Background
Methods
Review of evidence
Concept development
Operationalizing measurement constructs as indicators
Consultations and prioritization of metrics
Results
Community Health Worker Performance Measurement Framework
Indicator Domain | Definitions/explanations | References | |
---|---|---|---|
Inputs | |||
1. | Policies | National-level policies that support the development and deployment of CHW programs | |
CHW selection | Age, education and other policy-supported requirements for being eligible to become a CHW are listed | ||
CHW tasks/workload | Description of the role and tasks to be performed by a CHW from the community, CHW and health systems perspectives | ||
2. | Governance/stakeholders | Engagement with the Ministry, agencies and other stakeholders to support the CHW program | |
3. | Logistics | Provisions, material and technological to support CHW functions. | |
Transportation | Provisions, either monetary (fare for busses) or physical (bicycle) for CHWs to physically access target population | [5] | |
Commodities (including job aids) | Required equipment, medicines and supplies to deliver services, as well as resources such as job aids to support the quality of services | ||
4. | Funding | Level of government/donor and other stakeholder investments in CHW programs in country | |
5. | Information management systems | Support for CHW to document home visits including community-based health information systems, report visit-related data to the health system and link it to an assessment of CHW performance | [18] |
Programmatic processes | |||
Indicator domains | Definition/explanation | References | |
1. | Supportive systems | Structural processes that influence CHW functions at various levels of the health system (facility/local/sub-national/national) | |
A. | Supervision and performance appraisal | Consistent and continued support for problem solving, service delivery and skill development, including evaluation and supportive feedback on the work performed by the CHW in a set period | |
B. | Data use | The use of data by individuals at various levels of the health system to make decisions and improve operational processes | |
2. | CHW development | ||
A. | Recruitment | How and from where a community health worker is identified, selected, and assigned to a community | [18] |
B. | Training | Training is provided to the CHW to prepare for his/her role in service delivery and ensure s/he has the necessary skills to provide safe and quality care. | |
C. | Incentives | Includes financial incentives such as salaries and bonuses, and non-financial incentives such as training, recognition, uniforms and other opportunities for advancement | |
3. | Support from community-based groups | Role that the community (any organization or group at the community level) plays in selection, supervision, offering incentives and providing feedback to the CHW | |
Community health systems performance outputs—CHW level | |||
Indicator domain | Definition/explanation | References | |
4. | CHW competency | Degree to which CHW has the knowledge and skills necessary to carry out the assigned tasks | |
A. | CHW knowledge | Degree to which CHWs have theoretical knowledge of counseling, preventative and curative and other tasks they are responsible for | |
B. | Service delivery | Quantity of promotional, preventive and curative services CHWs provide to community members | |
C. | Service quality | Adherence to standards and procedures (counseling, health promotion, treatment accuracy) | [6] |
D. | Data reporting | Regularity and completeness of CHW reports on the services they provide at the community level | [50] |
E. | Absenteeism | Frequency with which CHWs do not carry out tasks | [6] |
5. | CHW well-being | The overall well-being of the CHW may be seen as a measure of effectiveness of the system that supports the CHW program | |
A. | Motivation | An individual’s degree of willingness to exert and maintain effort on assigned tasks; a CHW’s confidence, belief in his/her ability to produce a desired result | |
B. | Job satisfaction | Degree to which CHWs derive personal satisfaction from serving the community and providing services | |
C. | Attrition/retention | The rate at which practicing CHWs resign, retire or abandon their positions | |
Community health systems performance outputs—community level | |||
Indicator domain | Definition/explanation | References | |
