Figures & Tables
Figures
A community mobilizer in India conducting a home visit.Photo credit: © 2012 Rina Dey/CGPP India
Community mobilizers in India educating mothers on polio vaccination.Photo credit: © 2012 Rina Dey/CGPP India
Tables
- TABLE 1.
Selected Key Indicators of CORE Group Polio Project Program Performance by Country
Indicator Angola Ethiopia India Kenya Somalia Nigeria OPV0 dose 43% card inspection, (2008) to 47% card inspection (2012)1 49% (2013) to 59% (2017) compared to regional Ethiopia Demographic and Health Survey data of 15% (2011) to 27% (2016)2 36% (2010) to 78% (2017) in Uttar Pradesh within 15 days of birth3 64% (2015) to 97% (2017)4 95% (2017)4 55% (2014) to 99% (2018)5 OPV3 among children 12–24 months based on immunization card and mother’s recall 62% (2010)6 67% (2012) to 86% (2017) compared with regional state data of 41% (2011) to 50% (2016)2 Maintained above 80% coverage in Uttar Pradesh from 2010 to 20173 57% (2015) to 94% (2017)4 21% (2017)4 47% (2014) to 62% (2017)4 Non-polio acute flaccid paralysis rate per 100,000 children under age 15 within 14 days of onset of paralysis with 80% or better stool adequacy Not available 2.2 (2012) to 2.8 (2017) exceeding national rate of 2.5 (2017)7 Not applicable 2.5 (2017)4 4 (2017)4 13.6 (2014) to 19.6 (2017)8 Abbreviation: OPV, oral polio vaccine; OPV0, oral polio vaccine newborn dose; OPV3, oral polio vaccine third dose.
- TABLE 2.
CORE Group Polio Project Country Start Dates and Number of Collaborating NGOs, Past and Presenta
Angola Ethiopia India Kenya/Somalia Nigeria Year started 1999 2001 1999 2014 2013 Number of international NGOs 6 9 6 5 3 Number of local NGOs 4 10 77 5 8 Abbreviation: NGO, nongovernmental organization.
↵a The NGOs did fluctuate over time and area covered, so for all data in this article, we have referenced numbers from Losey et al.11
- TABLE 3.
Name, Number, and Type of Community Mobilizers by CORE Group Polio Project Country
Country Name Current Number Type Angola Community volunteers 2,700
(2017 FE)Part time Ethiopia Community volunteers 13,720
(2017 FE)Part time India Community mobilization coordinators 1,10011 Part time Kenya/Somalia Community health volunteers 1,025
(2017 FE)Part time Nigeria Volunteer community mobilizers 2,200
(2017 FE)Part time Abbreviation: FE, Final Evaluation.
- TABLE 4.
Location of CORE Group Polio Project Work and Population Reached (Annual Reports and 2017 Final Evaluations)
Country Location Population Reached Angola 5 provinces (Benguela, Bie, Cuanza Sul, Luanda, Malange) >9 million children under 15 Ethiopia 85 districts in 5 regions (Benshangul-Gumuz; Gambella; Oromiya; Southern Nations, Nationalities and Peoples; Somali) 185 border crossing pointsa >6 million people of which 1,806,950 are children under age 5a India 58 blocks in 12 high-risk districts of Uttar Pradesh, 2 districts in Assam, and 1 district in Haryana 600,000 households reaching population of 3 milliona Kenya/Somalia Kenya: 7 counties (Lamu, Garissa, Mandera, Marsabit, Turkana, Wajir, and parts of Nairobi)
Somalia: 3 border regions (Lower Juba, Gedo, and Bakool)Kenya: 466,250 children under age 5
Somalia: 109,000 children under age 5Nigeria 32 local government areas in 5 northern states (Borno, Kaduna, Kano, Katsina, and Yobe)
6 internally displaced persons campsApproximately 500,000 children under age 5a ↵a Data from secretariat directors.
- TABLE 5.
Community Health Worker Assessment and Improvement Matrix Tool Components and Criteria Used for CORE Group Polio Project
CHW AIM 2018: Revised Programmatic Components CHW AIM 2018 Elements
Examined for CGPP CMs1. 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.
