USAID Flagship CHW Resource Package

USAID Flagship CHW Resource Package

The United States Agency for International Development (USAID) Flagship Community Health Worker (CHW) Resource Package compiles priority resources for strengthening CHW programs developed through USAID’s Bureau for Global Health (BGH) investments, as well as what USAID BGH’s flagship partners have produced and prioritized. It includes tools, research, guides, approaches, and best practices recommended by USAID’s flagship project community health experts through a series of convenings and reviews. The rationale for the development of this package was to showcase these priority resources for greater internal and external dissemination and agenda setting, including the Community Roadmap and the WHO CHW Hub. It is a living document*, and we expect to update it periodically as emergent state-of-the-art resources are recommended by flagship experts.

 

This resource package is targeted at national CHW stakeholders (Ministries of Health, implementing partners, USAID missions, UNICEF country offices, and investors of community health) and others who make strategic investments in the health sector and other development areas.

 

The resources can be used to integrate CHWs within the broader health workforce and to promote their professionalization. For this reason, some resources may support broader health workforce development and strengthening, policy, program implementation, or financing, but can be applied to CHW programs. Professionalizing CHWs is a key step for ensuring the effective role of community health within primary health care, critical for achieving health for all and global health goals. Resources may be cross-cutting or technically specific, and all are relevant to optimizing CHWs in a health systems context.

 

The resources are presented according to the WHO guideline on health policy and system support to optimize community health worker programs using the HRH2030 lifecycle approach and the main categories of WHO’s recommendations:

 

I. CHW policy implementation enablers (cross-cutting)
II. Build
III. Manage
IV. Optimize

To learn more about each program strengthening area, click on the arrow to expand the box.

 

Additional resources included under each section were not developed through USAID investments, however they were highly recommended by USAID BGH flagship community health experts.

 

* Please share additional resources for consideration, or seek advice on adapting and applying resources by contacting: rdeussom@hrh2030program.org

I. CHW POLICY IMPLEMENTATION ENABLERS

These resources seek to support stakeholders addressing CHW policy implementation enablers:

 

  1. Tailoring CHW policy options to the context
  2. Considering the rights and the perspective of CHWs
  3. Embedding the CHW programs in the health system, and
  4. Investing in CHW programs
Community Health Worker Assessment and Improvement Matrix (CHW AIM): Updated Program Functionality Matrix for Optimizing Community Health Programs [TOOL, 2018]

Supports WHO Policy Implementation Enablers  A, B, C, D  & Recommendations  #1, #2, #3, #4, #5, #6, #7, #8, #9, #11, #12, #13, #15  

 

Tool objective: To support community health worker program design and/or improvement. Use to assess community health worker program design or implementation and identify strategies to improve performance.

 

Tool applications: A CHW stakeholder group can collaboratively complete the Program Functionality Matrix through guided discussion in less than one day. For existing programs, an extended review of existing program documentation and relevant performance data may provide additional value.  For example, the MOH in Liberia has integrated the CHW AIM tool into its quarterly reviews.

 

Tool description: Built around 10 core domains, the CHW Assessment and Improvement Matrix (AIM) toolkit uses a Program Functionality Matrix to assess the effectiveness of a CHW program’s design and implementation and a Service Intervention Matrix to determine how CHW service delivery aligns with program and national guidelines. Each domain is divided into four performance levels from 1 (non-functional) to 4 (highly functional). By scoring each domain, users create a picture of strengths and challenges in the CHW program. Scores and repeat assessments can be used to monitor program development over time.

Toward Harmonization: Community Health Policy and Program Trends: Data from the Community Health Systems Catalog [REPORT & CATALOG, 2018]
toward harmonization

Report link: 70 pages

Supports WHO Policy Implementation Enablers  A, B, C, D 

 

Resource objectives: To provide highlights, trends, and interesting findings from CHW policy and program documents to guide more harmonized policy design and scale­up strategies for national programs.

 

Resource application: The catalog is intended for policymakers, program managers, researchers, and donors interested in learning more about the current state of community health systems. It can be used on an ad hoc or ongoing basis to identify policy documents and examples. The catalog allows for filtered searches to efficiently identify relevant documents based on geography or health service area (e.g., family planning, maternal and child health, nutrition).

