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

Human Resources for Health

William Weiss¹  Lilian Otiso²  Meghan Bruce Kumar²  Rachel Hoy Deussom³  Neil Pakenham-Walsh⁴  Joseph Ana⁴  Vince Blaser⁵  Kathleen Buchholz⁶  Mallika Raghavan⁶  Brittney Varpilah⁶  Nan Chen⁶  Ryan Schwarz⁷  Richard Kintu⁸  Caroline Johnson⁹  Pooja Sripad⁹  Karen Kirk⁹  John Townsend⁹  Smisha Agarwal⁹  Ben Bellows⁹  Charlotte E. Warren⁹  Jérôme Pfaffmann Zambruni^1,10  Hannah Sarah Faich Dini^1,10  Nazo Kureshy^1,11  Lory Meoli^1,11  David Jacobstein^1,11  Alain Casseus^1,12 

[1] Department of International Health, Johns Hopkins Bloomberg School of Public Health;Department of International Public Health, Liverpool School of Tropical Medicine;HRH2030 Program, Chemonics International;Healthcare Information For All (HIFA);IntraHealth International;Last Mile Health;Nyaya Health Nepal;Pathfinder International;Population Council;UNICEF;USAID;Zanmi Lasante;

关键词: Community health worker;    Primary health care;    Health metrics;    Healthcare quality indicators;    Health information systems;   

DOI  :  10.1186/s12960-019-0422-0

来源: DOAJ

【 摘 要 】

Abstract Background With the 40th anniversary of the Declaration of Alma-Ata, a global effort is underway to re-focus on strengthening primary health care systems, with emphasis on leveraging community health workers (CHWs) towards the goal of achieving universal health coverage for all. Institutionalizing effective, sustainable community health systems is currently limited by a lack of standard metrics for measuring CHW performance and the systems they work within. Developed through iterative consultations, supported by the Bill & Melinda Gates Foundation and in partnership with USAID and UNICEF, this paper details a framework, list of indicators, and measurement considerations for monitoring CHW performance in low- and middle-income countries. Methods A review of peer-reviewed articles, reports, and global data collection tools was conducted to identify key measurement domains in monitoring CHW performance. Three consultations were successively convened with global stakeholders, community health implementers, advocates, measurement experts, and Ministry of Health representatives using a modified Delphi approach to build consensus on priority indicators. During this process, a structured, web-based survey was administered to identify the importance and value of specific measurement domains, sub-domains, and indicators determined through the literature reviews and initial stakeholder consultations. Indicators with more than 75% support from participants were further refined with expert qualitative input. Results Twenty-one sub-domains for measurement were identified including measurement of incentives for CHWs, supervision and performance appraisal, data use, data reporting, service delivery, quality of services, CHW absenteeism and attrition, community use of services, experience of services, referral/counter-referral, credibility/trust, and programmatic costs. Forty-six indicators were agreed upon to measure the sub-domains. In the absence of complete population enumeration and digitized health information systems, the quality of metrics to monitor CHW programs is limited. Conclusions Better data collection approaches at the community level are needed to strengthen management of CHW programs and community health systems. The proposed list of metrics balances exhaustive and pragmatic measurement of CHW performance within primary healthcare systems. Adoption of the proposed framework and associated indicators by CHW program implementors may improve programmatic effectiveness, strengthen their accountability to national community health systems, drive programmatic quality improvement, and plausibly improve the impact of these programs.

【 授权许可】

Unknown