Community Health Worker Assessment and

Improvement Matrix (CHW AIM):

A Toolkit for Improving CHW Programs and Services

REVISED SEPTEMBER 2013

This toolkit was prepared by Initiatives Inc. and University Research Co., LLC (URC) for review by the United States Agency for International
Development (USAID) and was authored by Lauren Crigler (Initiatives Inc.), Kathleen Hill (URC), Rebecca Furth (Initiatives Inc.), and Donna
Bjerregaard (Initiatives Inc.). CHW AIM was developed under the USAID Health Care Improvement Project, made possible by the generous
support of the American people.

CommunityHealthWorkerAssessmentand
ImprovementMatrix(CHWAIM):
AToolkitforImprovingCHWProgramsandServices

REVISEDVERSION,SEPTEMBER2013

LaurenCrigler,InitiativesInc.
KathleenHill,UniversityResearchCo.,LLC
RebeccaFurth,InitiativesInc.
DonnaBjerregaard,InitiativesInc.

Disclaimer
TheviewsexpressedinthispublicationdonotnecessarilyreflecttheviewsoftheUnitedStatesAgency
forInternationalDevelopmentortheUnitedStatesGovernment.


Acknowledgements
TheCommunityHealthWorkerAssessmentandImprovementMatrix(CHWAIM)wasdevelopedbyLaurenCrigler
andKathleenHilloftheUSAIDHealthCareImprovement(HCI)ProjectandRebeccaFurthandDonnaBjerregaard
ofInitiativesInc.FazilaShakirprovidedvaluableassistanceinconductingbackgroundresearchforthe
developmentofthetool.ChukaAnudecontributedtothedevelopmentoftheHIVandAIDSandTBIntervention
Matrices.AlisonWittcoffandNancyRoggenprovidededitorialassistance.
TheauthorswouldliketothankTroyJacobsandtheentirematernalandchildhealthteamattheUnitedStates
AgencyforInternationalDevelopment(USAID)JohnBorrazo,AlBartlett,MariaFrancisco,LilyKak,andMaryEllen
Stantonfortheircommentsonpriordraftsofthistoolandfortheirsuggestionsforitsimprovement.
TheUSAIDHCIProjectisimplementedbyUniversityResearchCo.,LLC(URC)underthetermsofContractNumber
GHNI03070000300.URCssubcontractorsfortheHCIProjectincludeEnCompassLLC,FHI360,InitiativesInc.,
andJohnsHopkinsUniversityCenterforCommunicationPrograms.InitiativesInc.isHCIsleadpartnerinhuman
resourcemanagement.FormoreinformationontheCHWAIMToolkit,pleasecontactInitiativesInc.at
info@initiativesinc.comorvisitwww.chwcentral.org.

Recommendedcitation
CriglerL,HillK,FurthR,BjerregaardD.2013.CommunityHealthWorkerAssessmentandImprovementMatrix
(CHWAIM):AToolkitforImprovingCommunityHealthWorkerProgramsandServices.RevisedVersion.Published
bytheUSAIDHealthCareImprovementProject.Bethesda,MD:UniversityResearchCo.,LLC(URC).

Revisionsinthisversion
This2013versionoftheCHWAIMToolkitreflectsfeedbackreceivedfromusersontheoriginalversionpublished
in2011.Whilethecoretools,methods,andcontentsremainlargelythesame,therearerevisionstotheCHW
ProgramFunctionalityMatrixandInterventionMatrices;asimplifiedFunctionalityScoreSheet;andastreamlined
ValidationQuestionnaire.OtherchangesincludeintegratingthedocumentreviewintotheCHWAIMimplementa
tionprocessandprovidingadditionalactionplanningguidance.ThethreeInterventionMatrices(maternal,new
born,andchildhealth,HIVandAIDS,andtuberculosis)havebeenstreamlinedandharmonized.Thescoringsys
temhasbeenadjustedfromtheoriginalscaleofzerotothreetoarevisedscaleofonetofour.Thischangeisin
responsetousersdiscomfortwithazeroscoreandtheconceptualdifficultiessomeusersfacedreconcilingthe
fourscoringlevelswithamaximumscoreofonlythree.Importantly,themeaningofthescoreshasnotchanged,
souserswhowanttocomparescoresachievedusingthisversionwithpreviousscorescansimplyconvertthe
scores.

TableofContents
SectionI.Introduction...............................................................................................................I1
SectionII.CHWProgramFunctionalityMatrix..........................................................................II1
SectionIII.InterventionMatrices............................................................................................III1
SectionIV.CHWAIMFacilitatorsGuide..................................................................................IV1
Step1.AdaptToolstoProgramContext...................................................................................................IV4
Step2.PlanfortheAssessmentWorkshop..............................................................................................IV5
Step3.ConducttheAssessmentWorkshop...........................................................................................IV10
Step4.FollowUp.....................................................................................................................................IV16
SectionV.References................................................................................................................V1
SectionVI.Appendices............................................................................................................VI1
AppendixA1:ParticipantSelectionForm.................................................................................................VI1
AppendixA2:ValidationQuestionnaire...................................................................................................VI3
AppendixA3:ScoreandScoreRationaleDocumentationWorksheet.....................................................VI7
AppendixA4:FunctionalityScoreSheet................................................................................................VI10
AppendixA5:ActionPlanningFramework.............................................................................................VI13
AppendixA6:OnlineResourcesandFieldExamples..............................................................................VI16

Abbreviations
ACSM

AIM

AMTSL

ARV

BCG

CD4

CHW

CHWAIM
CMAM

DOT

DOTHAART
DOTPlus
DOTTB

DOTS

DPT

GBV

GHI

Advocacy,communicationandsocialmobilization
Assessmentandimprovementmatrix
Activemanagementofthethirdstageoflabor
Antiretroviral
BaccilusCalmetteGuerinvaccinefortuberculosis
Clusterofdifferentiation4(testusedtoassesstheimmunesystemofHIVpatients)
Communityhealthworker
CommunityHealthWorkerAssessmentandImprovementMatrix
Communitybasedmanagementofacutemalnutrition
Directlyobservedtreatment
DirectlyobservedtreatmentforHIVusinghighlyactiveantiretroviraltherapy
Directlyobservedtreatmentshortcoursefordrugresistanttuberculosis
Directlyobservedtreatmentfortuberculosis
Directlyobservedtreatmentshortcourse
Diphtheria,pertussis,andtetanusvaccine
Genderbasedviolence
GlobalHealthInitiative
i

HAART
Highlyactiveantiretroviraltherapy(fortreatmentofHIV)
HCI
USAIDHealthCareImprovementProject
HIB
HaemophilusinfluenzaetypeBvaccine
HIVandAIDSHumanimmunodeficiencyvirusandacquiredimmunodeficiencysyndrome
IDU
Intravenousdruguse
IPT
Isoniazidpreventivetherapy
IPTp
Intermittentpreventivetherapyformalariainpregnancy
IUD
Intrauterinedevice
IYCF
Infantandyoungchildfeeding
LAM
Lactationalamenorrheamethod
LCD
Liquidcrystaldisplay
MARP
Mostatriskpopulation
MC
Malecircumcision
MDRTB
Multidrugresistanttuberculosis
MNCH
Maternal,newbornandchildhealth
MOH
MinistryofHealth
NA
Notapplicable
NGO
Nongovernmentalorganization
Oralrehydrationsalts
ORS
OVC
Orphansandvulnerablechildren
PCP
Pneumocystispneumonia
PEP
Postexposureprophylaxis
PEPFAR
U.S.PresidentsEmergencyPlanforAIDSRelief
PLHA
PeoplelivingwithHIV
PMTCT
PreventionofmothertochildtransmissionofHIV
PPH
Postpartumhemorrhage
STI
Sexuallytransmittedinfection
TB
Tuberculosis
TBHIV
Tuberculosishumanimmunodeficiencyviruscoinfection
USAID
UnitesStatesAgencyforInternationalDevelopment
WHO
WorldHealthOrganization
XDRTB
Extensivelydrugresistanttuberculosis

ii

SectionI. Introduction
TheUSAIDHealthCareImprovementProjectcreated
theCHWAIMToolkittohelpministries,donorsand
nongovernmentalorganizations(NGOs)assessand
strengthentheircommunityhealthworkerprograms
toimprovetheirfunctionality.Thissectionprovidesan
overviewoftheCommunityHealthWorker
AssessmentandImprovementMatrix(CHWAIM)
implementationprocess,thefunctionalitymodel,and
thefourstepstoadapt,plan,conduct,andfollowupa
CHWAIMprogramassessmentaswellasguidanceon
thecontentsanduseofthetoolkit.

SectionI.Introduction
A.Background
TheUSAIDHealthCareImprovement(HCI)ProjectdevelopedtheCommunityHealthWorkerAssessmentand
ImprovementMatrix(CHWAIM)ToolkittohelpprogramsassessCHWprogramfunctionalityandimprove
performance.Builtaroundacoreof15componentsdeemedessentialforeffectiveprograms,CHWAIMincludesa
guidedselfassessmentandperformanceimprovementprocesstohelporganizationsidentifyprogramstrengths
andaddressgaps.Throughdiscussionandreviewofcurrentpractices,theprocessassistsunderstandingofbest
practices,buildsconsensusaboutandcommitmenttochange,andprovidesguidanceforimprovingfunctionality.
AccordingtotheWorldHealthOrganization(WHO),57countriesfromAfricatoAsiaarefacingshortagesintheir
healthcareworkforces,andanestimated4,250,000workersareneededtofillthegaps.CHWshaveplayedan
importantroleinlinkingcommunitiestohealthservicesforover50years(WHO2006).TheimportanceofCHWsin
healthsystemsisbecomingincreasinglyrecognizedasgovernmentinstitutionsareunabletotrainenoughhealth
workerstomeettheirneedswhileatthesametimethehealthworkforceisbeingdepletedbymigration,HIV
relatedillness,andinadequateinfrastructure.Byprovidingbasichealthtasks,CHWsfreeupskilledhealth
providerstooffermorecomplexhealthcare.DespiteCHWachievements,therehasnotbeenasystematic
approachtoevaluatingCHWprogrameffectiveness.
TheUnitedStateGovernmentrecognizestheimportanceofaddressingthehumanresourcecrisisinordertobring
criticalhealthservicestounderservedpopulations.Tohelpaddressthiscrisis,theUnitedStatesAgencyfor
InternationalDevelopment(USAID)iscommittedtoincreasingthenumberoffunctionalCHWsservingin
maternal,newbornandchildhealth(MNCH)prioritycountriesbyatleast100,000by2013(USAID2008a/b).The
U.S.PresidentsEmergencyPlanforAIDSRelief(PEPFAR)alsoissuedguidelinesforthePresidentsGlobalHealth
Initiative(GHI)toprovidetrainingandretentionsupportformorethan140,000newhealthworkersinorderto
strengthenhealthsystems(PEPFAR2010a).
TheemphasisoncommunitysupportmakesassessingthefunctionalityofCHWprogramsincreasinglyimportant.
However,evaluatingCHWprogramsandhowindividualsdeliveringservicesareselectedandsupportedcanbe
difficult,particularlysincecharacteristics,roles,andresponsibilitiesforCHWscanvaryvastly.Thisdocument
proposesaworkingdefinitionofaCHWandamatrixtoolforassessingwhetherCHWprogramsarefunctional.

CommunityHealthWorkers

TheCHWAIMprocessdefinesacommunity
Knownunderavarietyoftitles,CHWsaregenerally
healthworkerasahealthworkerwho
membersoftheircommunitieswhoaretrainedtocarry
performsasetofessentialhealthservices,
outoneormorefunctionsrelatedtohealthcare.Their
receivesstandardizedtrainingoutsidethe
tasksrangefromhealthpromotiontodisease
formalnursingormedicalcurricula,andhasa
preventionandincludecurativecarefortuberculosis
definedrolewithinthecommunityandthe
(TB),careofHIVandAIDSpatients,malariacontrol,
largerhealthsystem.
referralsandreproductivehealthandfamilyplanning
educationandservices,andcareforchildrenundertheageoffive.Theymayvisitclientsintheirhomes,their
communities,oratclinics(WHO2007).AfterdiscussionswithkeystakeholdersincludingUSAIDandWHO,the
CHWAIMprocessdefinedacommunityhealthworkerasahealthworkerwhoperformsasetofessentialhealth
services,receivesstandardizedtrainingoutsidetheformalnursingormedicalcurricula,andhasadefinedrole
withinthecommunityandthelargerhealthsystem.

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CHWAIMToolkitOverview
TheCHWAIMToolkitassiststheassessment,improvement,andplanningofCHWprogramsbydeepening
understandingoftheelementsofsuccessfulprogramsandtheuseofbestpracticesasanevidencebased
approachtoimprovement.Thetoolkitisframedaroundtwokeyresources:1)aprogramfunctionalitymatrixwith
15keycomponentsusedbyparticipantstoassessthecurrentstatusoftheirprograms,and2)serviceintervention
matricestodeterminehowCHWservicedeliveryalignswithprogramandnationalguidelines.Worksheetsand
toolstoassistintheimplementationofthetworesourcesareincluded.Thekeyhealthinterventionmatrices
currentlyincludedinCHWAIMaddressmaternal,newborn,andchildhealth(MNCH),HIVandAIDS,and
tuberculosis(TB);additionalservicescanbeadaptedforassessment.
Audience:Thetoolkitisusefulforanyimplementingpartnersuchasaministryofhealth,anongovernmental
organization,orotherorganizationsthatimplementandmanageCHWprograms.
Objectives:Toprovideaframeworkandprocesstoenablegovernmentsandorganizationstosurvey,assess,and
improvethefunctionalityofCHWprograms.
UsersandUses:Althoughoriginallydesignedasacomprehensiveassessmentandimprovementprocess,
ministriesofhealth,internationaldevelopmentorganizations,andlocalNGOshaveusedtheprocessinanumber
ofways.

Users

Uses

Contents:ThetoolkitcontainsallthematerialstohelpprogramsassessthestatusoftheirCHWprograms,align
serviceswithprogramandnationalguidelines,anddevelopstrategiestoaddressgapsandbuildonstrengthsas
wellastrainothersinhowtousethetools.ThefollowingfiguremapsouttheresourcesincludedintheCHWAIM
Toolkit.

I2

Asasurveytool,thecriteriaandscoringincludedintheCHWAIMToolkithasbeenusedindeskreviewsofCHW
programsaroundtheglobe.Internationalorganizationshavealsousedthetooltocomparewhatelementsand
servicescoveredbytheCHWstheysupportversusthegovernmentcadreofCHWs.Thisexercisehelpedidentify
areasofoverlap,gaps,andneeds.Otherprogramshavefoundthetoolusefulinplanning.Theseprogramsusethe
bestpracticeslistedforCHWprogramsintheCHWProgramFunctionalityMatrixtothinkthroughhowtheywill
putkeyelementsofprogramfunctionalityinplacefromthestart.Stillotherprogramshaveusedthetooltodoa
quickdeskassessmentoftheirprograms,findgaps,andstartworkingwithteammemberstoaddressissues.
MinistriesofhealthareusingthetooltodocomprehensiveassessmentsoftheirCHWprogramsonadistrictby
districtbasis.LocalandinternationalNGOshavealsousedthetooltoassesstheirCHWprograms,identifygaps,

I3

anddevelopactionplanstoaddressissues.Finally,someinternationalNGOpartnershavenotedthattheyusethe
tooltobuildstaffawarenessabouttheissuesandelementstheyneedtoconsiderinplanning,managing,and
assessingaCHWprogram.
Althoughthetoolhasmanypotentialuses,andusersareencouragedtoadaptitfortheirownpurposes,mostof
theguidanceprovidedintheremainderofthisdocumentrelatestothemethodsandprocessesforusingthetool
inCHWprogramfunctionalityassessmentsandimprovement.

B.ProgramFunctionalityMatrixProcess
Facilitation:Althoughparticipatoryinnature,theprocessshouldbeledbyatrainedfacilitator,eitherexternalto
oramemberoftheorganization.Thefacilitatorsroleistoguidetheplanning,implementation,andfollowupof
theassessment.S/herunstheworkshopandensuresactiveparticipation,consensus,completionoftools,and
responsiveactionplans.AfacilitationguideisincludedasSectionIVofthisdocument.PowerPointslidestoorient
theleaderareavailableat:http://www.chwcentral.org/communityhealthworkerassessmentandimprovement
matrixchwaimtoolkitimprovingchwprogramsand.
Participants:Theassessmentiscarriedoutduringaworkshopwithmultiplestakeholdersknowledgeableabout
howtheprogramismanagedorsupportedandtheregionswithinwhichitfunctions.Between15and25
participantsisreasonableandshouldincludefieldmanagers,districtmanagers,CHWs,andCHWsupervisors.The
CHWAIMprocesspromotestheinvolvementofCHWsastheirexperienceandvoicesaddtoafairassessment.All
levelsofstaffshouldbeevenlyrepresentedintheworkshopifpossible.
Approach:TheCHWAIMapproachisbasedonaguidedselfassessmentthatallowsadiversegroupof
participantstoscoretheirownprogramsagainst15programmaticcomponentsand4levelsoffunctionality.
Followingthereview,participantsusetheresultstodevelopactionplanstoaddressweaknessesinperformance.
Theassessmentapproachencouragesrichdiscussionsonactualversustheoreticalimpressionsofcommunity
basedprograms.Italsoencouragescountryownershipthrougheaseofuse,upfrontadaptationtocountry
contexts,andstepbystepinvolvement.Itallowshostgovernmentstoquicklyandefficientlymapandassess
programsusingaratingscalebasedonbestpractices.Theprocesscanbeexpandedtoincludeotherservice
matricesand/orcanbeeasilycombinedwithothertoolsandapproaches.
Limitations:Theapproachdoesnotevaluatethequalityofservicesdeliveredbyindividualhealthworkers.The
methodologyreliesonsecondaryevidenceandselfreportsforassessment;therefore,informationcollected
cannotbeusedtoevaluateindividualCHWperformanceorCHWcontributionstocoverage,effectiveness,or
impact.

