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The purpose of the Community Health Worker Common Indicators (CI) Project is to contribute to the integrity, sustainability and viability of CHW programs.
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:
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,
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.
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.
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
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
By Keara Rodela on May 12, 2020
Table 1. Evaluation constructs co-identified by CHWs and other evaluation experts
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.
A conceptual framework for measuring community health workforce performance within primary health care systems
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.
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.
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.
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.
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A conceptual framework for measuring community health workforce performance within primary health care systems.
Authors: Agarwal, S., Sripad, P., Johnson, C. et al.
Hum Resour Health 17, 86 (2019). https://doi.org/10.1186/s12960-019-0422-0
Published 20 November 2019