TABLE 5.

Community Health Worker Assessment and Improvement Matrix Tool Components and Criteria Used for CORE Group Polio Project

CHW AIM 2018: Revised Programmatic ComponentsCHW AIM 2018 Elements
Examined for CGPP CMs
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 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 integrated		Initial 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 incentives

  • Financial (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.