I4

FunctionalityModel

ProgrammaticComponents
CHWAIMoutlines15programmaticcomponentsthathavebeenfoundtocontributetoaneffectiveCHW
program.
1.

Recruitment

Howandfromwhereacommunityhealthworkerisidentified,selected,and
assignedtoacommunity,includingselectioncriteria.

2.

CHWRole

Thealignment,design,andclarityofrolefromcommunity,CHW,andhealth
systemperspectives.Therolegenerallyincludesadescriptionofhowthejob
contributestotheprogram;clearexpectationsthatdefineactionsandbehaviors
necessaryfortheCHWtobesuccessful;andtasksthataremeasurableactivities
thattheCHWperformswhenprovidingservices.

3.

InitialTraining

TrainingisprovidedtotheCHWtoprepareforhis/herroleinservicedelivery
andensures/hehasthenecessaryskillstoprovidesafe,effectivequalitycare.

4.

ContinuingTraining

OngoingtrainingisprovidedtoupdateCHWsonnewskills,toreinforceinitial
training,andtoensurepracticingskillslearned.

5.

EquipmentandSupplies

Therequisiteequipmentandsuppliesareavailablewhenneededto
deliverexpectedservices.

6.

Supervision

Supportivesupervisioniscarriedoutregularlytoprovidefeedback,coaching,
problemsolving,skilldevelopment,anddatareview.

7.

IndividualPerformance
Evaluation

Evaluationisconductedtofairlyassessworkduringasetperiodoftime.

8.

Incentives

Abalancedincentivepackageincludesfinancialincentivessuchassalaryand
bonusesandnonfinancialincentivessuchastraining,recognition,certification,
uniforms,medicines,etc.appropriatetojobexpectations.

I5

9.

CommunityInvolvement Therolethatthecommunityplaysinsupporting(supervising,offeringincentives,
providingfeedback)aCHW.

10. ReferralSystem

Aprocessfordeterminingwhenareferralisneeded,alogisticsplanisinplace
fortransportandfundswhenrequired,andaprocesstotrackanddocument
referrals.

11. Opportunityfor
Advancement

ThepossibilityforgrowthandadvancementforCHWs,includingcertification,
increasedresponsibilitiesandapathtotheformalsectororchangeinrole.

12. Documentationand
Information
Management

HowCHWsdocumentvisits,howdataflowstothehealthsystemandbacktothe
community,andhowitisusedforserviceimprovement.

13. LinkagestoHealth
Systems

HowtheCHWsandcommunitiesarelinkedtothelargerhealthsystemthrough
involvementinrecruitment,training,incentives,supervision,evaluation,
equipmentandsupplies,useofdata,andreferrals.

14. ProgramPerformance
Evaluation

Generalprogramevaluationofperformanceagainsttargets,overallprogram
objectives,andindicatorscarriedoutonaregularbasis.

15. CountryOwnership

Theextenttowhichtheministryofhealthhaspoliciesinplacethatintegrateand
includeCHWsinhealthsystemplanningandbudgetingandprovideslogistical
supporttosustaindistrict,regionaland/ornationalCHWprograms.

ScoringofProgrammaticComponents
Foreachofthe15componentslistedabove,fourlevelsoffunctionalityaredescribedrangingfromnonfunctional
(level1)tohighlyfunctionalasdefinedbysuggestedbestpractices(level4).

LevelofFunctionality

Nonfunctional

Partiallyfunctional

Functional

Highlyfunctional

TheselevelsdescribesituationscommonlyseeninCHWprogramsandprovideenoughdetailtoallowstakeholders
toidentifywheretheirprogramsfallwithinthatrange.Level4,highlyfunctional,providesthecurrently
acceptedbestpracticeforeachcomponent.Resourcesandtoolstoaidimplementersinachievingahigherlevelof
functionalityareprovidedaspartofthisinstrument.

I6

C. CHWAIMProcessSteps

I7

D.UsingtheToolkit
Thetoolkitcontainsthetoolsanddocumentstoguidetheassessmentandactionplanningprocess.Itisavailable
inhardcopyandonthewebtoassistprintingoftheformsneededfordatacollection,scoringandactionplanning.
Itisdividedintosixsections.
ToolKitSectionsandContents
SectionI

Introduction

ProvidesanoverviewoftheCHWAIMprocess,thefunctionalitymodel
andthefourstepstoprepare,plan,implementandfollowupaCHWAIM
programassessmentaswellasguidanceonthecontentsofthetoolkit.

SectionII

CHWProgram
FunctionalityMatrix

IncludestheassessmenttoolusedtoreviewaCHWprogramagainst15
evidencebasedbestpracticesthatdefinehighlyfunctionalprograms.
Eachofthe15componentsissubdividedintofourlevelsoffunctionality
toenableprogramstomatchtheircurrentstatusagainstacontinuumof
responsestoguidetheirassessment.

SectionIII

Intervention
Matrices

IncludestheservicedeliveryinterventionsinthreekeyCHWprogram
areas:Maternal,NewbornandChildHealth(MNCH);HIVandAIDS;and
Tuberculosis(TB).

SectionIV

FacilitatorsGuide

ExplainsthestepsnecessarytoprepareforandimplementaCHW
programfunctionalityassessment,usetheassessmenttools,guideaction
planningandprovidefollowupsupport.

SectionV

References

ListsthepublicationsandresourcesusedinthedevelopmentoftheCHW
AIMToolkit.

SectionVI

Appendices

Includesthetoolsneededtoassistparticipantselectionforthe
assessmentworkshop,gatherdocumentationaboutcurrentpractices,
documentandscoretheirassessment,andcreatearesponsiveaction
planaswellasaresourcesectionforfurtherguidanceoneffective
interventions.

I8

SectionII.

CHWProgramFunctionality
Matrix
Thissectionincludestheassessmenttoolusedto
reviewaCHWprogramagainst15evidencebasedbest
practicesthatdefinehighlyfunctionalprograms.Each
ofthe15componentsissubdividedintofourlevelsof
functionalitytoenableprogramstomatchtheir
currentstatusagainstacontinuumofresponsesto
guidetheirassessment.Thistoolcontributestothe
overallfunctionalityscore.
Copiesofthisassessmenttoolshouldbeprintedforall
participantsintheassessmentworkshop.Insome
settings,translationofthetoolmayalsobeneeded.

SectionII.CHWProgramFunctionalityMatrix
LevelofFunctionality:1=nonfunctional2=partiallyfunctional3=functional4=highlyfunctional

1.Recruitment:Howandfromwhereacommunityhealthworker(CHW)isidentified,selected,andassignedtoacommunity,
includingselectioncriteria

Resources:CHWrecruitmentguidelines
1

4(bestpractice)

InCHWrecruitment:

InCHWrecruitment:

InCHWrecruitment:

CHWisnotfromcommunity

CHWisnotfromcommunity

Communityplaysnorolein
recruitment

Communityonlyapprovesof
finalselection

CHWisfromcommunity(except CHWisfromcommunity(except
inspecialcircumstances)!
inspecialcircumstances)

Noorfewselectioncriteriain
place,wellknownorcommonly
applied

Someselectioncriteria(literacy,
gender,maritalstatus,local
Mostselectioncriteria(literacy,
gender,maritalstatus,local
residence)inplaceandaremet
residence)inplaceandaremet
whenpossible
whenpossible

Communityparticipatesinthe
finalselection

InCHWrecruitment:

Communityparticipatesin
entirerecruitmentprocess
Allselectioncriterialiteracy,
gender,maritalstatus,local
residenceexistandaremet

Alleffortsshouldbemadetorecruitfromthecommunity.SpecialcircumstancesincludecasesinwhichhavingCHWsfromoutsidethecommunity
respondstocommunitydemandtoensureclientprivacyorforotherreasons.

II1

2.CHWRole(Alignment,designandclarityofrolefromcommunity,CHW,andhealthsystemperspectives):Aroleisageneral
descriptionofhowthejobcontributestotheprogram;clearexpectationsthatdefineactionsandbehaviorsnecessaryforthe
CHWtobesuccessful;andtasksthataremeasurableactivitiesthattheCHWperformswhenprovidingservices
Resources:CHWjobdescriptionortermsofreference,organizationalorgovernmentCHWpolicyand/orguidelines
1
TheCHWrole:

2
TheCHWrole:

Isnotdefinedordocumented Isnotdefinedordocumented

Isnotclearoragreedamong
CHW,community,andformal
healthsystem

4(bestpractice)

TheCHWrole:

TheCHWrole:

Isclearlydefinedand
documented,butcommunity
andotherstakeholdersplayed
nopartindefiningtherole

Isclearlydefinedand
documentedbyallstakeholders

Hasgeneralexpectations(e.g.
workingtime)andtasks(e.g.
Issupportedbygovernment
and/ororganizationalpolicies
nutritioncounseling)butnot
specificexpectations(e.g.
Hasgeneralexpectations(e.g.
Hasspecificexpectations(e.g.
workingtime)andtasks(e.g.
services,visits,tasks/servicesper
workload,clientload,timeper
nutritioncounseling)butnot
visit)
patient,maximumdistanceand
specificexpectations(e.g.
Isnotalwaysagreed/accepted
roleofcommunity)andtasks

services,visits,tasks/servicesper
amongCHW,communityand
(e.g.weighingchildrenfor
visit)
formalhealthsystem
nutritionguidance,providing
foodsupplementsforHBC
Isagreedandunderstoodby
CHW,communityandgeneral
clients)
healthsystem;occasional
Isagreedandunderstoodby
demandsaremadeonCHWthat
CHW,communityandgeneral
he/shecannotmeet
healthsystem
Ensuresfullservicecoverage
throughreferral
Isdiscussedandupdated
througharoutineprocess

II2

3.InitialTraining:TrainingisprovidedtoCHWtoprepareforhis/herroleinservicedeliveryandensures/hehasthenecessary
skillstoprovidesafe,effectivequalitycare

Resources:Trainingplansand/orguidelines,trainingcurricula,trainingdatabasesorrecords
1

4(bestpractice)

Initialtraining:

Initialtraining:

Isnotdoneorminimal

IsprovidedtoallCHWswithinsix IsprovidedtoallCHWswithinsix IsprovidedtoallCHWswithinsix

monthsofrecruitment
monthsofrecruitment
monthsofrecruitment

Initialtraining:

Doesnotfollow
national/internationalguidelines Doesnotmeet
Meetsnational/international
national/internationalguidelines
guidelinesforcontentand
forcontentorduration
forcontentorduration
duration
Isnottimely;CHWsarenot
1
enrolledintrainingwithinsix
Doesnotincludeonthejob
Includes:coreCHWtopics ,
trainingorpracticums
appropriatetechnicalcontent,
monthsofjoining
referrals,documentation,and
Doesnotincludecommunityor
hasapracticumcomponent
governmenthealthservice
participation
Doesnotincludecommunityor
governmenthealthservice

participation

Initialtraining:

Meetsnational/international
guidelinesforcontentand
duration
1
Includes:coreCHWtopics ,
appropriatetechnicalcontent,
referrals,documentation,and
gendersensitivityandhasa
practicumcomponent

Includesgovernmenthealth
serviceandcommunity
participation

CoretrainingforCHWs:abilitytoaccessresources,coordinationofservices,crisismanagement,leadership,organizationalskills,intrapersonal
communicationskills,confidentiality(source:GlobalExperienceofCommunityHealthWorkersforDeliveryofHealthRelatedMillennium
DevelopmentGoals:ASystematicReviewandRecommendationsforScalingUp,GlobalHealthWorkforceAlliance,2010).

II3

4.ContinuousTraining:OngoingtrainingisprovidedtoupdateCHWsonnewskills,toreinforceinitialtraining,andtoensure
practicingskillslearned
Resources:Trainingplansand/orguidelines,trainingcurricula,trainingdatabasesorrecords
1

TheCHWprogram:

TheCHWprogram:

TheCHWprogram:

4(bestpractice)
TheCHWprogram:

Providesnocontinuoustraining

Providesirregularcontinuous
Providescontinuoustrainingat Providescontinuoustrainingat
training;lessfrequentlythan
leastevery12months,forall
leastevery6monthsforall
Conductsoccasional,adhocvisits
every12months
CHWs
CHWs
bysupervisorswithsome
coaching
EnablesCHWstoparticipatein
Hasatrainingplan,buttracking Hasatrainingplanandroutinely
occasionalworkshopsonspecific
ofwhichCHWshavebeen
tracksCHWstrained
verticalhealthtopics
trainedisweak
Adherestonationalor
internationalguidelineswhere
Hasnotrainingplananddoes
Doesnotinvolvegovernment
nottrackwhichCHWshave
healthsystemorfacilitiesin
possible
attendedtraining
training
Offersopportunitiesina

consistentandfairmannertoall
CHWs
Involvesgovernmenthealth
systemand/orfacilitiesin
training
Hashealthworkersparticipatein
trainingand/orconducttraining
athealthcenter

II4

5.EquipmentandSupplies(includingjobaids):Requisiteequipmentandsuppliesareavailablewhenneededtodeliverthe
expectedservices

Resources:GuidelinesforCHWstocksandsupplies,supplyorderingproceduresandforms,inventoryformsandprocedures
1

TheCHWprogram:

TheCHWprogram:

TheCHWprogram:

TheCHWprogram:

Providesnoorincomplete,
equipment,supplies,orjobaids

Providesequipment,supplies,
andjobaids

Providesequipment,supplies,
andjobaids

Providesequipment,supplies,
andjobaids

IsunabletosupportdefinedCHW Experiencesregularstockoutsof Experiencessomestockouts;

tasksduetoinconsistentsupply
essentialsupplies(2times/
suppliesregularlyorderedand
year)thatlastmorethanone
available.Takesintoaccount

month
CHWneedswhenordering
supplies
Hasnoregularprocessfor
orderingsupplies(CHWsorder
Doesnotregularlyverify
expirationdates,quality,and
whentheyrunout)
inventory

4(bestpractice)

Experiencesnosubstantialstock
outs
TakesintoaccountCHWneeds
whenorderingsupplies
Regularlyverifiesexpiration
dates,quality,andinventoryof
allequipmentandsupplies

II5

6.Supervision:Supportivesupervisioniscarriedoutregularlytoprovidefeedback,coaching,problemsolving,skill
development,anddatareview

Resources:Supervisionplansandguidelines,supervisorjobdescriptionsandqualifications,supervisionchecklistsorothertools,
supervisionreports,supervisiontrainingdocuments
1

4(bestpractice)

CHWsupervisors:

CHWsupervisors:

CHWsupervisors:

Conductsupervisionlessthan3
timesperyear

Conductsupervisionvisitsevery Conductsupervisionvisitsevery
3months
1to3months

Collectmainlyreportsordata
duringsupervision

Reviewreports,collect
monitoringdata,andprovide
problemsolvingsupportduring
supervisionvisits

Donotexistorprovideno
regularsupervision

Arenottrainedinsupportive
supervision
Havenotbeenassignedand
introducedtospecificCHWsor
communities
Donotprovideindividual
performancesupport(problem
solving,coaching)

Aretrainedinsupportive
supervision
ArewellknowntoCHWsand
communities
Haveandusebasicsupervision
tools(checklists)
Consistentlymeetwiththe
community
Usedata/informationfor
problemsolvingandcoaching
duringsupervisionmeetings

CHW Supervisors:

Reviewreports,collect
monitoringdata,observeservice
deliveryandprovideproblem
solvingsupportduring
supervisionvisits
Aretrainedinsupportive
supervision,andconducting
servicedeliveryobservations
ArewellknowntoCHWsand
communities
Haveandusebasicsupervision
tools(checklists)
Consistentlymeetwiththe
communityandmakehome
visitswiththeCHWorprovide
onthejobskillbuilding
Usedata/informationfor
problemsolvingandcoaching
duringsupervisionmeetings
II6

7.IndividualPerformanceEvaluation:Evaluationisconductedtofairlyassessworkduringasetperiodoftime
Resources:Performanceevaluationguidelinesandtools,completedperformanceevaluationforms
1

4(bestpractice)

AstructuredCHWindividual
performanceevaluation:

AstructuredCHWindividual
performanceevaluation:

AstructuredCHWindividual
performanceevaluation:

AstructuredCHWindividual
performanceevaluation:

Isconductedonceayear

Isconductedonceayearandis
documented

Isconductedonceayearandis
documented

Isbasedonindividual
performance

Isbasedonindividual
performance

Includesevaluationsofservice
deliveryandcoverageor
monitoringdata(national/
programevaluation)

Includesevaluationsofservice
deliveryandcoverageor
monitoringdata(national/
programevaluation)

Doesnotexistorisnotdone

Isnotbasedonindividual
performance

Includesevaluationofonly
coverageormonitoringdata
Doesnotrewardgood
performance

Includescommunityfeedbackon Includescommunityfeedbackon
CHWperformance
CHWperformance
Providessomerewardsforgood Givesestablishedrewardsfor
performance,buttheyaread
goodperformanceand
hocandinconsistent
communityplaysarolein
providingrewards

II7

8.Incentives:Financial:Abalancedincentivepackageincludesfinancialincentivessuchassalaryandbonusesandnonfinancial
incentivessuchastraining,recognition,certification,uniforms,medicines,etc.appropriatetojobexpectations

Resources:ProgramguidelinesforIncentives,recordsofincentivepayments(asappropriate)
1

TheCHWprogram:

TheCHWprogram:

Iscompletelyvolunteer:no
financialornonfinancial
incentivesareprovided

Providesnofinancialornon
Providessomelimitedfinancial
financialincentives;but
incentivessuchastransportto
communityrecognizesCHWand
training,butnosalaryorbonus
sometimesgivessmalltokens
Providessomenonfinancial
incentives

TheCHWprogram:

4(bestpractice)
TheCHWprogram:
Providesbothfinancialandnon
financialincentivesinlinewith
expectationsplacedonCHW
(e.g.,numberanddurationof
clientvisits,workload,and
servicesprovided)

HasCHWsthataremotivated
Linksincentivestoperformance
and/orsupportedbythe
communitythroughrewards(e.g. Ensurescommunityoffersgifts
orrewards
labor,farming,formal
recognitionatevents)