 

Resource description: The document compiles community health policies, strategies, and related documentation from 25 countries, 89 programs, and 60 community health provider types. It synthesizes available policy guidance between 2016 and 2017, and notes where there are information gaps.

 

Reports showcase a range of innovative community health models, including which types of health workers can provide specific services. It can advance the dialogue on task-sharing and task-shifting by facilitating comparison of CHW interventions across cadres and countries. Countries profiled are: Afghanistan, Bangladesh, Benin, Democratic Republic of the Congo (DRC), Ethiopia, Ghana, Haiti, India, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Nepal, Nigeria, Pakistan, Philippines, Rwanda, Senegal, Sierra Leone, South Sudan, Tanzania, Uganda, and Zambia.

 

Health for the People: National Community Health Worker Programs from Afghanistan to Zimbabwe [REPORT, 2020]

Report link: 488 pages

Supports WHO Policy Implementation Enablers  A, C, D 

 

Report objective: To make available current information about national CHW programs for those around the world who have an interest in the further expansion and improvement of these programs and related CHW polices and strategies.

 

Report application: This compendium of 29 case studies of national CHW programs provides comprehensive contextual and systems support information and summarizes available information on CHW role and performance. It can be particularly relevant and useful for national-level policy makers, donors, academics, program managers, and even CHWs and communities who are interested in the delivery of community-based health services to whole populations.

 

Report description: This compendium of 29 case studies of national CHW programs follows a standard format: one-page summary, followed by the historical context, health needs and health system organization, details about the CHW program structure, scale-up, monitoring and data use, financing, impact and lastly, challenges. Updated from the 2017 version, country cases include perspectives from: Afghanistan, Bangladesh, Brazil, Ethiopia, Ghana, India, Indonesia, Iran, Kenya, Liberia, Madagascar, Malawi, Mozambique, Myanmar, Nepal, Niger, Nigeria, Pakistan, Rwanda, Sierra Leone, South Africa, Tanzania, Thailand, Uganda, Zambia, and Zimbabwe.

Developing and Strengthening CHW Programs at Scale: A Reference Guide for Program Managers and Policy Makers [GUIDELINES, 2013]

Full version: 386 pages Condensed version: 60 pages
Case studies: 114 pages

Supports WHO Policy Implementation Enablers  A, B, C, D 

 

Guideline objectives: To support program managers and policy makers with evidence, principles, programmatic suggestions, and examples of how large-scale, mostly public sector CHW programs have been developed, organized, improved, sustained, and scaled.

 

Guidelines application: Users can review in-depth best practices and country examples when considering their CHW program strategy and implementation.

 

Guidelines description: The CHW Reference Guide is organized into four main sections, which are further divided into chapters by topic area:

 

  1. History of CHW programs, planning, governance, and finance.
  2. Human resources management: CHW roles and tasks, recruitment, training, supervision, and incentives.
  3. Context of CHW programs in health systems and community participation.
  4. Operational issues for achieving program impact, such as scaling up and operating at scale, as well as measurement and data use.

 

Complementary case studies of large-scale CHW programs include examples from: Afghanistan, Bangladesh, Brazil, Ethiopia, India, Indonesia, Iran, Nepal, Niger, Pakistan, Rwanda, Zambia, and Zimbabwe.

Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all [ARTICLE, 2018]

Article link: 12 pages

Supports WHO Policy Implementation Enablers  A, B, C, D   & Recommendation  #12 

 

Article objective: To share a new “beyond building blocks” expanded framework to recognize, prioritize, and invest resources in health system elements that promote community health in efforts to reach global goals and achieve health for all.

 

Article application: The conceptual framework may be useful for planners to map and analyze to their national or subnational community health situation.

 

Article description: This paper presents an expanded WHO building blocks framework that articulates the need for dedicated human resources and quality services at the community level; it places strategies for organizing and mobilizing social resources in communities in the context of systems for health; it situates health information as one ingredient of a larger block dedicated to information, learning and accountability; and it recognizes societal partnerships as critical links to the public health sector.

USAID Community Health Framework [FRAMEWORK & TOOLKIT, 2015]

Supports WHO Policy Implementation Enabler  C 

 

Framework objective: To help identify priorities and strategies to improve community health.

