Scorecard metrics for assessing the extent of integration of community health worker programmes into national health systems

Mupara, Lucia M.; Mogaka, John J O; Brieger, William R.; Tsoka-Gwegweni, Joyce Mahlako

doi:10.4102/phcfm.v13i1.2691

Cited by 4 publications

(7 citation statements)

References 31 publications

(54 reference statements)

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“…34 For the purpose of this study, the integration parameters and indicators for WHO's human resources for health building block and CHW's recruitment, education and certification program component were extracted from the scorecard. 34 Scoring based on the CHWP-ISM scale was done according to the criteria as presented below. A "Yes"/tick was assigned if evidence for the occurrence/presence/execution of any of the stated indicators were presented and/or corroborated through the three means data were collected.…”

Section: Discussionmentioning

confidence: 99%

“…34 For the purpose of this study, the integration parameters and indicators for WHO’s human resources for health building block and CHW’s recruitment, education and certification program component were extracted from the scorecard. 34…”

Section: Methodsmentioning

confidence: 99%

“…Data on the training component of Botswana CSS were abstracted in line with the recruitment, education and certification (REC) theme in CHWP-ISM scale. 34 This was generally the first step in collating available data and informed the material content of KIIs and the survey as it was used to collect and review existing research data and reports before determining what additional information was to be collected.…”

Section: Methodsmentioning

confidence: 99%

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The Extent of Integration of Community Health Worker Programs Into National Health Systems: Case Study of Botswana

Mupara

Mogaka

Brieger

et al. 2022

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Background The paucity of Human Resources for Health (HRH) is a major global health challenge. The World Health Organization (WHO) recognizes the potentials that Community Health Workers (CHWs) have in closing the gap of an inadequate supply of human resources for health (HRH). However, weak CHW integration into national health systems curtails effective implementation of CHW delivered high impact interventions in resource constrained settings. This study assessed the extent of integration of the CHW Recruitment, Education, and Certification (REC) component into the national health system’s HRH building block, using Botswana’s CHW program as a case study. Methods The study used mixed methods. Data collated from CHW training program documentary abstraction, five key informant interviews were analyzed thematically. Data collected through the survey with 123 CHWs were analyzed quantitatively. A recently developed Community Health Workers Program Integration Scorecard Metrics (CHWP-ISM) that comprises of the WHO building blocks and corresponding CHW integration metrics, with process, evidence, and status of integration parameters, was used to determine the extent of integration. Results An analysis of Botswana’s CHW REC component using the CHWP-ISM scale showed that the component was 80% integrated into the national HS. Whereas the CHW training program was fully government sponsored and accredited, some aspects of the program’s selection and recruitment criteria and training modalities were lacking integration. Although CHW training was exclusively offered at a local private training institute, findings from documentation reviews, interviewed KIIs and the survey show that the training accreditation, regulation and funding was the responsibility of the central government. Conclusion The application of the CHWP-ISM scale to assess extent of CHW program integration into HS identified important CHW human resource integration gaps in CHW selection criteria and recruitment process as well non-inclusion of CHWs post-training accreditation by national accreditation board in government policy documents.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The Extent of Integration of Community Health Worker Programs Into National Health Systems: Case Study of Botswana

Mupara

Mogaka

Brieger

et al. 2022

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“…The present study was based on the earlier reported study (38), which is part of a wider study undertaken to generate items suitable for assessing the extent of integration of CHW programs into national HS. The study (Mupara et al (38) study on integration indicators) was based on WHO's building blocks for strengthening health systems (HSs) (Figure 1).…”

Section: Methodology Theoretical Considerations Item Selection and St...mentioning

confidence: 99%

“…This study validated newly developed scorecard metrics for measuring the extent of CHW programs' integration into national health systems (CHWP-ISM) in Sub-Saharan Africa (38) at the policy level. The paper tests the proposed CHW integration metrics scale's construct validity, dimensionality, and reliability.…”

Section: Introductionmentioning

confidence: 96%

Health systems strengthening through policy-level integration of community health worker programs into national health systems for improved health outcomes - scorecard metrics validation: A bifactor structural equation model approach

Mupara

Mogaka

Brieger

et al. 2022

Front. Public Health

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BackgroundSubsequent to the demonstrated potential of community health workers (CHWs) in strengthening health systems to improve health outcomes, recent literature has defined context and guidelines for integrating CHW programs into mainstream health systems. However, quantitative measures for assessing the extent of CHW program integration into national health systems need to be developed. The purpose of this study was to validate a newly developed scale, Community Health Worker Program Integration Scorecard Metrics (CHWP-ISM), for assessing the degree of integration of CHW programs into national health systems in Sub-Saharan Africa (SSA).MethodsData obtained through a pilot study involving a purposively selected sample of 41 participants selected from populations involved in CHW programs work in selected countries of SSA formed the basis of a 31-item bifactor model. Data were collected between June and December 2019. By applying a latent variable approach implemented with structural equation modeling, data analysis was mainly done using the R statistical environment, applying factor analysis procedures.ResultsDimensionality, construct validity, and the CHWP-ISM scale's internal consistency were assessed. Confirmatory factor analysis of the CHW-ISM bifactor model supported a co-occurring CHW integration general factor and six unique domain-specific factors. Both the comparative fit index (CFI) and Tucker–Lewis Index (TLI) fit indices were above 0.9, while the root mean square of the residuals (RMSR) was 0.02. Cronbach's alpha (α), Guttman 6 (Lambda 6), and Omega total (ωt) were above 0.8, indicating good scale reliability.ConclusionStatistical significance of the bifactor model suggests that CHW integration has to be examined using factors that reflect a single common underlying integration construct, as well as factors that reflect unique variances for the identified six subject-specific domains. The validated CHWP-ISM could be useful to inform policy advisers, health systems, donors, non-governmental organizations, and other CHW program stakeholders with guidance on how to quantitatively assess the integration status of different components of CHW programs into respective critical functions of the health system. Improved integration could increase CHW program functionality, which could in turn strengthen the healthcare systems to improve health outcomes in the region.

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Community Health Worker programmes’ integration into national health systems: Scoping review

Mupara¹,

Mogaka²,

Brieger³

et al. 2022

African Journal of Primary Health Care & Family Medicine

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Scorecard metrics for assessing the extent of integration of community health worker programmes into national health systems

Cited by 4 publications

References 31 publications

The Extent of Integration of Community Health Worker Programs Into National Health Systems: Case Study of Botswana

The Extent of Integration of Community Health Worker Programs Into National Health Systems: Case Study of Botswana

Health systems strengthening through policy-level integration of community health worker programs into national health systems for improved health outcomes - scorecard metrics validation: A bifactor structural equation model approach

Community Health Worker programmes’ integration into national health systems: Scoping review

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