II8

9.CommunityInvolvement:Therolethatcommunityplaysinsupporting(supervising,offeringincentives,providingfeedback)
aCHW

Resources:Communityagreements,guidelinesforcommunityinvolvement,supervisionreportsdetailingcommunityfeedback
1

3
Thecommunity:

4(bestpractice)

Thecommunity:

Thecommunity:

Sometimescollaborateswith
Playsasignificantrolein
Playsanactiverolesupporting
CHWsoncampaignsoreducation
supportingtheCHWby
CHWsinallareas:e.g.
discussingroleorobjectivesand
developingrole,providing
Hassomepeoplewhoseek
providingregularfeedbackto
feedback,solvingproblems,and
servicesfromtheCHW
theCHWandsupervisors
providingincentives

Playsnoroleinsupporting
CHWs

Thecommunity:

Widelyrecognizesand
appreciatestheCHW

HelpstoestablishCHWasa
leaderincommunity

Haslittleornointeractionwith
supervisor

Widelyrecognizesand
appreciatestheCHW
Hasleaderswhoregularly
discusshealthissueswiththe
CHWusingdata
Interactswithsupervisorsduring
visits,providesfeedbackonCHW
performance,helpsproblem
solve

II9

10.ReferralSystem:Aprocessfordeterminingwhenareferralisneeded,alogisticsplanisinplacefortransportandfunds
whenrequired,andaprocesstotrackanddocumentreferrals

Resources:Referralguidelines,referralforms,emergencyreferralorlogisticsplans(maybepartofguidelines),recordsand/or
reportsonreferral
1

4(bestpractice)

Thereferralsystem:

Thereferralsystem:

Isnotinplaceorisinactive

IsadhocwithCHWsknowing

whenandwheretoreferclients,
butnoformalreferralguidelines,
process,logisticsorforms

IsinplacewithCHWsknowing
whenandwheretoreferclients
basedonestablishedguidelines

IsinplacewithCHWsknowing
whenandwheretoreferclients
basedonestablishedguidelines

Isfacilitatedbymoderately

reliabletransportand/oraccess
toreferralfacilities

Isfacilitatedbyveryreliable
transportand/oraccesstoall
referralfacilities

Hasatrackingandlogistics

system:clientsarereferredwith
awrittenslip,referralsare
informallytrackedbyCHWs
(verbalfollowup)

Islimitedbynoorinconsistent
feedbackfromreferral
sites/providerstoCHWs

Includesalogisticsplanfor
emergenciesthataccountsfor
transportandfundsandhas
demonstratedeffectiveness

Thereferralsystem:

Thereferralsystem:

Includesarobusttracking
systemwithstandardized
forms,recordingandreporting
Ensuresthatinformationon
referralservicesflowsbackto
theCHWwithareturned
referralform

II10

11.OpportunityforAdvancement:ThepossibilityforgrowthandadvancementforCHWs,includingcertification,increased
responsibilities,andapathtoformalsectororchangeinrole

Resources:HRpolicydocuments,guidelinesandcriteriaforadvancement,performanceevaluationdocuments
1

TheCHWprogram:

TheCHWprogram:

TheCHWprogram:

Offersnoopportunitiesfor
advancement

Offersoccasionaladvancement
opportunitiestoCHWswhohave
beenintheprogramfora
specificlengthoftime

Doesnotrelateadvancementto
performanceorachievement

OffersadvancementtoCHWs
whohavebeenintheprogram
foraspecificlengthoftime
Provideslimitedtraining
opportunitiestoCHWstolearn
newskillstoadvanceroles

4(bestpractice)
TheCHWprogram:
OffersadvancementtoCHWs
whoperformwellandwho
expressaninterestin
advancement

Routinelyprovidestraining
opportunitiestohelpCHWs
learnnewskillsandadvance
ProvidesadvancementtoCHWs
theirroles
forgoodperformance,but
evaluationofperformanceor
Hasaclear,transparentandfair
systemtoassessCHW
achievementisnotalways
performanceandachievement
consistent,clearortransparent
foradvancementpurposes

II11

12.DocumentationandInformationManagement:HowCHWsdocumentvisits,howdataflowstothehealthsystemand
backtothecommunity,andhowitisusedforserviceimprovement

Resources:CHWnotebooksorrecordingformats,reportingformats,recordkeepingstandardsorguidelines
1

4(bestpractice)

TheCHWprogram:

TheCHWprogram:

TheCHWprogram:

HasCHWsrecordvisitsin
notebooks,butthereareno
standardizedformats

Doesnotdiscussqualityof
monitoringformsorhave
routinediscussionswithCHWs
orsupervisorsaboutdata

HasCHWsdocumenttheirvisits HasCHWsdocumenttheirvisits
andprovidedataonstandardized
andprovidedataonstandardized
formats
formatsandthisisconsistently
donetoahighstandard
Ensuressupervisorsmonitorthe
qualityofdocuments,discuss
Ensuressupervisorsmonitor
qualityofdocuments,discuss
themwithCHWsandprovide
themwithCHWs,andprovide
helpwhenneeded
helpwhenneeded
DoesnotprovideCHWsand
communitieswithdata
ProvidesCHWsandcommunities
withdatasummaries
summaries

DoesnotinvolveCHWsindata
basedproblemsolvinginthe
community

DoesnotinvolveCHWsindata
basedproblemsolvinginthe
community

Hasnodocumentation
processesorhasinformal
processesthatarefollowed
inconsistently

HasCHWsthatsometimes
reviewtheirrecordswithhealth
facilitystaff

TheCHWprogram:

InvolvesCHWsindatabased
problemsolvinginthe
community

II12

13.LinkagestoHealthSystem:HowtheCHWsandcommunitiesarelinkedtothelargerhealthsystemthroughinvolvementin
recruitment,training,incentives,supervision,evaluation,equipmentandsupplies,useofdata,andreferrals
Note:Healthsystemismadeupofgovernment,regions,districts,municipalities,andindividualhealthfacilitiesthatprovideresources,finances,and
managementtodeliverhealthservicestothepopulation.

Resources:NationalCHWprogramguidelines,nationaltrainingguidelines,nationalreferralforms,nationalsupervision
guidelines
1

TheCHWprogram:

TheCHWprogram:

Isnotlinkedtothehealthsystem Isrecognizedbythehealth
orlinksareweak
system,butthehealthsystem
provideslittleornosupport

Example:Policiesexistthatdescribe
CHWroleandoccasional(yearly)
monitoringvisitsoccurfromMOH

3
TheCHWprogram:

4(bestpractice)
TheCHWprogram:

Issupportedbythehealth
Isprovidedcomprehensive
systemthroughparticipationin,
supportbythehealthsystem
provisionof,orjointmonitoring
throughitsconsistent
ofatleastsomeofthe
participationin,provisionofand
following:
jointmonitoringof:
o

Training,supervision,
referral,equipmentand
supplies,incentives,CHW
performanceassessment,
advancementopportunities,
reporting,anduseand
sharingofdata

Sharesdatawiththehealth
system

Training,supervision,referral,
equipmentandsupplies,
incentives,CHWperformance
assessment,advancement
opportunities,reporting,and
useandsharingofdata

Sharesdatawiththehealth
system
Hasconsistentandrelatively
smoothcoordinationwiththe
healthsystem

II13

14.ProgramPerformanceEvaluation:Generalprogramevaluationofperformanceagainsttargets,overallprogram
objectives,andindicatorscarriedoutonaregularbasis

Resources:Programperformanceevaluationguidelines,programindicators,reports
1

4(bestpractice)

CHWprogramperformance
evaluation:

CHWprogramperformance
evaluation:

CHWprogramperformance
evaluation:

CHWprogramperformance
evaluation:

Isnotdoneorisnotconducted
onaregularbasis

Isconductedyearlyandcovers
CHWactivities

Isconductedyearlyandcovers
CHWactivities

Isconductedyearlyandcovers
CHWactivities

DoesnotassessCHW
achievementsagainstprogram
indicatorsandoutcomes

AssessesCHWachievements
againstprogramindicatorsand
outcomes

AssessesCHWachievements
againstprogramindicatorsand
outcomes

IsnotsummarizedandCHWsare Doesnotincludeevaluationof
Includesanevaluationofthe
notprovidedfeedbackonhow
thequalityofservicedelivery
qualityofservicedelivery
theprogramisperforming
providedbyCHWsandthe
providedbyCHWsandthe
againstexpectations
communityisnotaskedto
communityandhealthfacility
providefeedbackonCHW
staffareaskedtoprovide
ShowsthattheCHWprogramis
performance
feedbackonCHWperformance
realizinglessthan75%ofits
targets(uptoendofmostrecent IssummarizedandCHWsare
IssummarizedandCHWsare
providedfeedbackonhowthey
providedfeedbackonhowthey
quarter)
areperforming
areperforming

ShowsthattheCHWprogramis ShowsthattheCHWprogramis
realizingatleast75%ofits
realizingatleast75%ofits
targets(uptoendofmostrecent
targets(uptoendofmostrecent
quarter)
quarter)

II14

15.CountryOwnership:TheextenttowhichtheministryofhealthhaspoliciesinplacethatintegrateandincludeCHWsin
healthsystemplanningandbudgetingandprovideslogisticalsupporttosustaindistrict,regionaland/ornationalCHWprograms

Resources:NationalpoliciesonCHWs,nationalCHWsupervisionguidelines,trainingandbudgetrelatedtoCHWsandCHW
incentives
1
Thenationalhealthsystem:

2
Thenationalhealthsystem:

3
Thenationalhealthsystem:

DoesnotrecognizeCHWs

RecognizesCHWsashelpfulin
RecognizesCHWsaspartofthe
communitiesbutdoesnotassign
formalhealthsystemandhas
Doesnothaveplansoraprocess
aformalroletothem
policiesthatdefinetheirroles,
tocreateorsupportaCHWcadre
tasks,andrelationshiptohealth
ProvidesnosupporttoCHWs;

system
theyarefundedbyNGOsor
otherstakeholders
Providesminimalfinancial
supportforCHWsthroughlocal
Participatesinthesupervisionof
ordistrictbudgets
CHWsfundedbyNGOpartners
Participatesinsupervisionof

CHWsthroughdistricthealth

officesand/orfacilities

4(bestpractice)
Thenationalhealthsystem:
RecognizesCHWsaspartofthe
formalhealthsystemandhas
policiesthatdefinetheirroles,
tasks,andrelationshiptohealth
system
Providesadequatefinancial
supportforCHWs,including
incentives
SupervisesCHWsthroughdistrict
healthofficesand/orfacilities
EnsuresCHWsareadequately
suppliedthroughnationaland
localstores

II15

SectionIII.

InterventionMatrices
Thissectioncontainsservicedeliveryinterventionsin
threekeyCHWprogramareas:Maternal,Newborn
andChildHealth,HIVandAIDS,andTuberculosis.For
theassessment,useonlythematricesthatmatchthe
servicesthattheCHWsareexpectedtodeliver.The
InterventionMatricescanbereviewedwithall
workshopparticipantsorcanbecompletedby
programmanagerspriortotheworkshopand
validatedbytheworkshopgroup.Makeenoughcopies
ofthematrixoruseanoverheadprojectorforthe
participantstoreviewandindicateorvalidatewhich
activitiesarecurrentlyperformedbyCHWsinthe
programunderreview.Findingsfromthematrix
contributetotheoverallprogramfunctionalityscore.


SectionIII.InterventionMatrices
III.A.Instructions
Instructions:
1. Identifythetechnicalinterventionareas
Usetheinterventionsummarytableforeachtechnicalarea(MNCH,HIVandAIDS,andTB)toidentifythe
areasinwhichCHWsareactive.Thisisdonebysimplycheckingofftherelevantareainthelastcolumn.
Thiswillhelpthegroupsavetimesinceonlyrelevantareas,thoseinwhichCHWsareactive,aretobe
assessed.
2. CompletetheInterventionMatricesfortherelevantareas
Next,turntothedetailedinterventionmatrixforthetechnicalarea(s)(MNCH,HIVandAIDS,andTB)and
completetheformfortheservicesand/oractivitiesthataretobeassessedbasedonthesummarytable.
Tobefunctionalinasingleinterventionmatrix,anactivitymustbecomplete,meaningallactivitiesor
tasks,asappropriate,mustbemarkedcounsel,provide,refer,ornotapplicable;nonemaybe
markednotdone.
A. UsetheInterventionMatrixtocheckoffhowtheprogramaddresseseachapplicableactivity.
B. Thetablehasthreecomponents:Services,ActivitiesandTasks.
i.
ServicesarehighlightedinadarktintanddenotedbyRomannumerals;
ii.
Activitiesarehighlightedinalighttintanddenotedbyalowercaseletter;
iii.
Tasksareundertheactivity.Notethatnotallactivitieshavetasksassociatedwiththem.Some
activitieshaveassociatedtasksandotherslisttheactivityalone.Foraninterventiontobe
deemedcompleteatleastoneactivitymustbecompleted,meaningalltasksforthatactivity
areeithercounseledfor,provided,referredordone.Checktheappropriatedcolumn.
C. Incaseswhereonlyanactivityispresentorwheretasksarelistedundertheactivities,choose
whethertheroleoftheCHWistocounsel,provide,orrefer,orwhetherthetaskisnot
applicable,ornotdoneusingthefollowingdefinitions.
i.
Counsel:TheCHWprovideseducationorcounselingtoassisttheclient,group,orcommunity.
ii.
Provide:TheCHWdirectlyprovidestheservicetotheclientorgroup.
iii.
Refer:TheCHWreferstheclienttoanotherCHW,toaqualifiedproviderwithinthesame
facilityorprogram,toanotherprogram,ortoanotherfacilityfortheservice.
iv.
Notapplicable:Appliesonlywhen:

v.

Theinterventionisnotincludedintheprogramornationalguidelines/policies;
CHWsarenotpermittedtoprovidetheserviceortoreferclientsfortheservice,asitis
notpartofthetasksexpectedtobeperformedbytheCHW.
Notdone:TheCHWdoesnotconducttheactivity,whichsignalsitshouldbeinvestigated.
III1

D. Itisimportanttokeepinmindthatthissectionfocusesonwhetheractivitiesareconductedor
referralsmadeandnotontheirquality.
E. Notapplicable:SomeactivitiesandtaskshaveasectionmarkedwithNA(notapplicable).For
example,inthetaskNewborncarecounselingtheboxundercounselingismarkedNA.Insuch
cases,anothercolumnmustbechecked.
F. Checkoffcompleteinterventions:Intheinterventioncompletecolumn,placeacheckmark
ifallapplicabletasksareprovided,counseledfor,orreferred.Aprogrammusthaveatleastone
completeactivitytobefunctional.

III2

III.B.CHWMNCHInterventionSummaryTable

Maternal,Newborn,andChildHealthProgramInterventionMatrixOverview
Service

Activities

Service

Activities

Service

I.ANTENATALCARE

Anticipatorycounseling

Maternalnutrition

TetanusToxoid

Deworming

Malaria

II.CHILDBIRTHCARE

Cleandelivery/infectionprevention

Activemanagementofthethirdstageoflabor(AMTSL)forpreventionofpostpartum
hemorrhage(PPH)

Immediateessentialnewborncare

Maternalnewborncomplications

III.POSTPARTUM/POSTNATALCARE

Homevisit/contactwithmother/infantwithin23daysofbirth

Essentialnewborncare

Maternalnutritioncounseling

Specialcareforlowbirthweightinfant(Kangaroocare)

Activities

III3

Maternal,Newborn,andChildHealthProgramInterventionMatrixOverview

Service

Postpartumfamilyplanning

IV.CHILDNUTRITION

Infantandyoungchildfeeding(IYCF):counselingforimmediatebreastfeedingafter
birth;exclusivebreastfeedingfor6months;ageappropriatecomplementaryfoods

VitaminAsupplements(twiceannuallychildren659months)

Growthmonitoring

Communitybasedmanagementofacutemalnutrition(CMAM)usingreadytouse
therapeuticfoods

V.CHILDIMMUNIZATIONS

Mapping/trackingforimmunizationcoverage

Participationinimmunizationcampaigns

BaccilusCalmetteGuerinvaccinefortuberculosis(BCG)

Diphtheria,pertussis,andtetanus(DPT)

Polio

HaemophilusinfluenzaetypeBvaccine(HIB)

HepatitisB

Measles

Othervaccines(e.g.,Pneumococcal;Rotavirus,etc.)

Activities

Service

Activities

III4

Maternal,Newborn,andChildHealthProgramInterventionMatrixOverview
Service

Activities

Service

Activities

Service

Activities

VI.CHILDHOODILLNESS

Pneumonia

Diarrhea

Malaria

VII.PREVENTIONOFMOTHERTOCHILDTRANSMISSION(PMTCT)

Antibodytestingofpregnantwomenandmothers

Prophylacticantiretroviral(ARVs)/highlyactiveantiretroviraltherapy
(fortreatmentofHIV)(HAART)topregnantwomen/mothers

ProphylacticARVsforinfant

Earlyinfantdiagnosis

TrackingpregnantHIVinfectedwomen

TrackingHIVexposedinfants

VIII.PEDIATRICHIV

Cotrimoxazoleprophylaxis

HAART

Tracking,adherencesupport

III5

InterventionMatrix:Maternal,Newborn,andChildHealth

I.

Activity
Complete

COMMENTS

Notdone

Refer

Provide

Counsel

TobeconsideredafunctionalCHWwho
providesMNCHservices,theCHWstasks
mustincludeatleastonecompleteMNCH
activitylistedbelow.

Notapplicable

MATERNAL,NEWBORNandCHILD
HEALTHINTERVENTIONS

ANTENATALCARE

a. Anticipatorycounseling

Birthpreparedness/complication
readinesscounseling
(dangersigns;skilledbirth
attendant)

NA

Newborncarecounseling

NA

b. Maternalnutrition

Generalcounseling

NA

IronFolatesupplements

c. TetanusToxoid

d. Deworming

e. Malaria

Insecticidetreatednets

Intermittentpreventivetherapyfor
malariainpregnancy(IPTp)

III6

Activity
Complete

COMMENTS

Notdone

Refer

Provide

Counsel

TobeconsideredafunctionalCHWwho
providesMNCHservices,theCHWstasks
mustincludeatleastonecompleteMNCH
activitylistedbelow.