 

Framework application: The Framework assists decision makers in understanding community health and how it can be strengthened. It sets out the core components of the community health ecosystem and helps decision-makers answer four key questions about community health:

 

  • Why should we care about community health?
  • What is needed to deliver strong community health outcomes?
  • How can we develop or strengthen community health programs? and
  • Where can we find examples of models and innovations that seek to improve community health?

 

The Framework uses these questions to outline a process for identifying opportunities to strengthen community health ecosystems.

 

Framework description: The Framework also provides a toolkit, which highlights a number of successful models, innovations, and case studies. The toolkit consists of three parts:

 

  • A detailed series of questions to aid the five-step process that the Framework outlines for developing and strengthening community health programs,
  • A list of external resources to help decision makers develop and strengthen community health programs, and
  • A list of models and innovations that have shown promise in delivering community health outcomes across the various components identified in the Framework
Strengthening Primary Health Care through Community Health Workers: Closing the $2 Billion Gap [REPORT, 2017]

Report link: 26 pages

Supports WHO Policy Implementation Enabler  D 

 

Report objective: To identify key steps and highlight lessons learned from a country’s process to mobilize financing for an integrated community health approach to help countries create the conditions required for strong, integrated, sustainably financed systems.

 

Report application: CHW stakeholders can review the investment case statements, evidence and messaging to develop more effective strategies to advocate and plan for investing in integrated CHW programming.

 

Report description: It is estimated that an additional $2 billion is needed annually to build and strengthen community health systems in sub-Saharan Africa. Integrated horizontal programs offer cost-saving opportunities compared to vertical programs, which are often duplicative and run in parallel to government health systems. Meeting the need for community health financing in the most efficient way possible will require governments (supported by donors and implementing partners) to work across a financing pathway. Key steps and lessons learned include political prioritization; strategy, policies, and costing; resource mapping and identification; investment plans; and operational enablers.

Social Returns on Investments (SROI) in the Health Extension Program (HEP) in Ethiopia [REPORT, 2020]

Report link: 43 pages Summary: 2 pages

Supports WHO Policy Implementation Enabler  D 

 

Report objective: To demonstrate the benefits of Ethiopia’s ongoing community health extension program (HEP) in terms of equity, empowerment, employment, and productivity returns.

 

Report application: These findings are important to leaders of other national CHW programs as they provide evidence of the multisectoral benefits of investing in professionalized CHWs over time.

 

Report description: Based on the methodology described in the report, findings showed that the social return on investment in HEP is between $1.54 and $3.26 for every dollar invested and greater than one in all four of the regions studied (Amhara, Oromia, the Southern Nations, Nationalities, and People’s region [SNNP], and Tigray), indicating that the HEP’s economic benefits exceed Ethiopia’s investment in the program.

Additional resources

Strengthening Primary Health Care through Community Health Workers: Investment Case and Financing Recommendations [REPORT, 2015]

 

Supports WHO Policy Implementation Enabler  D 

 

Shares collective findings and recommendations to address the urgent need for national governments and development partners to substantially increase investment in community health workers as part of integrated health care systems. Government leaders can review the report’s findings when developing sustainable investment cases to identify the scale and economic impact that a strong, integrated CHW program could have in their own countries. Report link: 66 pages

 

Community Health Planning & Costing Tool 2.0 [TOOL, 2020]

 

Supports WHO Policy Implementation Enablers  A, B, C, D   &  Recommendations #7 , #14

 

The Community Health Planning and Costing Tool is designed to cost packages of community health services and produce results to help assess performance, plan future services, and prepare investment cases. The user-friendly, open-source, spreadsheet-based tool is designed to be used by health system managers and policy makers. It allows users to calculate the costs of all elements of comprehensive community health services packages, including start-up, training, and community-level service delivery costs, as well as support, supervision, and management costs at all levels of the health system. The tool also has a financing element that can be used to show program financing sources and gaps in current and future funding. The tool can be tailored for either national or sub-national programs and can project costs for up to five years. Tool link

II. BUILD

These resources seek to support stakeholders addressing WHO CHW Guideline recommendations:

 

  1. Selection
  2. Pre-service training
  3. Curriculum to develop competencies
  4. Training modalities
  5. Certification
Community-Based Access to Injectable Contraceptives (CBA2I) [TOOLKIT, 2018]

Supports WHO Recommendations  #2, #3, #4 

 

Toolkit objective: The materials aim to help stakeholders effectively implement community-based access to injectable contraceptives programs, as well as advocate for buy-in and change in policy and programs, including piloting, implementing, and scaling up programs.

