@article {MorrowS65, author = {Melanie Morrow and Eric Sarriot and Allyson R. Nelson and Felix Sayinzoga and Beatrice Mukamana and Evariste Kayitare and Halima Khamis and Omar Abdalla and William Winfrey}, title = {Applying the Community Health Worker Coverage and Capacity Tool for Time-Use Modeling for Program Planning in Rwanda and Zanzibar}, volume = {9}, number = {Supplement 1}, pages = {S65--S78}, year = {2021}, doi = {10.9745/GHSP-D-20-00324}, publisher = {Global Health: Science and Practice}, abstract = {Key FindingsGovernments in Rwanda and Zanzibar used the Community Health Worker Coverage and Capacity (C3) Tool to optimize community health worker (CHW) time allocation and to estimate how many CHWs were needed to meet universal health coverage goals, respectively.In Rwanda, 2 well-established CHW cadres were within a {\textquotedblleft}manageable{\textquotedblright} workload range, whereas a new cadre was projected to achieve less than half of assigned activities.In Zanzibar, the model projected that 2,200 community health volunteers could achieve approximately 90\% coverage of all defined services. Based on these figures, Zanzibar updated its national community health strategy, which officially launched in February 2020.Key ImplicationsPolicy makers can use the tool to check the feasibility of existing or new CHW policy and strategy with respect to CHW numbers, workload, and population coverage of interventions.Program managers may find the tool useful to establish reasonable expectations for CHW contributions within existing policies and strategies, helping managers to make more realistic plans. Iterative use of the tool supports CHW strategy refinement. Used collaboratively, it can help with building consensus around decisions.Community health worker (CHW) programs are a critical component of health systems, notably in lower- and middle-income countries. However, when policy recommendations exceed what is feasible to implement, CHWs are overstretched by the volume of activities, implementation strength is diluted, and programs fail to produce promised outcomes. To counteract this, we developed a time-use modeling tool{\textemdash}the CHW Coverage and Capacity (C3) Tool{\textemdash}and used it with government partners in Rwanda and Zanzibar to address common policy questions related to CHW needs, coverage, and time optimization.In Rwanda, the C3 Tool was used to analyze 2 well-established cadres of CHWs and 1 new one. The well-established CHW cadres were within a {\textquotedblleft}manageable{\textquotedblright} workload range whereas the new cadre was projected to achieve less than half of assigned activities. This is informing ongoing changes to the CHWs{\textquoteright} scopes of work. In Zanzibar, the C3 Tool was used to update the national community health strategy to include community health volunteers (CHVs) for the first time and determine how many CHVs were needed. The tool projected that 2,200 CHVs could achieve approximately 90\% coverage of all defined services. Based on these figures, Zanzibar updated its national community health strategy, which officially launched in February 2020.We discuss lessons from these 2 experiences. Translating analysis into decision making depends not only on the programmatic will and motivation of governments but also on finding opportune timing for when policy and program processes allow for optimization of CHW investments. Further research is needed but our experience supports the value of a modeling tool to ground program plans within estimated constraints on CHW time.}, URL = {https://www.ghspjournal.org/content/9/Supplement_1/S65}, eprint = {https://www.ghspjournal.org/content/9/Supplement_1/S65.full.pdf}, journal = {Global Health: Science and Practice} }