Notapplicable

MATERNAL,NEWBORNandCHILD
HEALTHINTERVENTIONS

II. CHILDBIRTHCARE

a. Cleandelivery/infectionprevention
(handwashing,cleanblade)

b. AMTSLforpreventionofPPH
(uterotonics,delayedcord
clamping/cutting,controlledcord
traction,uterinemassage)

c. Immediateessentialnewborncare

Immediatewarminganddrying

Cleancordcare

Earlyinitiationofbreastfeeding

d. Maternalnewborncomplications

Referralforobstructedlabor

NA

Newbornresuscitation

NA

Antibioticsforneonatalsepsis

NA

Lowbirthweight/premature
infantcare

NA

Antibioticsformaternalsepsis

NA

Referralforpreeclampsiacare

NA

III7

Stabilizeandreferformaternal
hemorrhage

Activity
Complete

COMMENTS

Notdone

Refer

Provide

Counsel

TobeconsideredafunctionalCHWwho
providesMNCHservices,theCHWstasks
mustincludeatleastonecompleteMNCH
activitylistedbelow.

Notapplicable

MATERNAL,NEWBORNandCHILD
HEALTHINTERVENTIONS

NA

III. POSTPARTUM/POSTNATALCARE
a. Homevisitation/contactwith
mother/infantwithin23daysof
birth

b. Essentialnewborncare

Cleancordcare

Exclusivebreastfeedingthrough6
months

Thermalprotection

Newbornimmunization

Newborneyecare

c. Maternalnutritioncounseling

NA

d. Specialcareforlowbirthweight
infant(Kangaroocare)

e. Postpartumfamilyplanning

Familyplanningcounseling

NA

Oralcontraceptives

III8

Activity
Complete

COMMENTS

Notdone

Refer

Provide

Counsel

TobeconsideredafunctionalCHWwho
providesMNCHservices,theCHWstasks
mustincludeatleastonecompleteMNCH
activitylistedbelow.

Notapplicable

MATERNAL,NEWBORNandCHILD
HEALTHINTERVENTIONS

Condoms

LAMeducation

NA

Injectables(DepoProvera,etc.)

Longactingandpermanentmethods
(IUD/tuballigation;implants)

IV. CHILDNUTRITION

a. IYCF:Counselingforimmediate
breastfeedingafterbirth;exclusive
breastfeedingfor6months;
ageappropriatecomplementary
foods

b. VitaminAsupplements(twice
annuallychildren659months)

c. Growthmonitoring

d. CMAMusingreadytouse
therapeuticfoods

V. CHILDIMMUNIZATIONS

a. Mapping/trackingforimmunization
coverage

b. Participationinimmunization
campaigns

c. BCG

III9

Activity
Complete

COMMENTS

Notdone

Refer

Provide

Counsel

TobeconsideredafunctionalCHWwho
providesMNCHservices,theCHWstasks
mustincludeatleastonecompleteMNCH
activitylistedbelow.

Notapplicable

MATERNAL,NEWBORNandCHILD
HEALTHINTERVENTIONS

d. DPT

e. Polio

f. HIB

g. HepatitisB

h. Measles

i.

Othervaccines
(e.g.,Pneumococcal;Rotavirus,etc.)

VI. CHILDHOODILLNESS

a. Pneumonia

Counseldangersigns,careseeking

NA

Assessandtreatwithantibiotics

NA

Referforantibiotics

NA NA

Referaftertreatingwithinitial
antibiotics

NA NA

b. Diarrhea

Hygienecounseling

NA

Pointofusewatertreatment

III10

Activity
Complete

COMMENTS

Notdone

Refer

Provide

Counsel

TobeconsideredafunctionalCHWwho
providesMNCHservices,theCHWstasks
mustincludeatleastonecompleteMNCH
activitylistedbelow.

Notapplicable

MATERNAL,NEWBORNandCHILD
HEALTHINTERVENTIONS

Oralrehydrationsalts(ORS)

Zinc

c. Malaria

Insecticidetreatednets

Counseldangersigns,careseeking

NA

Testingwithrapiddiagnostictest

Treatmentofmalariapernational
guidelines

VII. PMTCT

a. Antibodytestingpregnantwomen
andmothers

b. ProphylacticARVs/HAARTto
pregnantwomen/mothers

c. ProphylacticARVsforinfant

d. Earlyinfantdiagnosis

e. TrackingpregnantHIVinfected
women

f. TrackingHIVexposedinfants

III11

Activity
Complete

COMMENTS

Notdone

Refer

Provide

Counsel

TobeconsideredafunctionalCHWwho
providesMNCHservices,theCHWstasks
mustincludeatleastonecompleteMNCH
activitylistedbelow.

Notapplicable

MATERNAL,NEWBORNandCHILD
HEALTHINTERVENTIONS

VIII. PEDIATRICHIV

a. Cotrimoxazoleprophylaxis

b. HAART

c. Tracking,adherencesupport

III12

III.C. CHWHIVandAIDSInterventionSummaryTable

HIVandAIDSProgramInterventionMatrixOverview
Service

I.HIVPrevention

Educationandhealthpromotioncampaign

Counselingandtesting

Activities

PreventionofmothertochildtransmissionofHIV(PMTCT)

SexuallyTransmittedInfection(STI)screening,diagnosisandsyndromictreatment

Malecircumcision(MC)

Service

II.HIVCare

Adultfacilitysupportedandhomebasedcare

Activities
PediatricHIVcare

Service

III.HIVTreatment

AdultHIVtreatmentandadherencecounseling
Activities
PediatricHIVtreatmentandadherencecounseling

Service

Activities

IV.HIVSupport

Peersupportgroupandfollowup

III13

HIVandAIDSProgramInterventionMatrixOverview
Mentalhealth

Psychosocialandspiritualsupport

Stigmaanddiscrimination

Service

V.OrphansandVulnerableChildren(OVC)

Communityawarenessandsupporteducation

Caregiver/familysupport

Healthandnutritionaleducationandsupport
Activities
Educationalcounseling,support,andschoolplacement

Humanrightsandlegalissuesfororphansandvulnerablechildren

Incomegeneratingandothereconomiccapacitybuilding

III14

I.

HIVPrevention

a. Educationandhealthpromotioncampaign

EducationalandmassHIVand
AIDSawarenessevents

Activity
Complete

COMMENTS

Notdone

Refer

Provide

Counsel

HIVandAIDSINTERVENTIONS
TobeconsideredafunctionalCHWwho
providesHIVandAIDSservices,the
CHWstasksmustincludeatleastone
completeHIVandAIDSactivitylisted
below.

Notapplicable

InterventionMatrix:HIVandAIDS

NA

Communitymobilizationactivities NA
andcampaigns

Condompromotionand
counseling

NA

b. CounselingandTesting

Pretestandposttestcounseling NA

Couplecounselingincluding
NA
counselingfordiscordantcouples

Rapidtestingwithsameday
resultsinterpretation

Riskreductioncounseling

NA

Preventionwithpositives
counseling

NA

Stigmaanddiscrimination
counseling

NA

Counselingongenderrelated
issues

NA

Counselingonintravenousdrug
user(IDU)andharmreduction

NA

III15

Activity
Complete

COMMENTS

Notdone

Notapplicable

Refer

Provide

Counsel

HIVandAIDSINTERVENTIONS
TobeconsideredafunctionalCHWwho
providesHIVandAIDSservices,the
CHWstasksmustincludeatleastone
completeHIVandAIDSactivitylisted
below.
issuesspecificallyrelatedtomost
atriskpopulations(MARPs)
(whereMARPsareincludedasa
targetpopulation)
Condomusecounseling

NA

Condomprovision

Referforotherservicesas
required

NA NA

c. PreventionofMothertoChildHIVTransmission

Pretestandposttestcounseling

NA

Couplecounselingincluding
NA
counselingfordiscordantcouples

Rapidtestingwithsameday
resultsinterpretation

Riskreductioncounseling

NA

Preventionwithpositives
counseling

NA

Counselingongenderrelated
issues

NA

Stigmaanddiscrimination
counseling

NA

AntenatalcareforHIVpositive
mother

Prophylacticantiretroviraltherapy
formotherandchildforPMTCT

Facilitatinglaboranddeliverycare

III16

Activity
Complete

COMMENTS

Notdone

Notapplicable

Refer

Provide

Counsel

HIVandAIDSINTERVENTIONS
TobeconsideredafunctionalCHWwho
providesHIVandAIDSservices,the
CHWstasksmustincludeatleastone
completeHIVandAIDSactivitylisted
below.
ofHIVpositivemothers
Postnatalandnewborncarefor
HIVexposedchildren

Familyplanningservices

Counselingonsafersexandon
NA
partnerandchildrensHIVtesting

Referralforotherservicesand
NA NA
followupofHIVinfectedmothers
andinfants

d. STIScreening,DiagnosisandSyndromicTreatment

ScreeningforsymptomsofSTI

DiagnosisofsimpleSTIsusingthe
syndromicapproach

SyndromictreatmentofSTIs

Contacttracingforpartners

Condomusecounselingand
provision

NA

Referralforotherservicesand
followup

NA NA

e. MaleCircumcision

Sexualandreproductivehealth
counseling

NA

Presurgicalcounseling

NA

Counselingonsexualandnon
sexualHIVtransmission

NA

III17

Activity
Complete

COMMENTS

Notdone

Notapplicable

Refer

Provide

Counsel

HIVandAIDSINTERVENTIONS
TobeconsideredafunctionalCHWwho
providesHIVandAIDSservices,the
CHWstasksmustincludeatleastone
completeHIVandAIDSactivitylisted
below.
Counselingonthelimitationsof
circumcisioninHIVprevention

NA

Postsurgicalcounseling

NA

II. HIVCare
a. AdultFacilitysupportedandHomebasedCare

Healthylivingcounseling

NA

Assessmentofnutritionaland
othercareandtreatmentneeds
(functionalstatus)

NA

Nutritionalcounselingforpatient
andcaregivers

NA

Nutritionalsupport(including
provisionofnutritional
commodities)

Counselingforuseofsafedrinking NA
waterandsanitation

Basicopportunisticinfection

prophylaxisandmanagement
including:Cotrimoxazole
prophylaxisforaformof
pneumoniacausedbyayeastlike
fungus(PCP),bacterialinfections,
etc.),Tuberculosis,Toxoplasmosis,
fungalinfections

Malariascreening,prophylaxis,
andtreatment

Counselingandreferralforcervical NA
and/oranalcancerscreening

III18

Basicpalliativeandendoflifecare

Chronicpainmanagement

Trackingandhomevisitsfor
treatmentdefaulters

TBcasedetection

b. PediatricHIVCare

Healthylivingcounseling

Activity
Complete

COMMENTS

Notdone

Notapplicable

Refer

Provide

Counsel

HIVandAIDSINTERVENTIONS
TobeconsideredafunctionalCHWwho
providesHIVandAIDSservices,the
CHWstasksmustincludeatleastone
completeHIVandAIDSactivitylisted
below.

NA

Infantfeedingcounselingand
support

NA

Growthmonitoring

Assessmentofnutritionalstatus
andcareandtreatmentneeds
(functionalstatus)

Nutritionalsupport(including
provisionofnutritional
commodities)

Nutritionalcounselingforpatient
andcaregivers

NA

Counselingforuseofsafedrinking NA
waterandsanitation

Identificationandtreatmentfor
acuteorchronicmalnutrition

UniversalCotrimoxazole
prophylaxisasindicated

ImmunizationforHIVexposedand
infectedchildren

III19

Counselingandtestingofother
siblingsinthesamefamily

NA

Trackingandhomevisitsfor
treatmentdefaulters

NA

TBcasedetection

Activity
Complete

COMMENTS

Notdone

Notapplicable

Refer

Provide

Counsel

HIVandAIDSINTERVENTIONS
TobeconsideredafunctionalCHWwho
providesHIVandAIDSservices,the
CHWstasksmustincludeatleastone
completeHIVandAIDSactivitylisted
below.

III. HIVTreatment
a. AdultHIVTreatmentandAdherenceSupport

Assessmentofcareandtreatment
needs,includingpsychologicaland
supportneeds(functionalstatus)

Treatmentpreparation

HIVdrugadherencecounseling
andmonitoring

NA

Treatmentbuddy/partner
counseling

NA

Drugdispensinganddosing
counseling

NA

NA

Directlyobservedtreatment(DOT)
forhighlyactiveantiretroviral
therapy(fortreatmentofHIV)
(DOTHAART)withDOTforTB
Basicsideeffectscounselingand
management

b. PediatricHIVTreatmentandAdherenceSupport

Assessmentofcareandtreatment NA
needs,includingpsychologicaland
supportneeds(functionalstatus)

III20

Activity
Complete

COMMENTS

Notdone

Notapplicable

Refer

Provide

Counsel

HIVandAIDSINTERVENTIONS
TobeconsideredafunctionalCHWwho
providesHIVandAIDSservices,the
CHWstasksmustincludeatleastone
completeHIVandAIDSactivitylisted
below.
Treatmentpreparationsessions

Counselingofprimaryand
secondarytreatmentguardian

NA

HIVdrugadherencecounseling
andmonitoring

NA

Drugdispensinganddosing
counseling

NA

DOTHAARTwithDOTforTB

Basicsideeffectscounselingand
management

NA

IV. HIVSupport
a. PeerSupportGroups

Manageandleadsupportgroups NA

Addresskeyissuesinsupport
groupsincludinggenderissues,
genderbasedviolence(GBV),
caregiverneeds,MARPspecific
issues,andyouthneedsas
appropriateandrequired

NA

Educationalandmedical
informationmaterialsthrough
supportgroups

NA

Demonstrationsonproper
hygiene,storingandusingsafe
drinkingwater,nutritionand
healthydiets,andrecipes

NA

III21

Activity
Complete

COMMENTS

Notdone

Notapplicable

Refer

Provide

Counsel

HIVandAIDSINTERVENTIONS
TobeconsideredafunctionalCHWwho
providesHIVandAIDSservices,the
CHWstasksmustincludeatleastone
completeHIVandAIDSactivitylisted
below.
b. MentalHealthIssuesinHIV

Counselingandsupportforalcohol NA
andsubstanceuseaddiction

Counselingandsupportforfear,
anxiety,anddepression

NA

Counselingandsupportforpost
traumaticstressdisorder

NA

Counselingandsupportforsuicidal NA
ideationandisolation

c. PsychosocialandSpiritualSupport

CounselingforHIVdisclosureand
discriminationissues

NA

Endoflifediscussionsand
planning

Relevantreligious/spiritual
counselingandsupport

NA

d. StigmaandDiscrimination

Awarenessprogramstoreduce
stigmaanddiscrimination

NA

Communityleadermeetingsto
discussissuesrelatedtostigma
anddiscrimination

NA

Communityadvocacyandsupport NA
forpeoplelivingwithHIV(PLHA),
womenandmarginalizedgroups
toensureaccesstohealth
services,care,andtreatment

Counselingandlinkstoother

NA

III22

Activity
Complete

COMMENTS

Notdone

Notapplicable

Refer

Provide

Counsel

HIVandAIDSINTERVENTIONS
TobeconsideredafunctionalCHWwho
providesHIVandAIDSservices,the
CHWstasksmustincludeatleastone
completeHIVandAIDSactivitylisted
below.
services(suchaslegalservicesand
GBVsupport)toassistwithissues
relatedtostigmaand
discrimination.

Identificationofpatientsinneed NA
ofhumanrightsandlegalsupport

V. OrphansandVulnerableChildren
a. CommunityAwarenessandSupportEducation

Identificationoforphansand
vulnerablechildreninthe
community

NA

Promotionofinformationonand
awarenessofOVCissues

NA

b. Caregiver/FamilySupport

Assessmentoffamilyand
caregiversupportsystems

NA

Psychosocialsupportservicesfor
vulnerablechildren

Psychosocialsupportand
counselingservicesforcaregivers

c. HealthandNutritionalEducationandSupport

Healthandwellnesscounseling

NA

Nutritionalcounseling

NA

Foodavailabilityandaccessto
support

Referralsandlinkswithsocial

NA

III23

Activity
Complete

COMMENTS

Notdone

Notapplicable

Refer

Provide

Counsel

HIVandAIDSINTERVENTIONS
TobeconsideredafunctionalCHWwho
providesHIVandAIDSservices,the
CHWstasksmustincludeatleastone
completeHIVandAIDSactivitylisted
below.
welfareservicesinthecommunity

d. EducationalCounseling,SupportandSchoolPlacement

Counselingandassessmentof
educationalneeds

NA

Assistancewithreferralsforschool NA
placement

e. HumanRightsandLegalIssues

Assistancefororphansand
vulnerablechildreninneedof
humanrightssupport

Assistancefororphansand
vulnerablechildreninlegaland
inheritanceissues

f. IncomeGeneratingandotherEconomicCapacityBuilding

AssistanceforOVCfamiliesfor
socialandcommunitywelfare
support

Promotionofincomegenerating
ideasandactivitiesforOVC

III24

III.D. CHWTuberculosisInterventionSummaryTable

TuberculosisProgramInterventionMatrixOverview
Service

I.TBPREVENTION,ADVOCACY,COMMUNICATIONANDSOCIALMOBILIZATION(ACSM)

TBeducationandsensitization

TBsocialmobilizationandadvocacy

II.TBCASEDETECTIONANDFOLLOWUP

TBcasedetectionandfollowup

III.TBTREATMENTANDCARE

Directlyobservedtreatmentshortcourse(DOTS)

IV.TBHIVCoInfection

HIVtestingforTBclients

TBcasedetection,counselingandcareforHIVclients

DOTandDOTHAARTforTBHIV

V.DRUGRESISTANTTB

Identification,careandtreatmentfordrugresistantTB

VI.TBSUPPORTANDCROSSCUTTINGISSUES

MentalhealthissuesandTB

Generalhealthandnutritioneducationandsupport

Activities

Service

Activities
Service

Activities
Service

Activities

Service

Activities
Service

Activities

III25

TuberculosisInterventionMatrix

Notdone

Refer

Provide

Counsel

TobeconsideredafunctionalCHW
whoprovidesTBservices,theCHWs
tasksmustincludeatleastone
completeTBactivitylistedbelow.