 

Toolkit application: National CHW stakeholders can adapt and use these materials based on the CHW scope for their national programs. This comprehensive package of training materials serves as a best practice to support CHW in-service training for an enhanced scope, with this example illustrating how to train and scale community-based injectable contraception provision

 

Toolkit description: The implementation handbook is a step-by-step guide for introducing injectable contraceptives into an existing community-based distribution program. This is a comprehensive toolkit which includes jobs aids, a counseling tool for CHWs, a session plan for counseling tool orientation, as well as three country case studies.

 

Materials

 

Defining and Advancing Gender Competent Family Planning Service Providers: A Competency Framework and Technical Brief [RESOURCE, 2018]

Technical brief: 25 pages

Supports WHO Recommendation  #3 

 

Resource objective: Provide a framework and competencies for family planning (FP) service providers to improve gender-awareness in health workers, including CHWs.

 

Resource application: Competencies can be contextualized and integrated into CHW training to improve the gender competency of CHWs providing community-based family planning services.

 

Resource description: The competency framework includes specific knowledge, skills, and attitudes categorized under six domains:

 

  • Using gender-sensitive communication
  • Promoting individual agency
  • Supporting legal rights and status related to FP in accordance with rights and local laws
  • Engaging men and boys as partners and users
  • Facilitating positive couples’ communication and cooperative decision-making
  • Addressing gender-based violence
Additional resources

CHW Training Package: Caring for Newborns and Children in the Community [COURSE]

 

Supports WHO Recommendations  #2, #3, #4 

 

 

National CHW stakeholders can adapt and use these WHO-UNICEF materials based on the CHW scope for their national programs. Packages include a planning handbook, a facilitator manual, job aids, charts, and other related materials.

 

Strengthening the capacity of community health workers to deliver care for reproductive, maternal, newborn, child and adolescent health [REPORT]

 

Supports WHO Recommendations  #2, #3, #4 

 

Where CHW programs are identified as a viable contribution to the health system, policymakers and program managers can use recommendations for establishing CHW programs and conducting trainings for CHWs in. Resource link: 20 pages

 

Community Health Academy: Strengthening CHW Programs [COURSE]

 

Supports WHO Recommendations  #1, #2, #3, #4 

 

This free, 6-week, online course requires two to four hours per week and is taught by a faculty network of leading community health innovators from around the world. National CHW stakeholders may find useful example in the course to apply to their own context. Course link

 

Certification resources

 

Supports WHO Recommendations  #5 

 

III. MANAGE

These resources seek to support stakeholders addressing WHO CHW Guideline recommendations:

 

  1. Supportive supervision
  2. Remuneration
  3. Contracting agreements
  4. Career ladder
Community Health Performance Metrics Framework [RESOURCE & ARTICLE, 2019]

Supports WHO Recommendations  #1, #2, #3, #4 ,  #6, #7, #8, #9 ,  #10, #11, #12, #13   & WHO Policy Implementation Enabler  C 

 

Resource objective: To guide governments and implementing agencies in deployment of standardized metrics for measuring and monitoring the CHW program performance within the context of the broader health system.

 

Resource application: This consolidated, standardized measurement framework and metrics can be applied to measure CHW program effectiveness and guide implementers at various stages of program planning, implementation, review and scale.

 

Resource description: Drawing from existing resources including the AIM tool, the Frontline Health framework structure uses the common input-process-output-outcome logic model approach, and has four areas: inputs, programmatic processes, community health performance outputs (measured at the CHW level and at the community level), and outcomes. Specific measurement domains and sub-domains are defined under each of these categories. Indicators for the measurement sub-domains were developed and classified by their utility (high or moderate) for managers at the facility, district, and regional/national levels.