6. | Community access | Delivery of CH services in a timely manner within the client’s home/community OR clients’ physical/social access to CHW service | |
A. | Use of services | Clients are routinely seeking and using promotional, preventive and curative services that CHWs offer | |
B. | Knowledge of service availability | Clients’ ability to identify the location of CHWs and services they provide | [6] |
C. | Referral/counter-referral | The acceptance and use of services provided at a health facility following referral by a CHW | |
7. | Community-centered care | Community involvement, experience, and perceptions of services provided by CHWs | |
A. | Empowerment | Both individuals and communities participate actively in community health activities | [49] |
B. | Experience of care | Clients’ experience of services delivered by CHWs, including respectful care, and clients’ perception of quality of care. | [6] |
C. | Economic evaluation | Comparison of two or more possible courses of action, with respect to the costs, consequences, and/or benefits of each | [52] |
D. | Credibility/trust of CHW | Degree to which clients consider the services provided by CHWs to be credible and reliable | [6] |
Illustrative indicators | Indicator relevance/use by: | Suggested data sources** | |||
---|---|---|---|---|---|
Facility manager/QI team | District managers | Regional and national MOH | |||
H: High data use M: Medium data use | |||||
Domain 1: Supportive systems | |||||
Sub-domain A: Supervision and performance appraisal | |||||
1. | #/% of supervisors trained in management and supervision of CHWs | H | H | M | Training logs |
2. | Ratio of CHWs to supervisors | H | H | M | HRIS |
3. | #/% of supervisory visits that met the quality criterion | H | H | M | Special studies |
4. | Average # of visits per supervisor to monitor/support CHW activities in the last month | H | H | M | Supervisor report/special studies |
5. | #/% of CHWs who received a supervisory visit in the last 1–3 months that includes review of reports and data collected | H | H | M | CHW report |
6. | Average # of supervisory contacts (in-person visits, phone calls, text messages, etc.) per CHW | H | H | M | CHW report |
Sub-domain B: Data use | |||||
7. | #/% of health workers (CHWs/supervisors/health facility staff) who have access to client data AND who report using the data to make decisions about their provision of services | H | H | M | Special studies (CHW survey) |
8. | #/% of national/sub-national/facility/community meetings in which data (from standardized reporting platforms etc.) are discussed/reviewed | H | H | H | Routine meeting minutes |
9. | #/% of CHWs who have access to the client data they have collected (for follow-up) in the last 6 months | H | H | M | CHIS/HMIS |
Domain 2: CHW development | |||||
Sub-domain A: Recruitment | |||||
10. | #/% of CHWs who have been selected in alignment with selection criteria | M | H | H | HMIS/HRIS/training logs |
11. | # of CHWs who have been selected/recruited | H | H | H | HRIS |
12. | #/% of target communities/populations that have an assigned CHW | H | H | H | HRIS |
Sub-domain B: Training | |||||
13. | #/% of CHWs who have received initial training | M | H | H | HRIS/training logs |
14. | #/% of CHWs who have received follow-up training in the last 2 years | M | H | H | HRIS/training logs |
15. | #/% of CHWs who have completed the certification program | M | H | H | HRIS/training logs |
Sub-domain C: Incentives | |||||
16. | #/% of CHWs who have received their stipend in the last month | M | H | H | CHW report/supervisor report/special survey |
17. | #/% of CHWs who have received a specific non-financial incentive | M | H | H | CHW report/supervisor report/special studies |
Domain 3: Support from community-based groups | |||||
18. | # of planning/review meetings held at the level of the local government to discuss CHW program performance | M | H | H | Meeting minutes/special studies |
Domain 4: CHW competency | |||||
Sub-domain A: CHW knowledge | |||||
19. | #/% of CHWs who have passed knowledge/competency tests (following training) | H | H | H | Training/accreditation logs |
20. | #/% of CHWs who express that they feel confidence in their abilities to provide health education | H | H | H | Special studies |
21. | #/% of CHWs who express confidence in their abilities to deliver basic healthcare services | H | H | H | Special studies |