Notapplicable

TUBERCULOSISINTERVENTIONS
Activity
Complete

COMMENTS

I. TBPREVENTION,ADVOCACY,COMMUNICATIONANDSOCIALMOBILIZATION
a. TBEducationandSensitization

Communitymobilizationactivities NA
andcampaigns

TBawarenessincludingfacts,
prevention,treatment,andcare

SpecificTBHIVandmostatrisk
populations(MARPS)education

Specificcommunity/facilitybased
educationaboutmultidrug
resistance(MDR)TB

NA

Education/sensitizationabout
stigmaanddiscriminationand
theireffects

b. TBSocialMobilizationandAdvocacy

Interactwithlocalhealthandcivic NA
leaderstostreamlineandimprove
TBprogramsorpolicy

Mobilizationofcommunity
membersforTBprogramand
policychange

NA

III26

Notdone

Refer

Provide

Counsel

TobeconsideredafunctionalCHW
whoprovidesTBservices,theCHWs
tasksmustincludeatleastone
completeTBactivitylistedbelow.

Notapplicable

TUBERCULOSISINTERVENTIONS
Activity
Complete

COMMENTS

II. TBCASEDETECTIONANDFOLLOWUP
a. TBcasedetectionandfollowup

CHWinitiatedidentificationand
referralofpresumedcasesfor
screeningforTB

NA

Contacttracing

NA

Trackingandhomevisitsfor
defaulters

NA

III. TBTREATMENTANDCARE
a. DOTS

TBtreatmentpreparationanddrug NA
adherencecounseling

DOTSprovisionaspernational
protocols

Assessmentofnutritionaland
othercareandtreatmentneeds
(functionalstatus)

Drugadherencemonitoring

NA

Treatmentbuddy/partner
counseling,includinguniversal
precautionsforprevention

NA

III27

Notdone

Refer

Provide

Counsel

TobeconsideredafunctionalCHW
whoprovidesTBservices,theCHWs
tasksmustincludeatleastone
completeTBactivitylistedbelow.

Notapplicable

TUBERCULOSISINTERVENTIONS
Activity
Complete

COMMENTS

Counselingforandmanagementof NA
sideeffects

Healthylivingcounseling,including NA
cessationofsmokingandproper
nutrition

Referforandmonitoringoffollow NA
updiagnosticsandassessment
includingTBcureassessment

IV. TBHIV
a. HIVtestingforallsuspectedTBcases

Pretestandposttestcounseling NA

Couplecounseling,including
NA
counselingfordiscordantcouples

Rapidtestingwithsameday
resultsinterpretation

Riskreductioncounselingand
preventionwithpositives
counseling

NA

Counselingonsmokingcessation NA
forTBHIV

b. TBcasedetection,counselingandcareforallHIVinfectedpersons

ReferralofallHIVclientsforTB
screening

NA

III28

CounselingonTBprevention

NA

Notdone

Refer

Provide

Counsel

TobeconsideredafunctionalCHW
whoprovidesTBservices,theCHWs
tasksmustincludeatleastone
completeTBactivitylistedbelow.

Notapplicable

TUBERCULOSISINTERVENTIONS

Monitoringtheadherencetoclinic NA
appointmentsandtheIPTdrug
regimenanddrugtoxicity

Isoniazidpreventivetherapy(IPT)
provision

c. DOTTBandDOTHAARTforTBHIV

TBHIVtreatmentpreparation
sessions

Activity
Complete

COMMENTS

NA

TBHIVdrugadherencecounseling NA
andmonitoring

DOTwithDOTHAARTprovision

Counselclientsonmanagementof NA
sideeffects

Counselclientsoninfection
control

NA

Counselingforfamilymembersor NA
treatmentbuddiesonadherence,
infectioncontrol,universal
precautions,andprevention

Linkstootherservicesandfollow NA
upincludinglaboratoryservices,
psychosocialcare,legalservices,
etc.

III29

Notdone

Refer

Provide

Counsel

TobeconsideredafunctionalCHW
whoprovidesTBservices,theCHWs
tasksmustincludeatleastone
completeTBactivitylistedbelow.

Notapplicable

TUBERCULOSISINTERVENTIONS
Activity
Complete

COMMENTS

V. DRUGRESISTANTTB
a. Identification,Care,andTreatmentofDrugResistantTB

Directlyobservedtreatmentshort
coursefordrugresistantTB(DOTS
Plus)provision
Monitoringofandcounselingfor
managementofsideeffects

NA

Social,psychological,and

nutritionalsupportformultidrug
resistantandextensivelydrug
resistant(MDR/XDR)TBpatients

Monitoringoffollowup
diagnosticsandtreatment
recommendations

Counselclientsoninfection
control

NA

Counselfamilymembersor
NA
treatmentbuddiesoninfection
control,universalprecautionsand
prevention

VI. TBSUPPORTANDCROSSCUTTINGISSUES
a. MentalHealthIssuesinTBInfection

Counselingandsupportforfear,
anxiety,anddepression

NA

III30

Notdone

Notapplicable

Refer

Provide

TobeconsideredafunctionalCHW
whoprovidesTBservices,theCHWs
tasksmustincludeatleastone
completeTBactivitylistedbelow.

Counsel

TUBERCULOSISINTERVENTIONS

Counselingandsupportforsuicidal NA
ideationandisolation

Counselingandsupportfor
smokingandsubstanceuse
cessation

NA

Activity
Complete

COMMENTS

b. GeneralHealthandNutritionalEducationandSupport

Healthandwellnesscounseling

NA

Nutritionalcounseling

NA

Foodavailabilityandaccess
support

NA

Referralsandlinkswithsocial
NA
welfareservicesinthecommunity

III31

III32

SectionIV.

CHWAIMFacilitatorsGuide
Thisguideexplainsthestepsnecessarytopreparefor
andimplementaCHWprogramfunctionality
assessment,usetheassessmenttools,guideaction
planning,andprovidefollowupsupport.

AtaGlance

OverviewofCHWAIM..........................................................................................................IV1

Step1.AdaptToolstoProgramContext........................................................................IV4

Step2.PlanfortheAssessmentWorkshop..................................................................IV5

Step3.ConducttheAssessmentWorkshop.................................................................IV10

Step4.FollowUp....................................................................................................................IV16

Presentation:TrainingFacilitatorstoUsetheCHWAIMToolkit............................IV17

SectionIV.CHWAIMFacilitatorsGuide
OverviewofCHWAIM
TheRoleoftheFacilitator:ThisdocumentisdesignedtohelptheCommunityHealthWorkerAssessmentand
ImprovementMatrix(CHWAIM)facilitatorplan,manage,andguidetheassessmenttoensureobjectivesaremet
effectivelywithclearthinking,activeparticipation,andsupportfromallinvolved.Facilitatorscanbeeither
externaltotheorganizationormembersoftheorganization.Themajortasksofthefacilitatoraretoensureall
stepsarecompleted,discussionsareopenandhelpful,agreementisreached,andtimeismonitored.Itisequally
his/hertasktohelptheparticipantsunderstandthattheobjectiveoftheexerciseistomeasureCHWprogram
functionality,i.e.,theabilityoftheprogramtomeetitsintendedpurpose.
CHWAIMPurpose:TheCHWAIMtoolassistsnationalorregionalplannerstoidentifycurrentCHWservice
coverageandtoassessthefunctionalityofCHWprograms,thusenablingthemtostrategicallyincreasethe
numberofCHWswheretherearegeographicorservicegaps.ThetoolalsoassistsNGOs,umbrellaorganizations,
governmentprogrammanagers,CHWs,andsupervisorstoassesstheirCHWprogramsagainstbestpracticesthat
definehighlyfunctionalprogramsandtodevelopanimprovementplantoaddressweaknessesinprogram
performanceorsupport.Theassessmentcanbeusedrepeatedlytomeasurechangeandtoguidecontinuous
improvement.
Tools:CHWAIMisdesignedaroundtwomaintools,theCHWProgramFunctionalityMatrixandtheIntervention
Matricesformaternal,newbornandchildhealth(MNCH);HIVandAIDS;andTuberculosis(TB)programs.Thefirst
toolassistsprogrammanagers,CHWs,communityworkers,stakeholders,NGOs,donors,andministrystafftorate
theCHWprograminthe15elementsessentialtoprogramfunctionality.TheInterventionMatriceshelpthegroup
assesswhetherCHWtaskscomplywithnationalhealthguidelines.Templates,questionnaires,scoresheets,and
resourceguidesareincludedintheappendicesoftheCHWAIMtoolkittosupporttheassessment.
Preparation:Thefacilitatorshouldfamiliarizehim/herselfwiththetools,resources,andtimelineofthe
CHWAIMprocess.TrainingcanalsobeprovidedtofacilitatorsthroughtheuseoftheCurriculumforTrainingof
FacilitatorstousetheCHWAIMToolkit.Thisdocumentisavailableseparately.

IV-1

PreparationChecklist

PlantheAssessment
1.AssembleandreviewCHWAIMworkshoppacketincludingtoolsandappendices.

2.Meetwithparticipatingstakeholders,districtsorprograms,(whichcouldbeyourownNGO)andlay
outatimelineforassessment.

3.Organizevenue,budget,andrefreshments.

4.SendtheinvitationletterwithParticipantSelectionForm (AppendixA1).

5.SetupameetingwiththedistricthealthofficetoreviewtheCHWProgramFunctionalityMatrix
(SectionII)andtheInterventionMatrices(SectionIII).

Organizepreworkshopvisits
1.UsetheValidationQuestionnaire(AppendixA2)at23fieldsitesandinterviewupto
6CHWsinall.Thiscanbedoneinpreparationfortheassessmentoraftertheassessmentas
ameansofverification.

2.WorkwithprogrammanagerstoassessInterventionMatrices.

PreparefortheWorkshop
1.Identifyandtraingroupleadersusingthepresentation TrainingFacilitatorstoUsetheCHWAIM
Toolkit.

2.ArrangeforandtesttheLCDprojectoratthevenue(notethatwhileanLCDprojectorisdesirable,the
processcanbedonesimplywithflipcharts.
3.SetupmeetingroominacircleorUshapedpattern.

4.Compileadditionalmaterialaccordingtothesessionguidance.

Oneperparticipantofeachofthefollowing:
ProgramFunctionalityMatrix
InterventionMatrix(completed)
ScoreandScoreDocumentationWorksheet

5.DownloadtoolsneededforscoringandactionplanningfromtheCHWCentralwebsite(see
http://www.chwcentral.org/communityhealthworkerassessmentandimprovementmatrixchw
aimtoolkitimprovingchwprogramsand)ontoalaptop:
AppendixA4:FunctionalityScoreSheet
AppendixA5:ActionPlanningFramework

IV-2

TheFourCHWAIMSteps
Steps:Thefacilitatorisresponsibleformanagingthefourstepsintheassessmentandforguidingtheprocesssoit
iscarriedoutinacomprehensive,participatory,andeffectivemanner.

Step

Objective

EstimatedTime

Tools

1.Adapt
Adapttoolstoprogram
context

AlignInterventionMatrices Preparation:uptoone
withprogramandcountry month
guidance

InterventionMatrices
(SectionIII)

2.Plan
Planfortheassessment
workshop

Organizeassessment
workshop

ParticipantSelectionForm
(AppendixA1)

3.Assess
Conducttheassessment
workshop

Conductassessmentand
actionplanning

ValidationQuestionnaire
(AppendixA2)(Thistoolcan
insteadbeusedafterthe
assessmenttovalidate
findings.)

Onetotwodays

CHWAIMProgram
FunctionalityMatrix
(SectionII)
ScoreandScoreRationale
DocumentationWorksheet
(AppendixA3)
FunctionalityScoreSheet
(AppendixA4)
ActionPlanningFramework
(AppendixA5)

4.FollowUp

Providesupportforaction
planachievementand
reassessments

Periodic

ValidationQuestionnaire
(AppendixA2)(ifnot
completedpriortothe
assessmentworkshop)
OnlineResourcesandField
Examples(AppendixA6)

IV-3

Step1.AdaptToolstoProgramContext
Sharethetwomainassessmenttoolswiththeprogramandkeystakeholders,suchasimplementingpartnersand
districtrepresentative,priortotheworkshop.TheProgramFunctionalityMatrix(SectionII)isbasedon
internationalbestpractices,butdiscussingitcanraiseawarenessaboutitscontentsandusefulnessforassessing
andstrengtheningCHWprogramsinparticularcountrycontexts.TheImplementationMatricesforMNCH,HIV,
andTB(SectionIII)shouldbereviewedagainstprogramandnationalguidelines,andappropriateadaptations
madetoensureCHWsareprovidingservicesinlinewiththeprotocols.

Thefacilitatorisresponsiblefororganizingameetingwiththe
organization(s),stakeholdersordistrictstobeassessedtoalignthe
InterventionMatrices(SectionIII)withprogramguidelinestobesure
thefinaltoolincludesonlytheinterventionsCHWsarerequiredto
provide.Itisassumedthoseinterventionsarealsoinlinewith
countrycriteria.
SuggestedTiming:Preparationactivitiesshouldbegin
approximatelyonemonthbeforetheactualworkshop.

MeetingtoAlignInterventionMatrices
Organizeameetingwithallstakeholderstoalignthetools;identifyandinviteprogramleaders,field
managers,districtmanagers,CHWsandothersfamiliarwiththeimplementationdetailsoftheprogram.
UsethemeetingtoreviewtherelevantInterventionMatrices(SectionIII)todeterminethattheservices
performedbyCHWsmatchprogramandnationalguidelines.Eliminateormarkasnotapplicablethose
activitiesortasksCHWsarenotrequiredorpermittedtoimplement.
Determineifthereisaneedforawrittentranslationoriftranslatorswillbesufficient;usethemost
prevalentlocallanguage.

OrientationMeetingforOtherStakeholders
Introducethepurposeoftheassessmentanditsbenefitsandlimitationstothedistricthealthstaffandto
otherpartnersorsupportersoftheNGOorprogram.
Reviewthetools,process,andproductsfortheassessment;focusontheactionplanforwhichtheir
supportwillbehelpful.
Tellparticipantsthattheywillreceiveaninvitationtotheassessmentworkshop.

IV-4

Step2.PlanfortheAssessmentWorkshop

Thefacilitatorneedstopreparetechnicallyandlogisticallyforthe
assessment.Thisrequireshim/hertobecomefamiliarwiththe
programsrecordkeepingsystemandtheroleofcommunityhealth
workers.Dependingonthenumberofstakeholdersorthescopeof
theprogramstakingpart,theremaybeaneedforseveral
workshops.
SuggestedTiming:Preparationshouldbeginonemonthbefore
theactualassessmentworkshop

PlantheAssessmentWorkshop
Workwithlocalpartnerstodeterminehowmanyprograms(bydistrictsorregions,multipleorganizations,
ormulticountry)aretobeassessedandhowmanyworkshopswillberequired.Severaldistrictscanbe
assessedatthesametimeiftheyhavecriteriaincommon,e.g.,structure,CHWroles,andthemannerin
whichsupervisionandtrainingareprovided.Ifdistrictsfunctiondifferently,itisbettertoconductseparate
assessments.

Identifythenumberandvenuesofworkshops:between15and25peopleforasingleworkshopisa
reasonablenumber.Askpartnerstoidentifyavenuesuchasahotelormeetinghallthatcouldhost1525
peopleandprovideorarrangeforrefreshments.

Identifyandinviteparticipants.Explaintoprogrammanagerswhowouldbeappropriaterepresentatives
suchasMOH/districthealthstaff,programmanagers,supervisors,andCHWs.Thegoalistogetawell
balancedteam.AsktheorganizationtousetheParticipantSelectionForm(AppendixA1)toidentifyandlist
participantsfortheworkshop.

SampleParticipantList
Foraworkshopwith25participants,consider67CHWs,46
supervisors,45regional/districtmanagers,56stakeholdersor
NGOpartnersand,ifdesired,representativesfromdonorsandother
keypartnerssuchasUSAIDorotherimplementingpartners.

Sendouttheinvitationsandifavisitisnotarrangedpriortotheworkshop,askthatkeydocumentssuchas
supervisorslogs,CHWnotebooks,andotherrelevantmaterialbebroughttotheworkshoptoprepare
stakeholdersfortheirrolesintheassessment.
IV-5

Documentsincludethefollowing:supervisorslogs,jobdescriptions,recruitmentproceduresandnumber
ofCHWs,programindicators,targetsandmonitoringdata,CHWnotebooks,supplydocumentation,
trainingrecords,andotherdocumentsillustratingfieldactivitiesandwhatCHWsareresponsiblefor
delivering.Ifavisitisnotpossiblebeforetheworkshop,asktheprogrammanagertobringthedocuments
totheevent.

ConductVisitstotheProgramSite(s)
IfpossiblearrangevisitstouptothreefieldsitestousetheValidationQuestionnaire(AppendixA2)to
gatherkeyinformationfromuptosixCHWs.Thisaidstheassessmentupfront.Ifthisisnotpossible,
validationcantakeplaceduringthepostassessmentvisittoverifythediscussionsandscoringandto
strengthenactionplanning.

PreparetheBudgetfortheWorkshop
Determinethequantityandtypeofsuppliesrequired:
o Markers,flipchartpaper,onecopyperpersonoftheCHWAIMMatrices,onecopyoftheScore
andScoreRationaleDocumentationWorksheet(AppendixA3),onecopyoftheActionPlanning
Framework(AppendixA5),andonepenandnotebookperparticipant.