Human Resources Management Assessment Approach [TOOLKIT, 2013]

Tool link: 60 pages

Supports WHO Recommendation  #6 

 

Tool objective: To guide policymakers, managers, and human resources practitioners toward better understanding and responding to human resources management (HRM) challenges facing their health systems, including support to community-based health workers.

 

Toolkit application: The approach is flexible: it can be applied to an overall assessment of the health workforce management environment or modified to focus on a specific problem (e.g., workforce maldistribution, support to frontline, community-based workers). Alternatively, it can be used to examine HRM issues specific to a health program or intervention (e.g., CHWs). Additionally, the approach engages stakeholders in key stages of the assessment process to foster ownership and commitment as well as to ensure the assessment’s outcomes and proposed interventions are responsive to local needs, including at the community level.

 

Tool description: HRM is the integrated use of systems, policies, and practices that will provide the range of functions needed to plan, produce, deploy, manage, train, support, and sustain the workforce. HRM focuses on people: how they fit and are utilized within a health system, and how they can be most effective.  While the tool does not focus directly on CHW programs, it presents relevant cross-cutting best practices.

Rapid retention survey toolkit [TOOLKIT, 2015]

Tool link: 224 pages

Supports WHO Recommendations  #6, #7, #8, #9 

 

Tool objectives: To present a prescriptive formula of stages and steps to guide users to apply the discrete choice experiment (DCE) methodology to assess health worker job preferences and better pinpoint the bundle of incentives and interventions that could more effectively attract and retain health workers in underserved areas.

 

Tool application: The toolkit guides human resources managers through the survey process to rapidly assess health professional students’ and health workers’ motivational preferences to accept a position and continue working in underserved facilities. It allows for rapid data-gathering and analysis, and the results can be used to create evidence-based incentive packages. It can easily be adapted to a specific country context. to design evidence-based community health worker job packages to optimize the availability of motivated, well-supported frontline health workers. Specific adaptations for CHWs include comparisons between existing job packages of financial and non-financial incentives for CHWs working within their own communities. Working conditions, supplies, access to technology, career and training opportunities, and community-supported incentives could all be considered within a CHW job package.

 

Tool description: Based on the 2010 WHO Global Policy Recommendations: Increasing Access to Health Workers in Remote and Rural Areas through Improved Retention, this toolkit presents an approach to developing a frontline health worker incentive package by determining the relative importance that different kinds of health workers place on different job characteristics. While the tool does not focus directly on CHW programs, it presents a relevant approach that has been applied to CHWs.

Additional Resources

WHO CHW Monitoring and accountability framework [TOOL, in progress]

 

Supports WHO Recommendation  #6 

 

Through the National Health Workforce Accounts (NHWA) and a dedicated CHW Repository (CHWR) facilitated by WHO, the development and implementation of a monitoring and accountability framework for CHW policies will support a more holistic picture of the state of CHW programs. This will help countries with CHW programs make progress to include in their existing registries and HRH information systems the required mechanisms to track community health worker stock, training, distribution, capacity, and remuneration. In addition to the CHW data in existing NHWA fields, the CHWR will accept and triangulate new indicators relating to the policy and governance environment in which the CHW programs are implemented.

IV. OPTIMIZE

These resources seek to support stakeholders addressing WHO CHW Guideline recommendations:

 

  1. Target population size
  2. Collection and use of data
  3. Types of CHWs / integration in PHC
  4. Community engagement
  5. Mobilization of community resources
  6. Supply chain
CHW Coverage and Capacity (C3) Tool [TOOL, 2019]

Supports WHO Recommendations  #10, #12  

 

Tool objective: To estimate the number, geographic distribution, and scope of CHWs needed to achieve community health goals. The CHW Coverage and Capacity (C3) Tool was designed as an operational tool following the release of the CHW Reference Guide, notably Chapter 7 on CHW Roles and Responsibilities.

 

Tool application: C3 is an Excel-based tool that models options for CHW allocation and engagement. The generic C3 Tool can be downloaded to apply to different country contexts and needs. For instructions on the usage of the tool, the C3 Tool User Guide and C3 Tool Example provide instructions and illustrations on using the tool.

