By: Carey Westgate (1), Madeleine Ballard (1), and Rebecca Furth (2)
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Health systems the world over have embraced the value of community health workers (CHWs) in extending essential services to the community level, improving health equity and progressing toward universal health coverage. Governments now have an opportunity to institutionalize CHW programs and professionalize this essential cadre of the health workforce. What will it take to ensure CHW programs, at scale, can achieve their full potential?
Fortunately, policymakers, funders, NGOs, and other partners seeking to design, revamp, or strengthen CHW programs have a suite of tools at their disposal. One of the longest-standing and most rigorously field-tested of these tools is the Community Health Worker Assessment and Improvement Matrix (CHW AIM), an assessment tool which can be used to design, evaluate and strengthen CHW programs. Over the next few months, CHW Central will feature case studies from governments, NGOs, consultants, and others who have used the CHW AIM tool to improve the quality of CHW-delivered care in their countries and move one step closer towards Health for All.
CHWs improve maternal and child health services, expand access to family planning, support prevention and care for non-communicable diseases, and greatly enhance access to care for infectious diseases such as HIV and tuberculosis. Faced with the COVID-19 crisis, . Using rapidly adapted protocols and armed with personal protective equipment, CHWs ensured patients could continue to access essential health information and services, even as the locus of care shifted from health facilities to homes. While we may perhaps never know the full contributions of CHWs to bolstering health systems under strain, it is widely recognized that CHWs helped to interrupt the spread of the virus, maintain essential services, and shield the vulnerable, underscoring their value in addressing some of the world’s greatest health challenges.
Expanding and sustaining CHW programs at scale requires sufficient health systems investments. The CHW AIM Toolkit was originally developed in 2011 for the USAID Health Care Improvement (HCI) Project. Built around 15 core components, the original CHW AIM toolkit was framed around two key resources: (1) a Program Functionality Matrix – to assess the functionality of a CHW program’s design and implementation for each component using a rating scale of one to four, with one representing non-functional and four representing highly functional and (2) a Service Intervention Matrix – to determine how CHW service delivery aligns with program and national guidelines.
Since the launch of CHW AIM a decade ago, investment in CHW-led health delivery has continued to grow and the body of evidence related to CHW effectiveness has also expanded considerably. Building on these developments, in 2018 the Community Health Impact Coalition, USAID, UNICEF, CHW Central and Initiatives Inc. came together to update the CHW AIM Program Functionality Matrix to reflect the most recent evidence and recommendations for effective CHW program design and management. To enhance the usability of the tool, efforts to streamline the program components reduced the previous fifteen components to ten. The updated CHW AIM Program Functionality Matrix is the first resource featured in USAID’s Flagship CHW Program Resource Package and has been accessed by hundreds of NGOs, funders, and policymakers interested in CHW program assessment and improvement.
The tool can be used by anyone who is literate and committed to assessing their CHW program for alignment with evidence-based, quality-producing practices. Guidance for using the tool, sample materials for facilitation of stakeholder workshops, tools for scoring and action planning, and additional resources are freely available in English, French, and Spanish and can be used with the updated matrix.
The case studies to be presented in this CHW AIM series not only prove the tool’s utility in CHW program assessment and improvement, but also provide replicable examples for other countries and partners who, in the evolving tragedy of COVID-19, are eager to build back stronger, more resilient health systems underpinned by a well-supported health workforce that reaches every patient, starting at the household level.
In the series that follows, you’ll hear from partners in Kenya, where CHW AIM has been used to inform policy discussions about establishing a professionalized CHW cadre as part of the Community Health Services Bill. Features from practitioners in Madagascar and Togo will show how CHW AIM has been applied to design new CHW programs and improve existing programs, respectively. Technical assistance providers from the Financing Alliance for Health will discuss why they use CHW AIM prior to conducting costing analyses with Ministries of Health, and why getting system design right should be a prerequisite for funding programs. You’ll also hear from technical partners who discuss how applying CHW AIM can enhance data and technology initiatives to the benefit of the entire health system.
We invite you to follow our series in the coming months and think about how CHW AIM might be helpful in your own work. To learn more, check out www.chwimpact.org/chw-aim, CHW Central or contact aim.tool@chwimpact.org.
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Author Affiliations:
- Community Health Impact Coalition (Coalition d’Impact Sur La Santé Communautaire)
- CHW Central
Check out the rest of the features in the CHW AIM series:
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- Strengthening Community Health Worker Programs with CHW AIM
- Taking Action to Improve Data Alignment with Ministry Partners: Case Study from Togo
- How CHW AIM Can Help Ministries and Funders Optimize Investments in Community Health
- Government-NGO Partnerships to Assess and Improve CHW Programs at National and Sub-National Levels: Case Studies from Kenya
- Exploring the role of digital tools in strengthening CHW programs through CHW AIM
- Application of the CHW AIM Tool for high impact research: a case study from Madagascar
I am really enjoying in the field of health career as a CHW by profession. Is there any opportunity we can do further studies to enhance our skills and knowledge. Thank you.