Sub-domain B: Service delivery | |||||
22. | Average # of home visits made by CHWs in the last month (indicator to be disaggregated by type of home visit—i.e., sick child visit, antenatal care) | H | H | M | CHW record/CHW report |
Sub-domain C: Service quality | |||||
23. | #/% of CHWs who correctly identified the case/health problem (as per items in a checklist) | H | H | H | Special studies/supervisor report |
24. | #/% of CHWs who correctly addressed (treated) the identified health problem (as per items in a checklist) | H | H | H | Special studies/supervisor report |
25. | #/% of CHWs with all the key stock commodities in the last reporting period | H | H | H | CHW report |
26. | Average time from onset of symptom to first contact with CHW | H | M | M | Special studies |
Sub-domain D: Data reporting | |||||
27. | #/% of CHWs who submitted reports in the last month | H | H | M | CHIS/HMIS/supervisor report |
28. | #/% of CHW reports submitted that were complete/did not have missing information | H | H | M | CHIS/HMIS/supervisor report |
Sub-domain E: Absenteeism | |||||
29. | #/% of CHWs who reported on their activities in the last month | H | H | H | CHIS/HMIS |
30. | # of days CHW has performed at least one CHW responsibility in the last month | H | H | H | Special studies/supervisor report |
Domain 5: CHW well-being | |||||
Sub-domain A: Motivation | |||||
31. | Composite metric | H | H | H | Special studies |
Sub-domain B: Job satisfaction | |||||
32. | #/% of CHWs who expressed satisfaction with the community support they receive | H | H | M | Supervisor report/special studies |
33. | #/% of CHWs who expressed satisfaction with the support they receive from health facility staff | H | H | M | Supervisor report/special studies |
Sub-Domain C: Attrition/retention | |||||
34. | In the last 3 months, #/% of CHWs who have reported on their activities | H | H | H | CHIS/HMIS |
Domain 6: Community access | |||||
Sub-domain A: Use of services | |||||
35. | #/% of households who received at least one visit by a CHW in the last 3 months | H | H | M | Special studies |
Sub-domain B: Knowledge of service availability | |||||
36. | #/% of community members that know the name of the community CHWs | H | H | M | Special studies |
37. | #/% of community members who can name at least 3 services that the CHW provides | H | H | M | Special studies |
Sub-domain C: Referral/counter-referral | |||||
38. | % of individuals referred by CHW to the health facility per 100 clients seen (and subset by reasons for referral) | H | H | H | CHIS/HMIS/CHW record |
39. | #/% of clients that completed the referral at the health facility (referral completion) | H | H | H | CHIS/HMIS |
40. | #/% of referred clients seen at receiving service (health facility) that is seen back at referring service (CHW) with complete counter-referral information (counter-referral) | H | H | H | CHIS/HMIS |
41. | Average # of referrals made per CHW in the last month | H | H | H | CHW report/CHW record |
Domain 7: Community-centered care | |||||
Sub-domain A: Empowerment | |||||
42. | Composite metric | M | H | H | Special studies |
Sub-domain B: Experience of care | |||||
43. | #/% of women/households who express satisfaction with services they received from the CHW in the last 3 months | H | H | H | Special studies/community scorecards |
44. | #/% of women who report that in their interaction with the CHW they felt humiliated or disrespected (scale 1–5) | H | H | H | Special studies/community scorecards |
Sub-domain D: Credibility/trust of CHW | |||||
45. | #/% of women/clients who report they trust the health information provided by the CHW | H | H | H | Special studies/community scorecard |
46. | #/% of women/clients who report they trust the treatment services provided by the CHW | H | H | H | Special studies/community scorecard |
Measurement considerations for core framework constructs
Supportive systems
CHW development
Support from community-based groups
CHW competency
CHW well-being
Community access
Indicator | Source |
---|---|
% women seen by CHW at first check after most recent delivery (following facility-based delivery) | DHS 7 Woman’s Questionnaire |
% of women visited by a CHW in the last 12 months | DHS 7 Woman’s Questionnaire |
% of women who reported talking with a field worker about family planning in the last 12 months | DHS 7 Woman’s Questionnaire |