 

Tool description: It can support planners to (1) estimate the number of CHWs required to efficiently carry out specified health interventions, or (2) define, rationalize, and optimize the effective level of coverage for and mix of activities/interventions that a set number of CHWs can undertake at a given geographic scale (project, subnational, national). The C3 tool application involves an iterative decision-making process by CHW program managers and planners in making assumptions and creating scenarios related to CHW workload optimization.

Optimizing Health Worker Performance and Productivity to Achieve the 95-95-95 Targets [TOOL, 2018]

Toolkit link: 67 pages

Supports WHO Recommendations  #10, #12 

 

Tool objective: To present a quality-improvement, needs-driven process and relevant approaches for improving health workforce performance and productivity to achieve service delivery goals, such as the 95-95-95 targets. Optimization may include differentiated service delivery at the community level and harnessing the role of CHWs to contribute to comprehensive, client-centered care. This may include for HIV testing, referrals, ART adherence counseling and retention, as well as nutrition, prevention of mother-to-child transmission (PMTCT), health promotion, prevention, and the management of co-morbidities, including non-communicable diseases and mental health.

 

Tool application: National CHW program implementers can review process and apply tools to address service gaps that would be appropriately delivered by CHWs according to national policy, their scope, training, and competencies.

 

Tool description: The toolkit contains a suite of existing tools and resources to address site-level health workforce performance and productivity problems impacting HIV service delivery. The toolkit is designed so that each step stands on its own and can be used either independently or in a stepwise fashion to identify, analyze, address, monitor, and sustain interventions that improve health workforce performance and productivity.

Increasing community health worker productivity and effectiveness: a review of the influence of the work environment [ARTICLE, 2012]

Article link: 9 pages

Supports WHO Recommendations  #6 #10, #12, #13, #14, #15  & Policy Implementation Enabler  B 

 

Article objective: To present policymakers and program managers with key considerations for a model to improve the work environment as an important approach to increase CHW productivity and, ultimately, the effectiveness of community-based strategies.

 

Article application: Policymakers, program managers, and other stakeholders need to carefully consider how the productivity elements related to the work environment are defined and incorporated in the overall CHW strategy. Establishing a balance among the four elements that constitute a CHW’s work environment will help make great strides in improving the effectiveness and quality of the services provided by CHWs.

 

Article description: CHW productivity is determined in large part by the conditions under which they work. An enabling work environment encompasses four essential elements—workload, supportive supervision, supplies and equipment, and respect from the community and the health system. When CHWs have a manageable workload in terms of a realistic number of tasks and clients, an organized manner of out these tasks, a reasonable geographic distance to cover, the needed supplies and equipment, a supportive supervisor, and respect and acceptance from the community and the health system, they can function more productively and contribute to an effective community-based strategy.

Human Resources for Health Optimization Tools for Antiretroviral Treatment (“HOT4ART”) [TOOL, updated 2020]

Supports WHO Recommendations  #10, #12 

 

Tool objective: To provide health facility staff and district health management teams with potential scenarios to estimate needs and plan to optimize their health workforce for the roll-out of “Test and Start” utilizing differentiated service delivery (DSD) models in high HIV burden settings, which may include services delivered by CHWs, whether at the facility or community levels. Optimization may include harnessing the role of CHWs to contribute to comprehensive, client-centered care. This may include for HIV testing, referrals, ART adherence counseling and retention, as well as nutrition, prevention of mother-to-child transmission (PMTCT), health promotion, prevention, and the management of co-morbidities, including non-communicable diseases and mental health.

 

Tool application: Facility managers (site level) and program planners (above site) can use the HRH optimization tool for antiretroviral therapy (ART) – HOT4ART –  to estimate human resource requirements for different DSD models. Tool outputs enable users to make informed decisions for maximizing the use of the available workforce and to generate estimates of additional human resources needs, such as:

 

  • Staffing needs for implementing one or a combination of HIV service delivery models
  • Efficient antiretroviral therapy (ART) task distribution among existing health workers to implement DSD
  • Configuration of DSD and task-shifting/sharing (reassigning tasks from one health worker cadre/type to another) to reduce human resource imbalances (excesses or gaps)
  • Organization of site-level services to meet daily client needs (infrastructure, work hours, staffing)

 

Tool description: This tool helps to identify and address staffing gaps by showing decision-makers the impact of reorganizing service delivery on the workforce, including CHWs. Staffing gaps can be effectively addressed by sharing tasks among cadres and by offering stable clients’ participation in models of care that better meet their needs and offer quality services while requiring fewer interactions with health facilities.

