THE CHW ASSESSMENT AND IMPROVEMENT MATRIx

THE CHW  ASSESSMENT AND IMPROVEMENT MATRIX

CHW AIM enables organizations to assess strengths, weaknesses, and opportunities in CHW program design and operation. Results can then be used to inform quality improvement activities and proactively manage any risks to future service integrity.

At the core of the CHW AIM tool are 10 key components demonstrated through research and practitioner expertise  to be highly correlated with CHW program success:

At the core of the CHW AIM tool are 10 key components demonstrated through research and practitioner expertise  to be highly correlated with CHW program success:

1. Role and Recruitment: How the community, CHW, and health system design and achieve clarity on the CHW role and from where the CHW is identified and selected.
2. Training: How pre-service training is provided to the CHW to prepare for his/her role and ensure s/he has the necessary skills to provide safe and quality care; and, how ongoing training is provided to reinforce initial training, teach CHWs new skills, and to help ensure quality.
3. Accreditation: How health knowledge and competencies are assessed and certified prior to practicing and recertified at regular intervals while practicing.
4. Equipment and Supplies: How the requisite equipment and supplies are made available when needed to deliver expected services.
5. Supervision: How supportive supervision is carried out such that regular skill development, problem solving, performance review, and data auditing are provided.
6. Incentives: How a balanced incentive package reflecting job expectations, including financial compensation in the form of a salary, and non-financial incentives, is provided.
7. Community Involvement: How a community supports the creation and maintenance of the CHW program.
8. Opportunity for Advancement: How CHWs are provided career pathways. Data: How community-level data flow to the health system and back to the community and how they are used for quality improvement.
9. Linkages to the National Health System: The extent to which the Ministry of Health has policies in place that integrate and include CHWs in health system planning and budgeting and provides logistical support to sustain district, regional and/or national CHW programs.

The purpose of the Community Health Worker Common Indicators (CI) Project is to contribute to the integrity, sustainability and viability of CHW programs.

‍The Problem

Despite progress in documenting the outcomes of Community Health Worker (CHW) interventions, the lack of standardized measures to assess CHW practice has made it impossible to aggregate data across programs and regions, impeding commitment to sustainable, long-term financing of CHW programs. Lack of easy-to-use indicators hampers the ability of many community-based programs to reliably report outcomes to funders. Lack of attention to the processes by which CHWs achieve outcomes has made it difficult to conclusively demonstrate the importance of particular CHW roles, skills, and qualities. Finally, while CHWs have sometimes been involved as data collectors, they have seldom been engaged as full partners in all stages of research.

History of the National CHW Common Indicators Project

Responding to this set of problems, in 2013, members of the Michigan CHW Alliance (MiCHWA) began the process of creating a common set of evaluation indicators and measures to understand the unique contributions of CHWs to successful program outcomes and their added value to health care and human services systems. In 2015, CHWs and researchers in Oregon brought MiCHWA colleagues together with partners from three additional states and founded the national CHW Common Indicators (CI) Project.

Community Health Worker Assessment and Improvement Matrix (CHW AIM): Experiences from the Field. This series highlights experience from six Community Health Impact Coalition member organizations using CHW AIM to guide community health financing, data systems, research and program design. Readers will also find links to updated tools and guidance. 

Find the first two installments below: 

• Strengthening Community Health Worker Programs with CHW AIM
• Taking Action to Improve Data Alignment with Ministry Partners: Case Study from Togo

Community Health Worker Assessment and Improvement Matrix (CHW AIM)

Updated Program Functionality  Matrix for Optimizing Community Health Programs

Contributing Authors:

Community Health Impact Coalition: Madeleine Ballard, Matthew Bonds (PIVOT), Jodi-Ann Burey (Village Reach), Jennifer Foth (Living Goods), Kevin Fiori (Integrate), Isaac Holeman (Medic Mobile), Ari Johnson (Muso), Serah Malaba (Living Goods), Daniel Palazuelos (PIH), Mallika Raghavan (Last Mile Health), Ash Rogers (Lwala), and Ryan Schwarz (Possible) Initiatives Inc.: Rebecca Furth and Joyce Lyons (CHW Central)

UNICEF: Hannah Sarah F. Dini and Jérôme Pfaffmann Zambruni

USAID: Troy Jacobs and Nazo Kureshy

This toolkit builds on the original work (“Community Health Worker Assessment and Improvement Matrix (CHW AIM): A Toolkit for Improving CHW Programs and Services”) prepared by Initiatives Inc. and University Research Co., LLC (URC) for review by the United States Agency for International Development (USAID). It was authored by Lauren Crigler, Initiatives Inc. Kathleen Hill, University Research Co., LLC, Rebecca Furth, Initiatives Inc., and Donna Bjerregaard,

Initiatives Inc. 

