CHW AIM Toolkit Changes & Applications

DONNA BJERREGAARDINITIATIVES INC. FOR USAID HEALTH CARE

IMPROVEMENT PROJECTCORE GROUP MEETING 5-11-2011

CHW AIM Toolkit is enhanced:

Now available in CD or hard copy

Includes guidance, tools, and resources

CHW AIM Toolkit Contents

Introduction CHW Program

Functionality Matrix Intervention Matrices

MNCH, HIV/AIDS, and TB Soon to include WASH & FP

Facilitator’s Guide Training Guide Appendices

Participant Selection Form for Workshop

Comprehensive Document Review Guide and Checklist for CHW Programs

CHW AIM Validation Questionnaire

Score and Score Rationale Documentation Worksheet

CHW AIM Program Functionality Score Sheet

CHW AIM Action Planning Framework

Resources and Field Examples

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The CHW AIM Field Applications

Field tests in Nepal and Benin

Salvation Army in Zambia assessed the Chikankata Child Survival Project

WHO GHWA 8 country case studies on CHW Programs

Save the Children in Ethiopia assessed CHWs and HEWs

CHW AIM OR: comparative study in Zambia to assess impact of applying CHW AIM as an improvement framework

Quick Facts:

• Donor – USAID• Timeframe: 2008 –

present• Country applications: 11• Quantitative data sets

generated: 19• Workshops: 9 with 146

participants• Qualitative data sets

generated: 12 (interviews)

Quick Facts:

• Donor – USAID• Timeframe: 2008 –

present• Country applications: 11• Quantitative data sets

generated: 19• Workshops: 9 with 146

participants• Qualitative data sets

generated: 12 (interviews)

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WHO Results Country Case Studies

CHW-AIM Pakistan Bangladesh

Thailand Brazil Haiti Ethiopia Uganda Mozambique

Recruitment 3 3 3 3 3 3 3 3CHW Role 3 2 3 2 3 3 2 2Initial Training 3 2 3 3 3 3 3 3Ongoing Training 2 3 2 3 2 2 1 1Equipment and Supplies 2 3 2 3 2 2 1 2Supervision 3 3 0 3 3 3 2 2Performance Evaluation 3 2 0 3 2 2 2 1Incentives 2 2 2 3 3 2 1 0Community Involvement 2 3 3 3 2 2 2 2Referral System 1 1 1 3 3 2 1 1Professional Advancement

2 0 1 2 2 2 0 2

Documentation, Information System

2 1 0 3 3 3 2 0

Average Score 2.1 1.6 2.1 2.8 2.6 2.4 1.6 1.6

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NOTE: For a minimally functional program a score of at least 2 is required in each of the 12 components

CHW AIM Results from 19 programs

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CHW AIM OR: Does it improve performance

To test the effectiveness of the CHW AIM toolkit as a capacity building and performance improvement tool.

To test the theory that strengthening CHW program functionality leads to improved CHW engagement and performance.

To assess the costs associated with implementing the CHW AIM tool and the incremental cost effectiveness associated with its use.

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CHW AIM OR

Timeline: 2 years – July 2010 to June 2012

Partners: 3 I/FBO/I/NGO; 2 local and one regional program

Sample: 5 CHW programs and 130 CHWs, one control (30 CHWs)

Tools: CHW AIM, CHW engagement survey, CHW engagement interview, program management interview, performance assessments (against stds)

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CHW AIM OR Baseline Results

9

Performance Against National Service Delivery Standards

10

Self-Ranked Engagement11

CHW AIM Facilitating Factors

Both quantitative (scoring and counting) and qualitative (interviews and discussion)

Can be applied at a country level to assess multiple programs or at the individual level

Provides clear criteria across programs for multiple partners/implementers

Can be complemented with other tools Matrix can be applied without the workshop

through interviews and document discovery (e.g., GHWA 8 country case studies, Ethiopia)

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www.CHWCentral.org:

An Online Community of Practice

The importance of CHWs14

To reach the health-related MDGs, WHO (using CHW AIM) identified 2 major barriers: The need for Health Systems Strengthening Health care worker shortages

CHWs can bridge the gap: CHWs perform a set of essential health services; Receive standardized training outside the formal nursing

or medical curricula; Have a defined role within the community and the larger

health system.

Birth of the Community of Practice15

CHW AIM process presented 15 components & raised questions about how to

improve CHW program functionality. Questions about resources:

What information exists? What best practices can be shared? What questions need to be answered?

How can these gaps be addressed? www.CHWCentral.org was conceived to provide one-

stop shopping for collective learning, problem solving and sharing information and ideas

Situational Analysis & ResultsInitiatives

Inc. Annual Retreat 200816

Building on lessons learned: Literature Websites User Surveys and Key Informants

Identified priority topics: Training Program performance evaluation Incentives Community involvement

Methodology: Downloadable documents Email & Discussion forums Virtual learning sessions

What will CHWCentral Provide?17

A centralized forum for CHW program issues and information User-friendly access to resources and best practices, practical

tools, training materials, guidelines, policies and other documents Ability to retrieve documents

Opportunity to suggest new resources

Connections with experts Opportunities for dialogue on key issues

Ability to as questions

Updates on current research A forum for exchanges among members

Opportunities to grow and change: A COP is ‘more than a community of learners – it is a community

that learns’

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The Website: www.chwcentral.org

Current Status19

Launch: June 14th at the Global Health Council meetingJoin us: 6:30 pm at the Omni Shoreham

Resources ready to postFirst experts in place and discussion topic

prepared Additional experts lined up Technical Advisory Group being created

How Will We Know if the Site Works?20

Using metrics and qualitative surveys to determine: Is the number of members increasing over time?Does the content match user expectations?How easy is the site to access and use globally?Is the number of online resources growing? Does the material aid implementation?

Challenges and Next Steps21

Maintaining a vibrant, dynamic and unique site

Encouraging membership

Getting and responding to feedback

Monitoring and improving site

LaunchTAG meeting Engage field & HQ

members Moderate site activityTest

technology/content and incorporate feedback

Gather new/or update resources

What can you do?22

Visit www.chwcentral.org (June 2011)Promote the site to programs and projects

using CHWsRecommend resource materialsProvide feedback using our survey

Sign Up at URC/HCI booth