemic response: a rapid evidence synthesis

An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan.

Galvanizing Action on Primary Health Care: Analyzing Bottlenecks and Strategies to Strengthen Community Health Systems in West and Central Africa

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