SampleWorkshopBudget
BudgetItems:
Venueforoneday
Mealsanddrinksforparticipants
TransportcostsforstakeholdersandCHWS
Supplies(pens,notebooks,documents)
Lodging,ifneeded
SampleWorkshopCostsinZambia:
Onedayworkshopfor1321participantsrangedfrom$375
to$910
Averageworkshopcostwas$560

Preparethebudgetincludingsupplies,refreshments,andcostofvenue,transport,andlodging.

IdentifySmallGroupLeaders
Identifyandorientpeopleinadvancetobegroupleadersduringtheassessmentworkshop(seethe
presentationTrainingFacilitatorstoUsetheCHWAIMToolkitattheendofthissectionformore
IV-6

guidance).Assistthemtousethematricesandactionplanningtoolsappropriately.Criteriaforsmallgroup
leadersincludeanabilitytofacilitate,toencouragediscussion,toresolveissues,andtokeeptheprocess
moving.

ReviewtheInterventionMatricesPriortotheWorkshop
FacilitatorsandprogrammanagersshouldreviewtheInterventionMatrices(SectionIII)inadvance;they
aredesignedtohelpprogrammanagers,supervisors,andCHWsdefinewhichtaskstheyimplementand
whethertheycanreceiveafunctionalscorebecausetheyimplementallthetasksinatleastoneactivity,
e.g.,HIVcounselingandtesting.IfaccordingtopolicyguidelinesCHWsarenotpermittedtoprovidethe
service;theserviceshouldbenotedasNotAppropriateandwillnotaffectthefunctionalityassessment.
Programsratethemselvesonlyonthematrixrelevanttotheservicestheyprovide.Forexample,ifthey
provideonlyHIVandAIDSservices,onlytheHIVandAIDSmatrixwouldbeused.Thisexerciseenables
programstoassessthetypesofservicestheyofferbutdoesnotevaluatethequalityofservice.

Inthefollowingexample,allactivitiesunderHIVandAIDSEducationandHealthPromotionCampaignare
accessibletoclientseitherthroughdirectserviceprovision,referrals,orinformationonwheretheservice
canbeaccessedorarenotapplicablebecausetheyarenotpartoftheCHWsrole;thusthiswouldbea
functionalactivity.Counselingandtestingwouldnotbefunctional,assomeactivitiesarenotdone.Based
ontheanalysisofthematrices,managersshouldidentifytechnicalissues/interventionsthattheymaywant
toaddressorimplementandaddthemtotheactionplanandsharethiswithallworkshopparticipantsfor
agreementandverification.

Tobefunctional,anactivitymustbecomplete,meaningalltasksmustbemarkedcounsel,provide,refer,or
notapplicable;nonemaybemarkednotdone.
SampleInterventionMatrix

I.

Intervention
Complete
COMMENTS

Notdone

Notapplicable

Refer

Counsel

TobeconsideredafunctionalCHWwho
providesHIVandAIDSservices,theCHWs
tasksmustincludeatleastonecomplete
HIVandAIDSactivitylistedbelow

Provide

HIVandAIDSINTERVENTIONS

HIVPrevention

a. Educationandhealthpromotioncampaign

EducationalandmassHIVandAIDS
awarenessevents
Communitymobilizationactivities
andcampaigns

IV-7

Condompromotionandcounseling

b.

NA

COMMENTS

Notdone

Refer

Provide

Counsel

TobeconsideredafunctionalCHWwho
providesHIVandAIDSservices,theCHWs
tasksmustincludeatleastonecomplete
HIVandAIDSactivitylistedbelow

Intervention
Complete

Notapplicable

HIVandAIDSINTERVENTIONS

CounselingandTesting

Pretestandposttestcounseling

NA

Couplecounselingincluding
counselingfordiscordantcouples

NA

Rapidtestingwithsamedayresults
interpretation
Riskreductioncounseling

NA

Preventionwithpositivescounseling NA

Stigmaanddiscriminationcounseling NA
Counselingongenderrelatedissues NA

Counselingonintravenousdruguse NA
(IDU)andharmreductionissues
specificallyrelatedtomostatrisk
populations(MARPs)(whereMARPs
areincludedasatargetpopulation)

Condomusecounseling

NA

Condomprovision

Counselingforotherservicesas
required

NA

IV-8

SampleWorkshopPreparationandImplementationSchedule

Day1:Preparation
Meetwithprogrammanagers.

Day2:Intervention
ConductCHWAIMProgramFunctionality
Workshop

ReviewandcompleteInterventionMatrix.

ScoreProgramFunctionalityMatrix
Components.

Reviewdocuments.
Conductfieldvisits(thiscanbedone
followingtheworkshopifdesired).

ReviewcompletedInterventionMatrix
andverify.

Reconfirmvenue,meals,roomsetup,and
equipmentforDay2.

Developactionplans.

IV-9

Step3.ConducttheAssessmentWorkshop

Thefacilitatortakesresponsibilityformanagingandguidingthe
workshop,managingtime,andexplainingtheassessment,its
purpose,andtheagenda.S/heshouldmakeallparticipantsfeel
comfortableandfreetodiscusstheactions,ratings,and
interventions.S/heshouldremindthemthattheworkshopisnotan
evaluationofCHWperformanceorservicequalitybutratheran
efforttoassessprogramfunctionalityandguideimprovementin
programsusingCHWstodeliverservicestocommunities.
SuggestedTiming:Thisactivitywilltakeonetotwodays.

IntroducetheProcess
Welcomeparticipantsandletthemintroducethemselves.Statetheobjectivesoftheworkshop.

Assessment&ImprovementWorkshopObjectives:
Toassessfunctionalityandguideimprovementsin
CHWprograms;
Tocreateactionplanstoworktowardhighfunctionality.

ExplaintheCHWAIMprocess.Tellparticipants:
o

WeareallheretojointlyassessyourcurrentCHWprogrambyratingitagainst15established
bestpractices.Thiswillhelptocollectivelyidentifystrengths,challenges,andactionstoimprove
yourprogram.Duringtheassessment,eachparticipantwillhaveachancetoscorethe15
componentsusingascoringguideandtosuggestimprovements.Whenscoresdiffer,wewillcome
toanagreementasagroup.Wewilldothefirstcomponentinplenarysoeveryonecanseehow
theprocessworksandwillthenbreakintosmallgroupstodotheother14.

PassouttheCHWProgramFunctionalityMatrix(SectionII).
Readthedefinitionofrecruitmentandasktheparticipantstodescribetheprocesstheyuse.Theyshould
scorethemselvesfrom14basedonhowtheirprogrammatchesthecriteriaundereachlevelof
functionality.Notethattherearenohalfscoressuchas2.5.Theymustscoreawholenumberandthey
shouldmeetallthecriteriatofitaparticularscore.Givethemtimetomaketheirassessmentsandthen
askhowmanyscored1,2,3or4;writethenumbersonaflipchart.
Askthosewhosescoresdifferfromthoseofthemajoritytojustifytheirresponses.
IV-10

 Encouragediscussionforupto10minutesuntilconsensusisreachedonafinalscore.
Aftertheexercise,askifthereareanyquestions,clarifythemandprovidefeedback.Statethattheywill
usetheScoreandScoreRationaleDocumentationWorksheet(AppendixA3)todocumentandjustify
theirscores.Explainthatthe14remainingsectionswillbedoneinsmallgroupsofsevenoreightpeople.

SampleWorkshopAgenda

8:309:00IntroductionandWorkshopOverview
9:009:45ChallengesofSupportingCHWs
9:4510:45AdapttheTools
10:4511:00TeaBreak
11:0012:00PreparefortheAssessment
12:001:00ConducttheAssessment

1:001:45Lunch
1:453:10ConducttheAssessment,continued
3:104:00ProvideFollowupSupport
4:004:20Wrapup
4:204:35TeaBreak

BreakIntoSmallGroups
Breakingintosmallgroupsmakestheprocessgofaster,fostersmoreindepthdiscussion,facilitates
communication,andimprovesCHWparticipation.
Makesurethatanyrequireddocumentsareavailabletotheappropriategroups.Forexample,supervision
reportexamplesshouldbeprovidedtothegroupscoringsupervision.Alistofsuggesteddocumentsis
providedaboveeachofthe15elementslistedintheCHWProgramFunctionalityMatrixaftertheheading
Resources:.
IfCHWvalidationinterviewswereconductedpriortotheworkshop(asopposedtofollowingthe
workshop),ensurethatasummaryoffindingsisprovidedtoeachgroupsothesecanbeusedtoinform
discussionsandscoring.
Toensurethatalltypesofparticipantsareadequatelyrepresentedineachsmallgroup,haveeach
category(programmanagers,keystakeholders,supervisors,andCHWs)meetasagroupandcountoff
separately,thenhaveallthenumberonesfromonegroupandthenumbertwosformanothergroupand
soon.Keepthegroupsmanageable:seventoeightisareasonablenumberforanactivediscussion,
IV-11

especiallyiftranslationisnecessary.Eachgroupshouldbeledbyatrainedgroupleader;thefacilitator
shouldcirculateamongthemtoaidwithdiscussions.
Eachgroupwilllookathalfthecomponents,i.e.,sevenorfeweriftherearemorethantwosmallgroups.
AskeachgrouptonominateasecretarytodocumenttheScoreandScoreRationaleDocumentation
Worksheet(AppendixA3)andpresenttheresultsinplenary.Thetoolshouldbeusedtonotethescore,
therationaleforthescore,andpotentialactions.Thecommentsectionshouldbeusedtoaddpertinent
information.
Eachsmallgroupwillcometoagreementonascoreforeachcomponent.Whereresourcedocumentsare
listed,theyshouldbereviewedbythegroupbeforescoringisdone.

SampleScoreandScoreRationaleDocumentationWorksheet
Component

Workshop
Score

Rationale

ActionItems

Comments

Recruitment

Organizationrecruits
accordingtobest
practices:no
exceptionsfound.

Mayconsider
documentationof
process.

Individual
Performance
Evaluation

Noestablished
processorformfor
individual
performance
evaluation.

Developform and
guidancefor
performance
evaluation.

Norewardsfor
individuals
performingwell.

Developsystemto
rewardindividuals
performingwell.

ConductScoring
Participantsscorethecomponentsbasedontheirdiscussion.Thegroupthenreviewstheoutlyingscoresby
sharinganddefendingtheirrationaleuntilconsensusonafinalscoreisreached.Therationaleshouldbe
validatedbyevidencefromthedocumentsreviewedpriortotheworkshop.
Onceallgroupshavefinished,returntoplenaryforpresentationsandconsensus.
o Inthissession,consensusamongthegroupsisreached.
o Thefacilitatororsmallgroupleadershouldplacetwocolumnsontheflipchart:oneforthe15
areasandthesecondtorecordthescore.

IV-12

SampleFlipChart:ConsensusScoring

Element

Score

Recruitment

CHWRole

InitialTraining

ContinuingTraining

EquipmentandSupplies

Supervision

IndividualPerformanceEvaluation

Incentives

CommunityInvolvement

10

ReferralSystem

11

OpportunityforAdvancement

12

DocumentationandInformationManagement

13

LinkstoHealthSystem

14

ProgramPerformanceEvaluation

15

CountryOwnership

UsingthenotestakenontheScoreandScoreRationaleDocumentationWorksheet(AppendixA3),the
secretaryfromeachgroupshouldstatethescore,rationale,andactionforeacharea.Aftereach
component(e.g.,CHWRole),participantsfromothersmallgroupsshouldbeencouragedtoaskquestions
and,ifdesired,tochallengethescore.Ifthereisdisagreement,alargerdiscussionoccursuntilagreementis
reached.Whenconsensusisreached,thepresentermovestothenextarea.
Ifvalidationfieldvisitsaretobedoneaftertheworkshop,thenanyscoresthatarerevisedbasedonthe
findingsinthefieldneedtobesharedwithworkshopparticipantseitherthroughemailorsomeother
means.

ReviewtheInterventionMatrix
Followingscoring,reviewtheInterventionMatrices(SectionIII)toensureagreementonthefindingsand
toidentifyanyactionsthatshouldbeaddedtotheactionplan.Ifthiswasnotdoneinadvance,this
exerciseshouldtakeplaceattheworkshop.

IV-13

DetermineFunctionality
ThefacilitatorshouldcompletetheFunctionalityScoreSheet(AppendixA4).IfanLCDprojectorisavailable,
thiscanbedoneinplenarywiththeworkshopgroup.Ascoreofthreeineachcomponentisnecessaryfor
aprogramtobedeemedfunctional.Thesecondpartoffunctionalityisprovidedthroughtheintervention
matrix.Checkoffanyactivity,whichwasdeemedfunctional.Functionalmeansthatalltasks,applicableto
theroleoftheCHWareconductedandnonearenotedasNotDone.Ifaprogramisfunctional,allCHWs
intheprogramcanbecountedasfunctional.

StartActionPlanning
Divideparticipantsintothesamesmallgroupssotheycandevelopactionsfortheareastheyscored
previously.
Keepactionplansreasonableandrealistic.Ifactionplansaretoolong,theybecomeintimidatingand
difficulttomanage.Theworkshopgroupshouldfocusondevelopingactionsfornonfunctionalareas,
thosescoringlessthanthree,first.
Groupsshouldmarkhighpriorityissuesandactionsthosethatmustbeaddressedortheprogrammaybe
significantlycompromised.
Trytokeepthetotalnumberofactionsunder30ifpossible.Iftherearealotofactions,focusonthosethat
needtobeaddressedinthenext6monthsandthenreviewtheactionplanattheendoftheperiodand
draftanewactionplanifnecessary.
WheneachgrouphascompletedtheActionPlanningFramework(AppendixA5)fortheareasassignedto
them,thegroupsshouldexchangetheirplansandreviewwhattheothergroupshavedeveloped.Oncethe
actionplanhasbeenreviewedanddiscussed,eachgroupshouldhaveanopportunitytoaskquestions,
makeclarifications,andagreeonchanges.
Theactionplanisusedtodocumentissuesidentified,areaswhereafunctionalscorewasnotachieved,
andtheinterventionsnecessarytoimprovethecurrentstatus.Thefollowingexampledemonstrateswhat
needstogointotheplan.AnassessmentcodeisusedwhenmorethanoneNGOordistrictisassessed.

IV-14

SampleCHWProgramActionPlanningFramework
Name:NewBeginnings
Program
Component

Issue

District/NGO:

Improvement
Person
Activity
Responsible

Date:8March2013

Resources
Needed

Recruitment Clinicsnot
involvedin
recruitment
ofcaregivers

Involveclinic
Supervisor
nursesin
interviewing
caregiver
candidatesorin
reviewingand
agreeingon
finalselections

Stationery

CHWRole

Extra
demands
from
community
whichCHW
cannotmeet

Hold
Supervisor
sensitization
meetingwith
communities
ontheroleand
expectationsof
theCHW

Stationery

Initial
training

Lackof
certificates
fortraining

Advocatefor
certification
policyafter
trainingatthe
districtlevel

Venue

High
Priority

Timeline

April2013

#ofcaregivers
recruitedwith
someapproval/
involvementof
clinicstaff

May2013

#of
sensitization
meetingsheld

June2013

Changed
certification
policy

HQTAto
helpdefine
nursesrole
in
recruitment

Program
Manager

Indicator

Stationery

Certificates
developedand
issued
Orientation
workshopheld

Providetraining Program
certificatesto Manager
allCHWs
trained

Stationery

October
2013

#oftrained
caregiverswho
receivea
certificatefor
training

Wrapup
Attheendoftheworkshop,smallgroupleadersshouldpreparetheScoreandScoreRationale
DocumentationWorksheet(AppendixA3),theInterventionMatrices(SectionIII),theActionPlanning
Framework(AppendixA5)andtheFunctionalityScoreSheet(AppendixA4)sotheycanbeprovidedtothe
programforitsrecordsandforadditionalreviewandmodificationasrequiredonthefollowingday.If
possibleprintoutahardcopyofthedocuments.
IV-15

Step4.FollowUp

Thisstepisimportanttovalidatetheresultsoftheworkshop,
reviewandrevisetheactionplanasnecessary,developa
processformonitoringachievementoftheactionsintheplan,
andtoplanareassessmentasdesired.

Ifnotdonebeforetheworkshop,conductfieldvisitsatthreedifferentsitesandusetheValidation
Questionnaire(AppendixA2)tointerviewupto6CHWswhodidnotparticipateintheassessment
workshop.Afterverifyingtheinformation,reviewandupdatetheactionplanandscoresifnecessary.Ifany
scoreshavechanged,assessmentleadersshouldnotifyallworkshopparticipantsandgivethemachanceto
discussandagree.
Holdafollowupactionplanmeetingwithprogrammanagersandparticipantsfromtheassessment
workshop,includingCHWs,toreviewanddiscusshowtocompletetheactionplanandhowtoidentify
someonetotakeresponsibilitytoensureactionsareimplementedandmonitored.
Sharethefinalactionplanwithallstakeholdersfortheirknowledgeandassistance.
Discusshowtheplanwillbemonitored.Ifmorethanonelocationorprogramhasbeeninvolved,considera
meetingofrepresentativesfromallsitestoperiodicallyshareeffectiveactionsanddiscusschallenges.
Setadateforcheckingonprogress.
Determineifasecondassessmentisdesirabletomaintainimprovementsandthenplanforit.

IV-16

Presentation:TrainingFacilitatorstoUsetheCHWAIMToolkit

IV-17

IV-18

SectionV.

References
Thissectionliststhepublicationsandresourcesusedin
thedevelopmentoftheCHWAIMToolkit.

SectionV.References
BahaiInternationalCommunity.1996.CommunityhealthworkersinKenyastirbroadchanges.OneCountry:The
OnlineNewsletteroftheBahaiInternationalCommunity7(4)MarchJanuary1996.
BhattacharyyaK,WinchP,LeBanK,TienM.October2001.CommunityHealthWorkerIncentivesand
Disincentives:HowTheyAffectMotivation,RetentionandSustainability.PublishedbytheBasicSupportfor
InstitutionalizingChildSurvivalProject(BASICSII)fortheUnitedStatesAgencyforInternationalDevelopment.
Arlington,VA.
BoldSolutionstoAfricasHealthWorkerShortage.August2006.PublishedbyPhysiciansforHumanRights(PHR)
andHealthActionAIDS.
BurkhalterBR,GreenCP(Editors).1999.SummaryReport:HighImpactPVOChildSurvivalProgramsVolume1:
ProceedingsofanExpertConsultation,GalludetUniversity,Washington,DCJune2124,1998.PublishedbyBASICS
Project&COREGroup.

