Figures & Tables
Figures
- FIGURE
Diagrama of the Partners In Health Household Model
Abbreviation: CHW, community health worker.a Cartoon images courtesy of Mango Tree, Jesse Hamm, Petra Rohr-Rouendaal, and Rebecca Ruhlmann.
Community health worker Ida Mathala visits the home of Steria Kenoon, 38, and Evance Keneson, 47, in Mtengula Village, Lower Neno, Malawi. The visit covered an noncommunicable disease/diabetes lesson and verbal TB screening. Ida has worked with this family for 3 years and works with 38 other homes in the village. © 2018 Zack DeClerk/Partners In Health
Community health workers Hne-Nma Clark and Jacob Yieh lead a community education session on family planning in Wuduken community, Liberia. © 2020 Miry Choi/Partners In Health
Community health worker Maribel Huerta Luna visits the home of Máximo González López, 61, in Laguna del Cofre, Chiapas, Mexico. The visit covered a hypertension follow-up during the monthly routine household visit. His hypertension is under clinical control, so he receives a visit only once a month. © 2020 Ariwame Jiménez/Partners In Health
Tables
- TABLE.
Characteristics of Each Partners In Health Household Model Across 3 Country Contexts
Malawi: Community Health Workers Liberia: Community Health Promoters Mexico: Household Model Acompañantes Start date 2017 2019 2019 Number Currently Working 1045 CHWs, 183 SCHWs, and 14 site supervisors 46 CHPs, 5 CHP-S, and 1 CHN 70 CHWs (currently being piloted in only 1-2 of 10 target communities) Catchment Area Served 14 rural catchment areas (138,291 people) 7 peri-urban communities (10,369 people) 10 rural communities (11,645 people) CHW: Household Ratio 1:20–40 1:40–60 1:30–40 Frequency of Household Visits Monthly (daily for patients on TB treatment and those on first year of antiretroviral therapy) Monthly (more often if there are specific patients getting intensive treatment support) Monthly (monthly, biweekly, or weekly, depending on level of chronic disease control) Assigned Tasks Monthly Home Visits Provide health education
Monitor and screen household members for symptoms related to 8 priority health areas (TB, HIV, STIs, NCDs, family planning, maternal and neonatal health, child health and pediatric malnutrition)
Provide health education
Monitor and screen household members for symptoms related to 8 priority health areas (community event-based surveillance, reproductive, maternal, and neonatal health, child health, HIV, TB, leprosy and other neglected tropical diseases, mental health, and NCDs)
Provide health education
Monitor and screen household members for symptoms related to priority health areas (hypertension, diabetes, family planning, maternal and neonatal health, and child health)
Provide basic treatment at doorstep for diarrhea and acute malnutrition in children
Identify vulnerable families eligible for social support
Linkage to Care Refer or physically escort patient to health provider as needed
Follow up on missed appointments
Refer or physically escort patient to health facility as needed
Follow up on missed appointments
Refer or physically escort patient to health facility as needed
Follow up on missed appointments
Assist with scheduling appointments in coordination with health facility staff
Additional Visits for Chronic Conditions Follow-up visit within 48 hours of referral or after escort to health facility
Visit as needed for ongoing treatment adherence and psychosocial support
Follow-up visit within 48 hours of referral or after escort to health facility
Visit based on color risk code assigned by facility (daily, 8, 4, or 2 visits per month) for treatment adherence and psychosocial support
Follow-up visit within 48 hours of referral or escort to health facility, 5 days after identification of moderate acute diarrhea, or every 2 weeks for moderate acute malnutrition
Visit as needed, in coordination with physician, for ongoing support
Outside the Household CHWs and SCHWs escort their clients to the facility for medication collection at least once a month and help them navigate the health system.
Site supervisors support the integrated chronic care clinic, a mobile outreach clinic that provides care and treatment to all antiretroviral therapy and NCD clients under one roof.
CHWs, SCHWs, and site supervisors support HSAs activities (i.e., village clinics at catchment area level as required).
CHPs spend 1 day/month at health facility working with CHP supervisors to help patients navigate the health facility and access services.
CHPs work alongside health facility staff during Integrated Outstation Outreach, supporting community-based sputum collection for suspected TB patients and community HIV testing.
CHWs deliver prescribed drugs to home, if needed.