Level 3 requires:
Recruitment: CHWs recruited from community and community consulted in selection. Criteria for functionality, attitudes, expertise, and availability of CHWs clearly delineated.
Role: Clearly defined and documented, agreed upon by CHW, community, and health system.
Workload and location: CHW to population ratio reflects expectations, population density, geographical constraints, and travel requirements.Recruitment: Initial selection
Final decision
Type of CMRole:
Community mobilization to increase polio and routine vaccination rates
Community-based surveillance of acute flaccid paralysis
Promote maternal and child healthWorkload and location:
Number of work days/week
Hours worked
Average number of households reached monthly
Work locations
2. Training
How preservice training is provided to CHWs to prepare for their roles and to ensure they have the necessary skills to provide safe and quality care. How ongoing training is provided to reinforce initial training, teach CHWs new skills, and help ensure quality.
Level 3 requires:
Initial training: meets global guidelines and occurs within 6 months of recruitment.
Continuing education: provided at least annually and vertical topics are integratedInitial Training: Trainers
Content of trainingContinuing education
3. Accreditation
How health knowledge and competencies are assessed and certified prior to practicing and recertified at regular intervals while practicing.
Level 3 requires:
CHW health knowledge and competencies are tested and a minimum standard must be met.Assessment of CM health knowledge and competencies
External program evaluations
4. Equipment and Supplies
How the requisite equipment and supplies are made available when needed to deliver expected services.
Level 3 requires:
Equipment, supplies, and job aids are provided and available for resupply on a regular basis.Continuous supply of job aids
5. Supervision
How supportive supervision is carried out such that regular skill development, problem solving, performance review, and data auditing are provided.
Level 3 requires:
A dedicated trained supervisor uses checklists to conduct supervision visits at least every 3 months and uses summary statistics to identify areas for improved service delivery.Type of supervisor
Average number CMs supervised
Supervisor paid
Tools used
Frequency of supervision performance evaluation (individual and program)
6. Incentives
How a balanced incentive package reflecting job expectations, including financial compensation in the form of a salary and nonfinancial incentives, is provided.
Level 3 requires:
CHWs are compensated at a competitive rate and receive nonfinancial incentivesFinancial (honorarium, transport/food allowance)
Nonfinancial (certificates, performance awards, formal recognition, skill development, uniforms, job aids, free access to health services)
Community recognition
7. Community Involvement
How a community supports the creation and maintenance of the CHW program.
Level 3 requires:
Community supports, recognizes, and appreciates CHWs. CHWs engage with community structures.Discuss CM role and selection
Provide feedback on performance
Solving problems
Provide incentives/recognition
Ongoing data-based dialogue
Use of community influencers
Community structure engagement
8. Opportunity for Advancement
How CHWs are provided career pathways.
Level 3 requires:
Advancement is offered to CHWs, training opportunities are provided to learn new skills, and advancement rewards good performance.Potential for advancement Project, government, community
Retention
Percentage retained
Length of service
Reasons for leaving
9. Data
How community-level data flow to the health system and back to the community and how they are used for quality improvement.
Level 3 requires:
CHWs document visits and provide data that are reported to public sector monitoring systems. Supervisors monitor data quality, and CHWs and communities use data in problem solving.Data collection tools
Feedback provided to community and local government
Data used for problem solving
10. 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.
Level 3 requires:
Linkages between CHWs and the formal health system (Ministry of Health), including referral, recognition and appropriate CHW provisions.CM referrals
Formal health system recognition and support
Country ownership
Abbreviations: AIM, Assessment and Improvement Matrix; CHW, community health worker; CM, community mobilizer.
Angola Ethiopia India Kenya/
SomaliaNigeria Initial selection CGPP provides generic criteria X X X X X NGO identifies candidates X X Community leaders nominate candidates X X X X X Community interviews candidates X Health facility staff X Final decision NGO X X X Community leaders X X Local government X X Type of CM selected Existing CMs X X X Community leaders and influencers X X X Abbreviations: CGPP, CORE Group Polio Project; CM, community mobilizer; NGO, nongovernmental organization.
- TABLE 7.
