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Community Health Worker Assessment and Improvement Matrix (CHW AIM): a Toolkit for Improving CHW Programs and Services

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Community Health Worker Assessment and Improvement Matrix (CHW AIM): a Toolkit for Improving CHW Programs and Services Community Health Worker Assessment and Improvement Matrix (CHW AIM): A Toolkit for Improving CHW Programs and Services MARCH 2011 This toolkit was prepared by Initiatives Inc. and University Research Co., LLC (URC) for review by the United States Agency for International Development (USAID) and was authored by Lauren Crigler (Initiatives Inc.), Kathleen Hill (URC), Rebecca Furth (Initiatives Inc.), and Donna Bjerregaard (Initiatives Inc.). CHW AIM: A Toolkit for Improving Community Health Worker Programs and Services MARCH 2011 Community Health Worker Assessment and Improvement Matrix (CHW AIM): A Toolkit for Improving CHW Programs and Services MARCH 2011 Lauren Crigler, Initiatives Inc. Kathleen Hill, University Research Co., LLC Rebecca Furth, Initiatives Inc. Donna Bjerregaard, Initiatives Inc. Disclaimer The views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government. i CHW AIM: A Toolkit for Improving Community Health Worker Programs and Services MARCH 2011 Acknowledgements The Community Health Worker Assessment and Improvement Matrix (CHW AIM) was developed by Lauren Crigler and Kathleen Hill of the USAID Health Care Improvement (HCI) Project and Rebecca Furth and Donna Bjerregaard of Initiatives Inc. Fazila Shakir provided valuable assistance in conducting background research for the development of the tool. Alison Wittcoff and Nancy Roggen provided editorial assistance. The authors would like to thank Troy Jacobs and the entire maternal and child health team at USAID (John Borrazo, Al Bartlett, Maria Francisco, Lily Kak, and Mary Ellen Stanton) for their comments on prior drafts of this tool and for their suggestions for its improvement. The USAID HCI Project is implemented by University Research Co., LLC (URC) under the terms of Contract Numbers GHN-I-01-07-00003-00 and GHN-I-03-07-00003-00. URC’s subcontractors for the HCI Project include EnCompass LLC, Family Health International, Initiatives Inc., Johns Hopkins University Center for Communication Programs, and Management Systems International. Initiatives Inc. is HCI’s lead partner in human resource management. For more information on this tool, please contact Ms. Lauren Crigler, Senior QI Advisor for Workforce Development, USAID Health Care Improvement Project, at [email protected] or [email protected]. Recommended citation Crigler L, Hill K, Furth R, Bjerregaard D. 2011. Community Health Worker Assessment and Improvement Matrix (CHW AIM): A Toolkit for Improving Community Health Worker Programs and Services. Published by the USAID Health Care Improvement Project. Bethesda, MD: University Research Co., LLC (URC). ii CHW AIM: A Toolkit for Improving Community Health Worker Programs and Services MARCH 2011 Table of Contents Section I. Introduction ......................................................................................................... I-1 Section II. CHW Program Functionality Matrix .................................................... II-1 Section III. Intervention Matrices ..................................................................................III-1 Section IV. CHW AIM Facilitator’s Guide ..................................................................IV-1 Overview of CHW AIM ..................................................................................................IV-1 Step 1. Adapt Tools to Program Context .................................................................IV-4 Step 2. Plan for the Assessment Workshop ...........................................................IV-5 Step 3. Conduct the Assessment Workshop .........................................................IV-10 Step 4. Follow Up ............................................................................................................IV-15 Section .V Curriculum for Training of Facilitators ..............................................V-1 to use the CHW AIM Toolkit About this Curriculum .................................................................................................. VI-1 Session 1: Introductions and Workshop Overview ........................................... VI-4 Session 2: Challenges of Supporting Community Health Workers ............. VI-11 Session 3: Step 1: Adapting the Tools .................................................................... VI-14 Session 4: Step 2: Planning the Assessment Workshop ................................. VI-17 Session 5: Step 3: Conducting the Assessment Workshop ............................ VI-23 Session 6: Step 4: Providing Follow-Up Support ................................................ VI-48 Session 7: Closing and Evaluation ........................................................................... VI-51 Section VI. Appendices ........................................................................................................ VI-1 Preparation Appendix A1: Participant Selection Form for Workshop .............................. VI-1 Appendix A2: Comprehensive Document Review Guide ............................. VI-2 and Checklist for CHW Programs Appendix A3: CHW AIM Validation Questionnaire ......................................... VI-5 Assessment Appendix A4: Score and Score Rationale Documentation Worksheet .... VI-9 Appendix A5: CHW AIM Score and Assessment Sheets ............................... VI-11 CHW Program Functionality Matrix Score Sheet ................ VI-11 Intervention Matrix Assessment ............................................... VI-12 Action Planning Appendix A6: CHW AIM Action Planning Framework ................................... VI-13 Follow-Up Appendix A7: Resources and Field Examples ................................................... VI-16 Appendix A8: References ......................................................................................... VI-23 iii CHW AIM: A Toolkit for Improving Community Health Worker Programs and Services MARCH 2011 Abbreviations ACSM Advocacy, communication and social IPTp Intermittent preventive treatment for mobilization malaria in pregnancy AIM Assessment and improvement matrix IUD Intrauterine device AMTSL Active management of the third stage of IYCF Infant and young child feeding labor LAM Lactational amenorrhea method ARV Anti-retroviral MARPS Most at-risk populations BCG Baccilus Calmette-Guerin vaccine for tuberculosis MC Male circumcision CD4 Cluster of differentiation 4 (test used MDR-TB Multi-drug esistantr tuberculosis to assess the immune system of HIV MNCH Maternal, newborn and child health patients) MOH Ministry of health CHW Community health worker NGO Non-government organization CHW AIM Community Health Worker Assessment and Improvement Matrix ORS Oral rehydration salts CMAM Community-based management of acute OVC Orphans and vulnerable children malnutrition PCP Pneumocystis pneumonia DHMT District Health Management Team PEP Post-exposure prophylaxis DOT Directly observed treatment PEPFAR President’s Emergency Plan for AIDS DOT-HAART Directly observed treatment for HIV using Relief highly active antiretroviral therapy PLHA People living with HIV DOT-Plus Directly observed treatment short-course for drug resistant Tuberculosis PMTCT Prevention of mother-to-child transmission of HIV DOT-TB Directly observed treatment for Tuberculosis PPH Post-partum hemorrhage DOTS Directly observed treatment short-course PPTCT Prevention of parent (mother) to child HIV transmission DPT Diphtheria, pertusis, tetanus injection STI Sexually transmitted infection GBV Gender-based violence TB Tuberculosis GHI Global Health Initiative TB-HIV Tuberculosis-Human Immunodeficiency HAART Highly active antiretroviral therapy (for Virus co-infection treatment of HIV) USAID Unites States Agency for International HIB Haemophilus influenzae type B vaccine Development HIV/AIDS Human Immunodeficiency Virus/Acquired WHO World Health Organization Immunodeficiency Syndrome XDR-TB Extensively drug-resistant tuberculosis IDU intravenous drug user IPT Isoniazid preventive therapy iv CHW AIM: A Toolkit for Improving Community Health Worker Programs and Services MARCH 2011 Introduction Section I. Introduction The USAID Health Care Improvement Project created the CHW AIM Toolkit to help Ministries, donors and NGOs assess and strengthen their CHW programs to improve their functionality. This section provides an overview of the CHW AIM process, the functionality model and the four steps to prepare, plan, implement and follow up a CHW AIM program assessment as well as guidance on the contents and use of the Toolkit. Section I. Introduction CHW AIM: A Toolkit for Improving Community Health Worker Programs and Services MARCH 2011 Section I. Introduction A. Background The USAID Health Care Improvement (HCI) Project developed the Community Health Worker Assessment and Improvement Matrix (CHW AIM) Toolkit to help organizations assess CHW program functionality and improve program performance. Built around a core of 15 components deemed essential for effective programs, CHW AIM includes a guided self-assessment and performance improvement process to help organizations identify program strengths and address gaps. Through discussion and review of current practices, the process assists understanding of best practices, builds consensus about and commitment to change, and provides guidance for improving functionality. According to WHO, 57 countries from Africa to Asia are facing shortages in their health care workforces, and an estimated 4,250,000 workers are
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