CHW Selection Step 1: Mapping of the catchment area (# of households, # of CHWs required).
Step 2: Nomination by community leadership and community structures (i.e., chiefs, village health committees, area development committees, village development committees, community-based organizations, and HSAs).
Step 3a: Literacy test, and pre- and post-foundational training test. Underperformers are provided with support and mentorship to be effective on their job.
Step 3b: SCHWs undergo an extra 2-day training after the 5-day foundational training.Step 1: Mapping of the catchment area (# of households, # of CHWs required).
Step 2: Nomination by community health committee using established selection criteria.
Step 3: Literacy and numeracy test, followed by interview to assess for knowledge, skills, and attributes.
Step 4: Passing grade (70%) of all training modules and demonstration of a minimum level of core competency, as determined by training facilitators via previously publicized criteria.Step 1a: Mapping of the catchment area (# of households, # of CHWs required).
Step 1b: Existing vertical CHWs given opportunity to remain in household model after consideration of increased workload.
Step 1c: Open call for potential CHWs disseminated broadly in target communities.
Step 2: Literacy and numeracy test followed by interview and subjective ranking of applicants based on interest, availability, and aptitude.
Step 3: Training for twice as many candidates as positions available. Selection of final CHWs based on daily pre- and post-test evaluations, a final practical evaluation, combined with qualitative assessments from multiple team members (supervisors, trainers, CHW coordinator, etc.).
Step 4: All remaining candidates that completed the initial training retained as substitute CHWs in case of attrition due to maternity leave, illness, etc.Payment for Time Worked Monthly continuous stipend:
-CHWs: US$23
-SCHWs: US$31
(full-time minimum wage about US$26)Monthly stipend:
-CHPs: US$50 for ∼20 hours/week
-CHP supervisors: US$70 for ∼30 hours/week
-CHNs: US$313 for full-time
(full-time minimum wage about US$105)Monthly stipend for CHWs US$100 for ∼20 hours/week (full-time minimum wage about US$170) Training Schedule 5 days foundational training and quarterly 1-day refresher trainings 2 months foundational training, regular refresher trainings 2 weeks of foundational training (theoretical + practical training and mentorship) with monthly continuing education Supervision and Mentoring 1 SCHW assigned to 10 to 15 CHWs 4 CHW visits per month
All CHWs visited per quarter using standardized form for feedback
3 households per CHW visited for spot checks
1 site supervisor assigned to 4–19 SCHWs (depending on number of villages in catchment area)4 SCHW visits per month
All SCHWs visited per quarter using standardized form for feedback
3 households per SCHW visited for spot checks
Supervision Tools:Checklists written for supervisors that sit at primary health centers to communicate with health care workers and bridge them to the CHWs on a daily basis
An organogram, that everyone understands and helped to write, and with lines of communication mapped out
Formal systems for missed visit tracking that different service lines can access (be it NCD, HIV, TB, malnutrition, or patients with cervical biopsy results)
1 CHP-S assigned to up to 10 CHPs Visit all CHPs monthly
Spend 1 day per week at the health facility to help patients referred by CHPs navigate health facility and access health services
Facilitate monthly meetings of CHPs to collect data and discuss challenges
1 CHN assigned up to 10 CHP-SVisit all CHP-Ss monthly
Supervise community-based sputum collection for TB suspects, and community HIV testing
Restock monthly supplies (reporting tools, family planning commodities, stationary, etc)
Spend up to 40% of the time at the facility for clinical screening, addressing relationships between CHPs and health facility staff, supporting patients in accessing services and with care coordination
Facilitate training and refresher trainings
Represent the CHP program's successes and challenges at weekly health facility review meetings
1 CHW supervisor assigned to 10 CHWs Hold monthly group meetings to discuss challenges, reinforce key competencies, restock CHW supplies, and schedule 1:1 mentoring meetings
1:1 mentoring with supervisor once every 3 months using CHW performance indicators and a standardized open-ended form that encourages supportive supervision
Observation-based supervision with CHW during household visits using a standardized form and immediate feedback
Household spot checks using standardized form
Expected to informally gather feedback from health facility physicians and observe group dynamics
Abbreviations: CHN, community health nurse; CHP, community health promoter; CHP-S, community health promoter supervisor; CHW, community health worker; HSA, health surveillance assistant; SCHW, senior community health worker, NCD, noncommunicable disease.