CatholicReliefServices.CRSGuidetoWorkingwithVolunteers.Baltimore,Maryland:CRS,2012.
ChenL,EvansT,AnandS,BouffordJ,BrownH,ChowdhuryM,CuetoM,DareL,DussaultG,ElzingaG.2004.
Humanresourcesforhealth:overcomingthecrisis.Lancet364:19841990.
CommunityHealthWorkersinAfrica.2008.HealthSystemsReporter.February27,2008.ProducedbytheIDS
HealthandDevelopmentInformationTeamincollaborationwithEldisandtheDFIDHealthResourceCenter.
DarmstadtGL,BhuttaZA,CousensS,AdamT,WalkerN,deBernisL.2005.Evidencebased,costeffective
interventions:howmanynewbornbabiescanwesave?Lancet365:977988.
GilsonL,WaltG,HeggenhougenK,OwuorOmondiL,PereraM,RossD,SalazarL.1989.NationalCommunity
HealthWorkerPrograms:HowCanTheyBeStrengthened?JournalofPublicHealthPolicy,10(4):518532.
HainesA,SandersD,LehmannU,RoweA,LawnJE,JanS,WalkerDG,BhuttaZ.2007.Achievingchildsurvival
goals:potentialcontributionofcommunityhealthworkers.Lancet369:212131.
HallS.2007.PeopleFirst:Africansolutionstothehealthworkercrisis.PublishedbyAfricanMedicalandResearch
Foundation(AMREF).
Jennings,LarissaM.2005.ProcessLearningandDocumentation:ExaminingtheIntroductionofCommunityBased
NeonatalhealthWorkersinSylhet,Bangladesh.CenterforHealthandPopulationResearchICDDR.B.
LewinSA,DickJ,PondP,ZwarensteinM,AjaG,VanWykB,BoschCapblanchX,PatrickM.2005.Layhealth
workersinprimaryandcommunityhealthcare.CochraneDatabaseSystRev(1):CD004015.
MukherjeeJS,EustaheFE.2007.CommunityhealthworkersasacornerstoneforintegratingHIVandprimary
healthcare.AIDSCare,19(Suppl1):S73S82.
PrasadBMandMuraleedharanVR.2007.CommunityHealthWorkers:areviewofconcepts,practicesandpolicy
concerns.FromtheHRHGlobalResourceCenter.Availableonlineat:
http://www.hrhresourcecenter.org/hosted_docs/CHW_Prasad_Muraleedharan.pdf.
V-1

PresidentsEmergencyPlanforAIDSRelief(PEPFAR).2006.ActionToday,AFoundationforTomorrow.Available
onlineat:http://www.state.gov/s/gac/rl/c16742.htm.
PresidentsEmergencyPlanforAIDSRelief(PEPFAR).2010a.ImplementationoftheGlobalHealthInitiative.
ConsultationDocument.Availableonlineat:http://www.PEPFAR.gov/documents/organization/136504.pdf.
PresidentsEmergencyPlanforAIDSRelief(PEPFAR).2010b.TheU.S.PresidentsEmergencyPlanforAIDSRelief.
FiveYearStrategy.
PresidentsEmergencyPlanforAIDSRelief(PEPFAR).2010c.TheU.S.PresidentsEmergencyPlanforAIDSRelief.
FiveYearStrategyAnnex:PEPFARScontributionstotheGlobalHealthInitiative.
TravisP,BennettS,HainesA,PangT,BhuttaZ,HyderA,PielemeierN,MillsA,EvansT.2004.Overcominghealth
systemsconstraintstoachievetheMillenniumDevelopmentGoals.Lancet364:900906.
UnitedNations.2002.MillenniumProject.Availableonlineat
http://www.unmillenniumproject.org/documents/MainReportCompletelowres.pdf.

UnitedStatesAgencyforInternationalDevelopment(USAID).2008.InterventionsandMeasuringImpact.Available
onlineat:http://www.usaid.gov/our_work/global_health/mch/publications/docs/mch08_masure_impact.pdf.
UnitedStatesAgencyforInternationalDevelopment(USAID).2008.ReporttoCongress:Workingtowardthegoal
ofreducingmaternalandchildmortality:USAIDProgrammingandResponsetoFY08appropriations.Washington,
DC:USAID.Availableonlineat:http://pdf.usaid.gov/pdf_docs/PDACL707.pdf.
WellinsRS,BernthalP,PhelpsM.2005.Employeeengagement:Thekeytorealizingcompetitiveadvantage.
PublishedbyDevelopmentDimensionsInternational.
WorldHealthOrganization(WHO).2007.Communityhealthworkers:Whatdoweknowaboutthem?Evidence
andInformationforPolicy,DepartmentofHumanResourcesforHealth.Geneva:WHO.
WorldHealthOrganization(WHO).1978.DeclarationofAlmaAta.Availableonlineat:
http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf.
WorldHealthOrganization(WHO).2008.TaskShifting:rationalredistributionoftasksamonghealthworkforce
teams:globalrecommendationsandguidelines.Geneva:WHO.
WorldHealthOrganization(WHO).2006.Treat,Train,Retain.TheAIDSandhealthworkforceplan.Geneva:WHO.

V-2

SectionVI.

Appendices
Thissectionincludesthetoolsneededtoassist
participantselectionfortheassessmentworkshop,
gatherdocumentationabouttheprogramscurrent
practices,documentandscoretheirassessment,and
createaresponsiveactionplan.Thereisalsoa
resourcesectionforfurtherguidanceoneffective
interventions.TheActionPlanningFrameworkand
FunctionalityScoreSheetshouldbedownloadedfrom
theinternetontoalaptoptoenableparticipantsto
participateincreatingandreviewingtheprocess.

AtaGlance

AppendixA1:

ParticipantSelectionForm........................................................................VI1

AppendixA2:

ValidationQuestionnaire...........................................................................VI3

AppendixA3:

ScoreandScoreRationaleDocumentationWorksheet.........VI7

AppendixA4:

FunctionalityScoreSheet....VI10

AppendixA5:

ActionPlanningFramework..VI13

AppendixA6:

OnlineResourcesandFieldExamplesVI16

SectionVI.Appendices
AppendixA1:ParticipantSelectionForm
Instructions:Sendthisformtotheparticipatingorganizationsorprogramsinadvancetoguidetheirselectionof
appropriateparticipantsintheassessmentprocess.
GuidanceforUsingthisForm:SelectingParticipantsfortheCHWAIMMatrixWorkshop

TheonedayCHWAIMworkshopisanopportunityforprogrammanagers,healthfacilitystaff,CHWs,andkey
stakeholderstodiscusstheCHWprogram,toidentifyissuesorproblems,andtodevelopanactionplantoaddress
thoseissues/problems.Theworkshopworksbestwhenitincludesamixofdecisionmakersandthosewithonthe
groundknowledge(suchasCHWsandhealthfacilitystaff).Usethefollowingtabletoidentifypeoplewhoshouldbe
includedintheworkshop.Aimforbetween15and20peoplewithnomorethan25asthiswouldbetoomanyto
manage.Thenumbersprovidedbelowarejustsuggestions:youknowyourprogramsandwhatisneeded.

RepresentativesFrom

Name

Title

Location

Fromcommunityhealthworkers(aim
for56)whocanspeakfortheprogram
asawhole

FromyourCHWprogrammanagement

teamandhealthfacilitystaff(aimfor57);
considerincludingsomeonefrom

headquartersifthisisappropriatein
additiontolocalmanagersandsupervisors

VI-1

Fromkeystakeholderssuchasdistrict
healthoffices,healthfacilitiesdistrict
areataskforces(aimfor57)

VI-2

AppendixA2:ValidationQuestionnaire
Instructions:Usethisdocumenteitherbeforeoraftertheassessmentworkshoptoverifythescoringestablishedby
workshopparticipants.Trytovisit23fieldsitesthatdidnotparticipateintheworkshopandinterviewupto6
CHWsintotal.Thencompareresponseswiththescoresandactionplantodetermineifanychangestoeither
documentarenecessary.Ifconductedpriortotheassessment,usetheinformationasaguideduringthe
discussion.Iftheinterviewsareaftertheassessment,discussthechangeswiththosewhoparticipatedinthe
assessment.

Type/titleofCommunityHealthWorker(CHW)____________________________________Date___________
1.HowlonghaveyouworkedasaCHW?

________Months

2.Pleasedescribehowyouwererecruited.

3.Howwereyouassignedtothecommunity(s)inwhichyoucurrentlywork?

4.Pleasedescribethekeytasksforwhichyouareresponsible.

Yes

No

5.DoyoufeelthatwhatyoudoasaCHWmeetstheexpectations
ofthecommunity?

VI-3

6.PleasedescribetheinitialtrainingyoureceivedtoprepareyouforyourroleasaCHW.
Date(s)_____________________Duration_____________days
Topicscovered:

7.Pleasedescribeanyadditionaltraining(refresher/ongoingtraining)youhavereceivedtohelpyoufulfill
yourroleasaCHW.
Date(s)

Duration(days) TopicsCovered

8.Doyouhavethesuppliesandequipmentyouneedtoprovidethe
servicesyouareexpectedtodeliver?

Yes

No

9.Whoisyoursupervisor?

Name:______________________________________

Title:_______________________________________

VI-4

10.Whatdoesyoursupervisordowhenhe/shevisitsyou?
Activity
Observationofservicedelivery
Coachingandskillsdevelopment
Troubleshooting,problemsolving
RecordReview
Supplycheck

Done(Y/N) Example

11.Haveyoureceivedawrittenevaluationofyourworkinthe
last12months?

Yes

No

12.Ifyes:
1.Whoevaluatedyou?___________________________________________________________________
2.Howwereyouevaluated?_______________________________________________________________
3.Whatwasevaluated?__________________________________________________________________

13.Doyoureferclientsforhealthservicesyoudonotorcannot
provide?

Yes

No

Yes

No

14.Ifyes,doyoucompleteareferralformfortheclienttotaketo
thefacility?

VI-5

15.Pleasedescribeanyfeedbackorcounterreferralyoureceivefromthefacilityforclientsyouhavereferred.

16.Pleasedescribethetransportationsystemsavailabletogetclientstoreferralfacilities.

17.PleasedescribeanyopportunitiesforpromotionorprofessionaladvancementyouhavethroughtheCHW
program?

18.Pleasedescribeanyreportsyoucompileonyourclients?

a.Whatdoyouincludeinthereports?_______________________________________________________
b.Towhomdoyousubmitthereports?______________________________________________________
c.Howdoyouusetheinformationyoucollect?_______________________________________________
d.Howdoestheprogramusetheinformationyoucollect?______________________________________
e.Arereportssharedwiththecommunity?___________________________________________________
f.Noreports______

19.Arereportsorinformationabouttheprogramanditsresultssharedwith:

You(CHW)
Withthecommunity?
Withotherstakeholders?__________________________________

20.WhatareyourbiggestchallengesasaCHW?

21.Whatchangesareneededtohelpyoudoyourjobbetter?

VI-6

AppendixA3:ScoreandScoreRationaleDocumentationWorksheet
Instructions:Thisworksheetisforparticipantstonotetheirscoresandtheevidencetheyhaveforchoosingthatscore.Theywillusetheactionitem
columntosuggestinterventionsthatcanhelpthemmovetowardachievingthebestpractice.Notethatscorescanberevisedaftertheworkshoponly
iffieldvisitsorotherinformationprovidesevidencethatsupportsadifferentscore(lowerorhigher)thanthatagreedonintheworkshop.Rationales
fororiginalworkshopscoresandanyrevisedscoresshouldbedocumentedinthecommentssection.

Component

Score

Rationale

ActionItems

Comments

Recruitment

CHWRole

InitialTraining

ContinuousTraining

EquipmentandSupplies

Supervision

IndividualPerformance
Evaluation

Incentives

VI-7

Component

Score

Rationale

ActionItems

Comments

CommunityInvolvement

ReferralSystem

Documentation,
InformationManagement

LinkagestoHealthSystem

Opportunityfor
Advancement

ProgramPerformance
Evaluation

CountryOwnership

VI-8

SampleScoreandScoreRationaleDocumentationWorksheet
Component

Score

Rationale

ActionItems

Recruitment

Programrecruitsaccordingtobest
practices:noexceptionsfound

CHWRole

Programdoesntregularlydiscuss Scheduletalkswiththecommunity
theroleoftheCHWwiththe
todiscussroleandexpectations.
community.Programusesa
Involvesupervisors.
contractbetweentheCHWand
communitythatdescribesroleand
relationshipsandevenspecifies
thatcommunityshouldfarmaplot
forCHW(notbeingdone).

Comments

VI-9

AppendixA4:FunctionalityScoreSheet
Thefunctionalityassessmentcomprisestwoparts:theprogramfunctionalitymatrixscoresheetandthe
interventionmatrixassessment.

Part1.CHWProgramFunctionalityMatrixScoreSheet
ScoringGuidance:Onthissheetthecomponentsmustadduptoaminimumof45points.Inaddition,each
componentmustscoreatleasta3.
Instructions:Putthescoreforeachcomponentunderthecolumnlabeledscore;
addthescoresandrecordthetotal.
COMPONENT

Recruitment
CHWRole

InitialTraining

Training

EquipmentandSupplies

Supervision

IndividualPerformanceEvaluation

Incentives

CommunityInvolvement

ReferralSystem

OpportunityforAdvancement

DocumentationInformationManagement

SCORE

VI-10

LinkagestoHealthSystem

ProgramPerformanceEvaluation

CountryOwnership

A.Allelementsscoregreaterthan2(scoreof3or4)?

Yes
No

B.Thereisatleastoneinterventionarea(activity)thatisfunctionalintheIntervention
Matrix.

Yes
No

C.Totalfunctionalityassessment

A: Yes + B: Yes = Functional

A: No

+ B: Yes = Non Functional

A: Yes + B: No

= Non Functional

A: No

= Non Functional

+ B: No

VI-11

Listthefunctionalinterventionareasforfuturereference:

___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
NoteanyinterventionareasInneedofimprovement:

___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________

VI-12

AppendixA5:ActionPlanningFramework
Instructions:Usethisformtodocumenttheactionplan;theplanshouldincludetheissue,theimprovement
activitiessuggestedbytheparticipantsanddocumentedonAppendixA3,theScoreandScoreRationale
DocumentationWorksheet,shouldbeexpandedonandplacedintheimprovementactivitycolumn.Additional
boxesshouldbecompletedasdescribedbelow.

DefinitionsforActionPlanningFramework
CommunityHealthWorkerProgramComponent:Thisreferstothe15itemslistedintheCommunityHealth
WorkerAssessmentImprovementMatrix(CHWAIM)tool:recruitment,CHWrole,initialtraining,continuous
training,equipmentandsupplies,supervision,performanceevaluation,incentives,communityinvolvement,
referralsystem,professionaladvancement,documentation/informationmanagement,programperformance
management,communityhealthfacilitylinks,andcountryownership.Inaddition,actionsfromtheclinical
interventions:MNCH,HIV,andTBinterventionsmayalsobeaddedbyservicearea(e.g.,antenatalcare,HIV
counselingandtesting,TBpsychosocialandspiritualsupport).
Issuereferstothegap,problem,orotherconcernidentifiedduringthereviewordiscussionthatshouldbe
addressedtoimproveCHWprogramfunctionality.
Improvementactivityreferstotheactionthatwillbecarriedouttoaddresstheissue.Itshouldbespecific,
actionable,andclearlystated.
Personresponsibleshouldbethepersonwhowillultimatelyensuretheactioniscarriedout.Itcouldbethe
personwhoactuallycarriesouttheactionbutmayalsobesomeoneinanoversightormanagementpositionwho
willensurethatallpartiesinvolvedintheactivitywillcarryouttheirdutiesandrealizetheactivityasagreed.
Resourcesneededmayrefertofinancial,materialortechnicalresourcesincludingthetechnicalassistancethat
theprogramwillneedtoeffectivelycarryouttheaction.
HighPriorityreferstoactionsthatmustbeaddressedortheprogrammaybesignificantlycompromised.They
mayalsorefertoactionsthatneedtobedoneurgentlysothatotheractionscanbeaddressed.
Timelinereferstotheperiodinwhichtheactivitywillbecarriedout.Wherepossiblethefinaldateonwhichthe
activityisexpectedtobecompletedshouldbeindicated.
Indicatorreferstohowtherealizationoftheactionwillbemeasured.

VI-13

ActionPlanningFramework
Program
Component

Improvement
Activity

Issue

Person
Responsible

Resources
Needed

HighPriority

Timeline

Indicator

VI-14

SampleActionPlanningFramework
Program
Component

Issue

Improvement
Activity

Person
Responsible

Resources
Needed

Equipmentand
Supplies

Frequentstock
outsofCTA,ORS,
MILD,FP
productsinsome
districts

Reviewandmodify CHWSupervisor Securitystock

calculationof
averagemonthly
consumption
(includeneedsof
theCHW),including
bufferstock

Performance
Evaluationand
Incentives

Communities
currentlyarenot
following
throughontheir
commitmentto
provide
incentivesand
supportCHWs

DiscusswithCHW
Program
andthecommunity Manager
howtofindawayto
recognizeCHWs

ReferralSystem

Clientsare
referred,butno
formalsystem
existswith
standardsfor
referralor
methodsfor
trackingreferral.