CORE Group Polio Project Country Program Community Mobilizer Selection Criteria: Sex and Literacya
Country Sex (% Women) Rationale Literacy/Education Angola 90% Women preferred Low literacy Ethiopia 89% Community preference
Religious beliefs
Insecurity
Women’s Development Army Leaders must be women by government policy55% with basic reading and writing India 97% Women preferred Basic high school education Kenya/Somalia 29% Community preference
Religious beliefs
Insecurity
Difficult terrainBasic reading and writing Nigeria 99% Community preference
Religious beliefs
Insecurity
Influence in the communitySome literacy; value of literacy diminished over time ↵a Data from the Secretariat Directors as of August 2019.
Days of Work and Household Coverage Angola Ethiopia India Kenya/Somalia Nigeria Average days per week 2–3 2 5 3 4 Average hours per day/worked 2–4 2 4 2–4 4–5 Median average hours/month 30 16 80 36 72 Median average households/month 75 75 450 100 225 Range of households reached monthly 50–100 50–100 400–500 100 150–300 - TABLE 9.
CGPP Achievement of Community Health Worker Assessment and Improvement Matrix Tool Components
CHW AIM 2018: Revised Programmatic Components CGPP Achievement of Level 3 Functionality 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.Level 3 achieved
Clarity and clear criteria identified for recruitment and role. Some criteria changed over time.2. Training
How preservice training is provided to CHWs to prepare for their roles and ensure they have the necessary skills to provide safe and quality care. How ongoing training is provided to reinforce initial training, teach CHWs new skills, and help ensure quality.Level 3 achieved
Initial training in 4 of 5 programs 3–5 days, maximum was 2 weeks in Angola.
Trainers included CGPP and NGO staff with health facility and government officials and other resource people varying.
Training content in addition to polio, provided broad maternal and child health and social and behavior change skills in most programs.
On-the-job mentoring was the major method of continuing education through CM mentoring, monthly meetings, and annual meetings.3. Accreditation
How health knowledge and competencies are assessed and certified prior to practicing and recertified at regular intervals while practicing.Level 3 not achieved because there was no formal certification system.
CM health knowledge and competencies assessed initially and periodically. External program evaluations documented Knowledge, Practice, and Coverage of CMs and verified with community.4. Equipment and Supplies
How the requisite equipment and supplies are made available when needed to deliver expected services.Level 3 achieved
Continuous supply of job aids (flip books, registers, writing books, pens, posters, sometimes bicycles).5. Supervision
How supportive supervision is carried out such that regular skill development, problem solving, performance review, and data auditing are provided.Level 3 achieved
All country programs addressed supervision at all levels and types.6. Incentives
How a balanced incentive package reflecting job expectations, including financial compensation in the form of a salary and nonfinancial incentives, is provided.Level 3 partially achieved CMs were part-time workers and did not receive a salary.
In 3 of 5 programs, CMs received a monthly honorarium (underpaid compared to UNICEF).
All provided transport/food allowances for campaigns and program meetings.
3 of 5 provided certificates and performance awards.
1 provided free access to health services.
All had community recognition.
7. Community Involvement
How a community supports the creation and maintenance of the CHW program.Level 3 achieved
This was one of the strongest components of the CGPP. All programs demonstrated strong and continuous community involvement.8. Opportunity for Advancement
How CHWs are provided career pathways.Level 3 partially achieved
Because the program was vertical and had changing geographic areas, opportunities to advance within the program were limited.
3 of 5 programs reported opportunities in government and community.
Retention was high (86%–95%) in 3 of the programs, 40% in another, no data in the fifth.9. Data
How community-level data flow to the health system and back to the community, and how they are used for quality improvement.Level 3 achieved
Data collection tools included community maps, registers of pregnant women and newborns, defaulters, child immunization status, and household visits. Feedback was provided to community and local government and health system. Data were used for problem solving to improve program performance.10. 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.Level 3 partially achieved
Because program was vertical and had limited time expectations, it was never fully integrated with the national health system even though CM referrals were made and CMs worked closely with government cadres in all countries.Abbreviations: AIM, Assessment and Improvement Matrix; CGPP, CORE Group Polio Project; CHW, community health worker; CM, community mobilizer; NGO, nongovernmental organization.