% of women who saw a CHW for antenatal care services for most recent pregnancy | DHS 7 Woman’s Questionnaire |
% babies seen by CHW at first check after most recent delivery (Following facility-based delivery) | DHS 7 Woman’s Questionnaire |
% women who were seen for PNC services by a CHW after leaving the health facility | DHS 7 Woman’s Questionnaire |
% of babies seen by CHW within first 2 months of life | DHS 7 Woman’s Questionnaire |
% of children under 5 seen by a CHW for diarrhea | DHS 7 Woman’s Questionnaire |
% of children under 5 seen by a CHW for fever | DHS 7 Woman’s Questionnaire |
% of women who obtained condoms from CHWs at time of last intercourse | DHS 7 Woman’s Questionnaire |
% of men who discussed family planning with CHW | DHS 7 Man’s Questionnaire |
% of men who obtained condoms from CHWs at time of last intercourse | DHS 7 Man’s Questionnaire |
% of circumcised men who were circumcised by a CHW | DHS 7 Man’s Questionnaire |
% of mothers who received postnatal care within 2 days of childbirth (regardless of place of delivery) | Countdown to 2030 |
% of mothers and babies who received postpartum care within 2 days of childbirth (regardless of place of delivery) | WHO Core 100 (2015) |
# of health workers per 1 000 population (physicians, nurses and midwives, community health workers, etc.) | WHO IPCHS Global |
% of mothers and babies who received postpartum care within 2 weeks/2 days of childbirth (regardless of place of delivery) | WHO IPCHS Global |
# of CHWs trained and deployed for iCCM per 1 000 children under five in target areas | Integrated Community Case Management |
Ratio of CHWs deployed for iCCM to iCCM supervisors | Integrated Community Case Management |
Proportion of CHWs who received at least one administrative supervisory contact in the prior 3 months during which registers and/or reports were reviewed | Integrated Community Case Management |
Proportion of CHWs who received at least one supervisory contact during the prior 3 months during which a sick child visit or scenario was assessed, and coaching was provided | Integrated Community Case Management |
Proportion of CHWs who demonstrate correct knowledge of management of sick child case scenarios | Integrated Community Case Management |
Proportion of sick children visiting a trained CHW who receive correct case management from that CHW | Integrated Community Case Management |
Proportion of CHWs trained in iCCM who are providing iCCM 1 year after initial training | Integrated Community Case Management |
Proportion of sick children who were taken to an appropriate provider (appropriate provider and aspects of timeliness defined by country protocols) (reported separately for each iCCM condition) | Integrated Community Case Management |
Proportion of children recommended for referral who are received at the referral facility | Integrated Community Case Management |
Proportion of CHWs targeted for iCCM who are trained and providing iCCM according to the national plan | Integrated Community Case Management |
Proportion of CHWs (or iCCM sites in cases of multiple CHWs/area) treating at least X cases per month (to be defined locally) | Integrated Community Case Management |
Proportion of overall treatment coverage of diarrhea and malaria being provided through iCCM by CHWs (reported separately for each iCCM condition) | Integrated Community Case Management |
Proportion of CHWs targeted for iCCM who are trained and providing iCCM according to the national plan | Integrated Community Case Management |
Proportion of CHWs who correctly count respiratory rate | Integrated Community Case Management |
Proportion of sick children provided first dose of treatment in the presence of a CHW | Integrated Community Case Management |
Proportion of sick child cases recommended for referral by the CHW | Integrated Community Case Management |
Proportion of sick children under five in iCCM target areas taken to iCCM-trained CHWs as first source of care | Integrated Community Case Management |
Number and proportion of cases followed up according to country protocol after receiving treatment from CHW | Integrated Community Case Management |
Proportion of caregivers in target areas who know of the presence and role of their CHW | Integrated Community Case Management |
Proportion of CHWs whose registers show completeness and consistency between classification and treatment | Integrated Community Case Management |