Human Resources for Health Optimization Tools for Family Planning (“HOT4FP”) [TOOL, in progress]

Supports WHO Recommendations  #10, #12  

 

Tool objective: To provide health facility staff and district health management teams with potential scenarios to estimate needs and plan to optimize their health workforce for the roll-out of family planning. Optimization may include CHWs providing family planning services at the facility and community levels according to national policy, designated CHW scope and competencies.

 

Tool application: This HRH optimization tool for family planning – HOT4FP – enables facility managers (site level) and program planners (above site) to estimate human resource requirements for different family planning service delivery models, based on national guidelines. Outputs from the tool enable users to make informed decisions for maximizing the use of the available workforce and to generate estimates of additional human resources needs where appropriate.

 

Tool description: This tool helps to identify and address staffing gaps by showing decision-makers the impact of reorganizing service delivery on the workforce, including CHWs. Staffing gaps can be effectively addressed by sharing tasks among cadres  as appropriate and by offering family planning clients’ participation in models of care that better meet their needs and offer quality services while requiring fewer interactions with health facilities.

Human Resources for Health Optimization Tools for Primary Health Care (“HOT4PHC”) [TOOL, in progress]

Supports WHO Recommendations  #10, #11, #12  

 

Tool objective: To provide health facility staff and district health management teams with potential scenarios to estimate needs and plan to optimize their health workforce for the delivery of primary health care (PHC) services, including services delivered by CHWs at the facility and community levels.

 

Tool application: This HRH optimization tool for PHC – HOT4PHC –  enables facility managers (site level) and program planners (above site) to estimate human resource requirements for different PHC service delivery models, based on national guidelines and essential service package. Outputs from the tool enable users to make informed decisions for maximizing the use of the available workforce and to generate estimates of additional human resources needs where appropriate.

 

Tool description: This tool helps to identify and address staffing gaps by showing decision-makers the impact of reorganizing service delivery on the workforce. Staffing gaps can be effectively addressed by sharing tasks among cadres and by offering clients’ participation in models of care that better meet their needs and offer quality services while requiring fewer interactions with health facilities.

Community Engagement Implementation Toolkit [TOOL, 2017]

Supports WHO Recommendation  #13  

 

Toolkit objective: To document and guide the community engagement process for greater ownership of local health facility quality through the existing facility management committee structure.

 

Toolkit application: National community health stakeholders can review and adapt this Sierra Leone-specific toolkit and strategy for their own community engagement approach. The toolkit is intended for use by district health management teams and implementing partners.

 

Toolkit description: Developed to strengthen primary health care services in post-Ebola Sierra Leone, this toolkit provides a series of phases and step-by-step activities and related materials to: assess community structures’ functionality and capacity; identify and address issues; and then monitor and maintain the local health facility. The process seeks to increase community representation and feedback, accountability for facility quality, advocacy for resources, and CHW monitoring and feedback.

 

Materials

 

Additional resources

DHIS2 Community Health Information Systems Guidelines [GUIDANCE, 2018]

 

Supports WHO Recommendations  #6 #11, #12  

 

This document serves as a practical guide for national and local decision makers involved in the design, planning, deployment, governance, and scale up of successful DHIS2-based CHIS that support community-based health service providers and the communities they work in. It provides an in-depth review of key questions that should be considered when addressing issues relevant for governance, design, development, and use of large-scale CHIS for adaptation within country contexts. Guidelines: 196 pages

 

Minimum quality standards and indicators in community engagement [GUIDANCE, 2020]

 

Supports WHO Recommendation  #13  

 

This guidance supports the implementation of high-quality, evidence-based community engagement in development and humanitarian contexts. Historically, it has been difficult to scale community engagement due to a lack of consensus around definitions, core criteria, measurement, and local and national contexts. These minimum standards seek to establish a common language for governments, local populations, donors, implementing actors, and policy makers, in order to facilitate the adoption and acceptance of this essential range of practices. Full report: 37 pages Summary: 2 pages