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Human Resources for Health
Published in: Human Resources for Health 1/2019

Open Access 01-12-2019 | Care | Research

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

Authors: Smisha Agarwal, Pooja Sripad, Caroline Johnson, Karen Kirk, Ben Bellows, Joseph Ana, Vince Blaser, Meghan Bruce Kumar, Kathleen Buchholz, Alain Casseus, Nan Chen, Hannah Sarah Faich Dini, Rachel Hoy Deussom, David Jacobstein, Richard Kintu, Nazo Kureshy, Lory Meoli, Lilian Otiso, Neil Pakenham-Walsh, Jérôme Pfaffmann Zambruni, Mallika Raghavan, Ryan Schwarz, John Townsend, Brittney Varpilah, William Weiss, Charlotte E. Warren

Published in: Human Resources for Health | Issue 1/2019

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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.
Appendix
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Metadata
Title
A conceptual framework for measuring community health workforce performance within primary health care systems
Authors
Smisha Agarwal
Pooja Sripad
Caroline Johnson
Karen Kirk
Ben Bellows
Joseph Ana
Vince Blaser
Meghan Bruce Kumar
Kathleen Buchholz
Alain Casseus
Nan Chen
Hannah Sarah Faich Dini
Rachel Hoy Deussom
David Jacobstein
Richard Kintu
Nazo Kureshy
Lory Meoli
Lilian Otiso
Neil Pakenham-Walsh
Jérôme Pfaffmann Zambruni
Mallika Raghavan
Ryan Schwarz
John Townsend
Brittney Varpilah
William Weiss
Charlotte E. Warren
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
Human Resources for Health / Issue 1/2019
Electronic ISSN: 1478-4491
DOI
https://doi.org/10.1186/s12960-019-0422-0

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