CHW AIM was originally developed under the USAID Health Care Improvement Project, made possible by the generous support of the American people.

Design: Sonder Design

Released: December 2018

 CHW Common Indicators Project 

 Goal: In partnership with and building on work begun by Dr. Edith Kieffer and Gloria Palmisano of the Michigan CHW Alliance (MiCHWA), the CHW Common Indicator Project, are attempting to identify common process and outcome indicators for CHW practice. 

 Jan 11 2017: Over 90 people joined  CHW Common Indicators Project for a pre-conference workshop at the Annual Meeting of the American Public Health Association in Denver, Colorado. We gathered additional input on the proposed list of indicators as well as suggestions for tools and scales to measure the indicators. 

 Executive-Summary_Community-Health-Worker-Common-Indicator-Summit_Final.pdf

Prepared by: Edith Kieffer, Gloria Palmisano, Pei-ru Wang, Leticia Rodriguez Garcia, Kenneth Maes, Caitlin Allen and Noelle Wiggins 

Funders:  Cambia Health Foundation and Social Venture Partners of Portland, OR.

Pages: 10

Noelle Wiggins, MS, EdD, co-principal investigator for the CHW Common Indicators Project, was the lead author on the Roles and Competencies chapter of the 1998 National Community Health Advisor (NCHA) Study. She came to the CHW/P community as a researcher and an advocate.

Why CHW indicators are needed

• Indicators are needed to measure the processes by which CHW programs achieve their outcomes. 
•  How specifically do CHW address the social determinants of health or other non-clinical indicators. 
•  Metrics for  long term CHW programs:  often developed using community-based participatory research (CBPR) approaches, take time to develop, fully implement and evaluate over a long enough time to measure sustained individual or community outcomes 
•  One of the reasons CHWs are so effective is that they respond in unique ways to the unique needs of diverse individuals and communities. They address a wide array of health issues and social concerns in a range of contexts from clinic to community.19 This strength can become a weakness when evaluating CHW programs, since it is challenging to measure program processes and outcomes in such a way that data can be aggregated to create a more comprehensive picture of CHW programs’ processes and effects.  

The summit, which was held in Portland, OR, on October 2-3, 2015, brought together 16 CHWs, researchers and evaluators, and program staff from five states. 

 Proposed Process Indicators:

 1. Workforce capacitation/support (level of CHW) 

a. Involvement of CHWs in decision making process 

b. Level of social support the organization provides for the CHW 

c. Value of CHW to the organization and acceptance of CHW 

2. Frequency of enactment of 10 core roles (level of community member/participant/client) 

3. Trust/satisfaction with CHW relationship (level of community member/participant/client) 

4. Referrals made (level of community member/participant/client) a. CHW facilitated connections at all levels b. Connections to resources, organizations, and policy makers (level of systems) 

5. The extent to which CHWs are part of the policy-making process 

a. CHWs teaming with systems, organizations and policy making bodies 

b. Degree are CHWs are integrated into health care teams 

 Proposed Outcome Indicators 

1. CHW satisfaction with their job 

2. Participant food, water, transportation, and security 

3. Participant access to health and social services 

4. Participant knowledge, attitudes and behaviors 

5. Participant social support 

6. Participant empowerment  

READ MORE

Community Health Workers and the Power of Measurement  

By Keara Rodela on May 12, 2020 

Table 1. Evaluation constructs co-identified by CHWs and other evaluation experts

(See above)

How should community health worker (CHW) programs be evaluated?  A collaborative team recently published an important article advancing an answer to this pressing question, focused  on CHW programs in low- and middle-income countries. Here, we provide a complementary answer to this question, advanced by the CHW Common Indicators Project (CI Project), which aims to identify and recommend a set of evaluation indicators to systematically assess the work and impacts of CHWs in the USA.  The CI Project’s long-term objective is nationwide adoption of these indicators and development of infrastructure to collect data and report results, with the ultimate goal of optimizing CHW contributions through standardized monitoring and quality improvement, while centering CHWs as experts and leaders. 

READ MORE