Formalizethe
referralsystemby
developingreferral
cards

Document
referralsand
feedback

Program
Manager

HighPriority

Timeline

Indicator

April2013

numberofstock
outsofcommodities
eachmonth

June2013

numberofCHWs
recognizedby
community

May2013

numberofreferrals
tracked
numberoftimes
feedbackis
documented

VI-15

AppendixA6:OnlineResourcesandFieldExamples
Instructions:Thisdocumentshouldbereviewedinadvanceoftheassessmenttogatherinformationaboutissues,
interventionsandbestpracticessupportingCHWprograms.
Areviewofrecentlypublishedliteratureoncommunityhealthworkerprograms,primarilyfocusingonmaternal
andnewbornchildhealth,wasconductedbytheUSAIDHealthCareImprovement(HCI)Projectforthepurposes
ofidentifyingkeycomponentsofsuccessfulcommunityhealthworker(CHW)programs,reviewingpastsuccesses
andfailuresofCHWprogramimplementation,andsummarizingimportantlessonslearned.Thisreviewof
literaturecontributedtothedevelopmentoftheCHWAssessmentandImprovementMatrixandisavailableat
http://www.chwcentral.org/communityhealthworkerassessmentandimprovementmatrixchwaimtoolkit
improvingchwprogramsand.Fromthisreview,thefollowingexampleswereidentifiedwithlinkstorelevant
programexamplesandreferences.

Recruitment
ThereisextensiveevidencethatsupportsthebestpracticeofrecruitingCHWsfromthecommunityorgivingthe
communityasubstantialroleinrecruitmentandselectionastheCHWswillhavemorecredibilityandwillthusbe
abletoachievemore.Althoughidentifyingthecandidateswiththeappropriateskillsandabilitieswithinthe
communityisnotalwayspossible,activelyinvolvingcommunityleadersindefiningarolefortheCHW,identifying
thenecessaryskillsandcharacteristics,andallowingthecommunitysomesayinwhoisassignedtothemwill
enableCHWstodotheirjobsmoreeffectively.
http://model.pih.org/community_health_workers/chw_recruitment
http://www.who.int/hrh/documents/community_health_workers.pdf(pp.68)
http://www.who.int/hiv/pub/meetingreports/TTRmeetingreport2.pdf(pp.911,3747)

ExamplefromtheField:RecruitingandSupportingCommunityHealthVolunteers
BRACdevelopedastrategyforworkingwithcommunitiesandcommunityhealthvolunteers(CHV)thatpaid
attentiontocarefulrecruitment,trainingandsupervisionandprovidingameansforincome.AsBRACmoves
intoanewvillagetheyhelptosetupavillageorganization(VO),composedofpoorwomenwillingtoimprove
theirlives.TheVOisaskedtosuggestcandidatestobetrainedasCHVs.CHVsareallwomenvolunteerschosen
bytheircommunity,age2535,marriedwithnochildrenunder5years,motivated,withsomeschoolingand
notlivingnearahealthfacilityorbigbazaartoavoidcompetition.Theyreceive4weeksoftrainingoncommon
illness;afewreceivespecializedtraininginTBorARI.Monthlyrefreshertrainingsareprovidedtokeep
knowledgeupdated,discussproblems,replenishsuppliesandstrengthenmotivation.Theyassistupto250
households,providinghealthandhygieneeducation,andreferringclientsasnecessary.Supervisionis
conductedbyBRACdoctorsandprogramorganizersonfieldvisits.Volunteersarehelpedtoearnalivelihood
bysellingessentialdrugsandotherhealthproductsandhaveaccesstomicroloans.
Producingeffectiveknowledgeagentsinapluralisticenvironment:WhatfutureforCHWs?Standing,
H.,Chowdhury,M.A.,2008
SuggestedInterventions
InvolvecommunityandevenhouseholdsinidentifyingCHWs
Advertiseinnewspaper/radio
Setcriteria:age,residency,gender,etc.

VI-16

Testonliteracy/numeracy
Interview
Involvecommunityandhealthcenterinfinalselection
GlobalExperienceofCommunityHealthWorkersforDeliveryofhealthRelatedMillenniumDevelopmentGoals,
WHO,GHWA2010

CHWRole
UnclearexpectationsandpoorlydefinedrolesforCHWsarecitedasfrequentcausesforthefailureofmanyCHW
programs.CommunitiesoftenhavedifferentexpectationsfortheCHWsthantheyhaveforthemselvescausing
confusionanddisappointment.FrequentlycommunitiesexpectCHWstoperformmoreofacurativerole,whereas
inrealitymanyareunpreparedandunabletodoso.
http://www.who.int/hiv/pub/imai/om_4_community.pdf(pp.1012)
http://model.pih.org/community_health_workers/roles_and_functions
http://www.who.int/healthsystems/TTRTaskShifting.pdf(pp.3233)

InitialandContinuousTraining
TrainingisanintegralcomponenttoensuringthatCHWshavethecapacityandskillsnecessarytocarryouttheir
workinthecommunityandtoprovidesafe,highqualitycare.InitialtrainingaidsindefiningtheroleofCHWsand
inpreparingthemfortheworktheywillundertake;however,continuoustrainingisalsovitalforCHWsto
maintainandreinforcetheirpresentskillsaswellastoupdatethemonnewskills,practices,andprocedures.
http://www.who.int/hrh/documents/community_health_workers.pdf(pp.1920)
http://pdf.usaid.gov/pdf_docs/PNADJ527.pdf(pp.89)
http://model.pih.org/community_health_workers/training
http://www.who.int/hiv/pub/meetingreports/TTRmeetingreport2.pdf(pp.1113,4957)

Jennings,LarissaM.2005.ProcessLearningandDocumentation:ExaminingtheIntroductionofCommunityBased
NeonatalhealthWorkersinSylhet,BangladeshCenterforHealthandPopulationResearchICDDR.B.

ExperiencefromtheField:Training
CHWsrequirestrongpreservicetrainingprogramstoorientthemtothebasicscienceofhealthpromotion,
diseaseprevention,andtreatmentandcare.Trainingshouldalsocoverethicalstandardsincluding
confidentiality,nondiscrimination,andotherpatientrightsandeducationonthepriorityinterventionsthey
areexpectedtoundertake,whichisdependentontheepidemiologyofdiseasewithintheircommunities,e.g.
HIVandAIDS,TB,malaria,andchildandmaternalhealth.Ongoinginservicetrainingsystemsarerequiredto
improvetheskillsandservicedeliveryofcommunityhealthworkers.
www.healthworkforce.info/advocacy/Task_Shifting.pdf

VI-17

EquipmentandSupplies
Toeffectivelycarryouttheirworkinthecommunity,CHWsneedaccesstotheproperjobaids,equipmentand
supplies.Thisrequiresprocurementonaregularbasistoavoidanysubstantialstockoutperiods.
http://www.who.int/hiv/pub/towards_universal_access_report_2008.pdf(pp.105)

http://transition.usaid.gov/in/newsroom/pdfs/ashaplus_rpt.pdf(pp.15)

ExperiencefromtheField:JobAidsforMalariaRapidDiagnosticTests
AstudyinZambiaresearchedtheeffectivenessofjobaidstoenableCHWstoprepareandinterpretrapid
diagnostictests(RDTs)accurately.Using3groupsofCHWs,observersusedstructuredobservationcheckliststo
scorepreparationofRDTsandreadphotographsshowingdifferentresults.Thefirstgroupusedonlythe
manufacturersinstructions;the2nd,thejobaid,apictorialandscriptedprocedurescardandthe3rd;thejob
aidafterreceiving3hoursoftraining.Alltoolswerepretestedandtranslatedintolocallanguage.Results
showedgroup1completed57%ofthestepscorrectly,group2,82%andgroup3withadditionaltraining,93%.
ThestudyconcludedthatCHWswithwelldesignedjobaidsandbrieftrainingcanensurehighperformance.
HarveySA,JenningsL,ChinyamM.URC2008.ImprovingCHWUseofMalariaRapidDiagnosticTestsinZambia:
PackageInstructions,JobandJobAidPlusTraining
Jobaidsincludemedicines,healtheducationmaterialssuchascounselingcards,firstaidkits,andpotsfor
demonstratingpreparationofweaningfoods,pensandpencils,flipcharts,notebooks,andboxestostore
records.
(Henderson2000).http://www.malariajournal.com/content/7/1/160

VI-18

SupervisionandEvaluation
Thereisstrongdocumentationandwideacknowledgementthatforprogramstobesuccessful,CHWsneedregular
andsupportivesupervisiontohelpthemcarryoutadministrativetasksandtoprovideindividualperformance
support(feedback,coaching,datadrivenproblemsolving).
http://data.unaids.org/pub/Manual/2007/ttr_taskshifting_en.pdf(pp.3132)
http://model.pih.org/community_health_workers/supervision
http://www.who.int/hrh/documents/community_health_workers.pdf(pp.20)

ExperiencefromtheField:Supervision
Historically,clinicalstaffhasdirectlysupervisedCHWs,butPartnersinHealthhasintroducedtheroleof
AccompagnateurLeader.ChosenfromamongCHWs,whosehighqualityofwork,leadershipqualitiesand
standinginthecommunity,educationandexperienceareappropriate.ThenumberofCHWssupervisedvaries
from15and25inRwandatoupto50inHaiti.SupervisorresponsibilitiesincludeseeingthatCHWsvisittheir
patientsdaily,administermedicationscorrectly,andvigilantlymonitorpatienthealth.Inaddition,theleader
helpstheclinicalteambyansweringpatientsquestions,joiningtheteamonpatientvisits,andidentifying
problemsbetweenCHWsandpatients.Usingunannouncedvisitstopatienthomes,CHWleadersandhealth
centerstaffidentifyproblemsbetweenCHWsandpatients.Whenaconflictdoesarise,theCHWiscalledto
thehealthcentertodiscussthesituation.CHWleadersmeetregularlywithHCstafftoexchangeinformation
anddiscusscommonissuesandmonthlyforongoingtrainings.

http://model.pih.org/community_health_workers/supervision

SuggestedInterventions:
Setcriteriaforselectionofsupervisors
Developclearjobdescriptions
Trainonsupportivesupervisionandequipwithtoolsandjobaids
Defineexpectations
ratioofsupervisortosupervisee
numberofsupervisionvisits
requireddocumentation

VI-19

PerformanceEvaluation
Theobjectiveofthisprocessistogiveconstructivefeedbackonperformance.Ideallyavolunteersperformance
shouldbeappraisedatthebeginningoftheassignment,everyfourtosixmonthsandattheendofthe
assignment.Thefrequencyofperformancemanagementalsoshouldbedeterminedbyanysignificantchangesin
performance,activity,managementorworkactivity.Assessmentisanopportunitytolearnaboutthe
achievementsofthevolunteerandwhatmaystillneedattention.Thisimprovestheprocessforthevolunteerand
theprogram.

www.crsprogramquality.org

ExperiencefromtheField:PerformanceAppraisal
Performanceappraisalshouldreviewthestatusofthevolunteer'sobjectives/goals;andmeasuresuchthingsas
punctuality,consistency,reliability,flexibility,adaptability,enthusiasm,andinteractionwithothers;ascertain
theeffectivenessofthepositionandwhetherthevolunteerisagoodfitforher/hisparticularassignment;and
identifyareasofweaknessandneed.Ideally,everyareaofcontributionofthevolunteersworkshouldbe
assessedandfeedbackoffered.Thiswillensureoptimalmatchingofskillstotasks,appropriatereallocationof
tasksasnecessaryandoverallimprovementinindividualandprojectperformance.Assessingtheactual
amountoftimeindividualvolunteerscontributetotheprojectonaweeklyormonthlybasiswillhelpstaff
understandavolunteersworkloadanddeterminehowaccuratelyprojectstafforiginallyestimatedthetime
neededforvolunteercontributionsascomparedtotheactualquantityoftimevolunteersspendonservice
delivery.Thiscanhelpinthedesignoffutureprojectsinvolvingvolunteers.
Possiblequestions*foruseduringvolunteerperformancemanagementsessions:
1.Whatpartofvolunteeringareyouenjoyingthemost?
2.Whathaveyoulearnedoverthepastfourmonths?
3.Whatworkrelationshipsorpartnershipshaveyoubuilt?
4.Whatactionshaveyoutakenoverthepastfourmonthstoachievetheobjectivespresentedinyourscopeof
work?
5.Whatareyoustrugglingwith?Whatcanwedoaboutthis?
6.Whatwillbeyourmainfocusforthenextfourmonths?
7.Doweneedtomakechangestoanyvolunteerobjectives?
8.WhatcanIdotosupportyouintheachievementofyourresponsibilities?

*AdaptedfromtherequiredquestionsforCatholicReliefServicesCoaching.SeeCatholicReliefServices.CRS
GuidetoWorkingwithVolunteers.Baltimore,Maryland:CRS,2012.

VI-20

IncentivesandtheOpportunityforAdvancement
FinancialandnonfinancialincentiveshavebeenshowntoinfluencethebehaviorandattitudeofCHWsina
positiveway.Theyareanimportantmechanismthatcanbeemployedtoreward,retain,motivate,engage,and
evenimproveperformance.Manydocumentsthatrefertoincentivescitetheopportunityforadvancementasa
criticalcomponentformotivatingandretainingCHWs.
http://www.ichrn.com/publications/factsheets/Incentive_systems_for_health_care_proEN.pdf
http://model.pih.org/community_health_workers/payment
http://www.who.int/hiv/pub/meetingreports/TTRmeetingreport2.pdf(1415,6169)

ExperiencefromtheField:NonFinancialIncentiveInterventions

Tobuildrespectandreducepotentialconflict,orientcommunityandcommunity
groups/institutionsonhealthpractices,theroleofCHWsandtheirvoluntarystatusbeforestarting
interventions.

Involveandtraincommunityanchorssuchaschurches,mosques,youthandwomensassociations
aswellascommunityleaders,tosupportandmotivateCHWsby:
o promotingthemandrecognizingtheirwork;
o providingmoralesupportand
o facilitatingandfollowingupontheimplementationofhealthpractices.

EncouragecommunityleaderstojointlyorganizetalksinwhichCHWsprovideinformation,are
publiclyrecognizedandshowntobesupported.

UsepubliceventssuchascelebratorydaystohighlightachievementsofCHWs.
RecognizesuccessofcommunityaswellasCHWtofacilitatebondbetweenthem.
Provideuniforms,tshirts,badges,posterstogiveCHWsenseofidentity.
Usemonthlymeetings,fieldvisitsandtrainingsessionstoprovidecontinuinginstructionand
mentoring.

Assessandstrengthenteachingmaterialstoaddressdiverseaspectsofcommunityhealth.
UsecertificatesandseekfutureopportunitiesforCHWspersonaladvancementinthehealth
sector.
Provideindividualorgroupperformancereviewstoidentifyshortcomingsandcreateasense
ofcompetition.

Amare,Yared.2009.NonFinancialIncentivesforVoluntaryCommunityHealthWorkers:AQualitativeStudy.
WorkingPaperNo.1,TheLastTenKilometersProject,JSIResearch&TrainingInstitute,Inc.,AddisAbaba,
Ethiopia.

VI-21

CommunityInvolvement
OnekeycomponenttothesuccessofCHWprogramsiscommunityinvolvement.Thecommunityneedstoplayan
activeroleandfeelinvestedintheCHWprogram.Activeinvolvementandparticipationofthecommunityhelps
definetheroleandexpectationsoftheCHWandalsoenablesthecommunitytoprovidefeedbackontheCHWs
performance.
http://www.prb.org/pdf06/WorkingWithTheCommunity.pdf
http://www.who.int/hrh/documents/community_health_workers.pdf(pp.21)
http://www.thelancetglobalhealthnetwork.com/wpcontent/uploads/AlmaAta1.pdf
http://futuresgroup.com/files/publications/Communitybased_Workers_Improve_Health.pdf

LinkagestotheHealthSystemandReferral
SuccessfulCHWprogramsarelinkedtoandsupportedbyprimaryhealthcarefacilities.Establishingeffective
linkagestakesthought,planningandcoordination.Aspartofaneffectivelylinkedsystem,successfulCHW
programsthatprovidequalitycareneedtohaveareferralsysteminplacetodeterminewhenareferralis
necessaryaswellasanavailablemeansoftransportationtogetthepatienttoahealthcarefacility.Itisessential
thattheCHWisabletorecognizethepointatwhichapatientneedstobereferred.
http://1millionhealthworkers.org/files/2013/01/1mCHW_TechnicalTaskForceReport.pdf(pp.2024)
http://futuresgroup.com/files/publications/Communitybased_Workers_Improve_Health.pdf
http://data.unaids.org/pub/Manual/2007/ttr_taskshifting_en.pdf(pp.4445)
http://www.thelancetglobalhealthnetwork.com/wpcontent/uploads/AlmaAta1.pdf

GuidancefromtheField:SettingUpaReferralNetwork
Conveneaninitialstakeholdersworkshopinvitingkeystakeholdersfromthenationalgovernment,district(s),
facilities,andcivilsociety.Conductaparticipatorymappingexercisetocreatealistofallorganizationsand
facilitiesprovidingrelatedserviceswithinthegeographicarea.Developadirectoryofservicesincludingclinical
andsocialserviceagenciesandNGOs,theirlocation,servicesandhoursofoperationandpotentialfeesandany
accessissues.
Createsystemstodevelopandsupportthereferralnetwork.Trainkeystaffateachreferralsiteandcreate
MOUstodefinerolesandresponsibilities.Ensurestaff/CHWsaretrainedonhowthenetworkworks.Create
referralformsandregisterstodocumenttheprocessandfollowup.Monitorthenetworksactivitiesanduse
findingstoimprovethesystem.Mobilizethecommunitytouseandsupportthereferralnetworkandbuild
demand.

MakingaReferral
Identifyclientsimmediatereferralneeds;assesswhichfactorsmaymakeitdifficultfortheclienttocomplete
thereferral(e.g.,lackoftransportationorchildcare,workschedule,cost,stigma)andtrytoaddressthem.
Makeanoteofthereferralintheclientsfileandthereferralregister.Ensurefollowupisrecordedand
monitorthereferral.Asktheclienttogivefeedbackonthequalityofservicestowhichheorsheisreferred.
KeyTools:DirectoryofservicesReferralformClienttrackingformReferralregister.
Adaptedfrom:EstablishingReferralNetworksforComprehensiveHIVCareinLowResourceSettings,FHI2005.

VI-22

USAID HEALTH CARE IMPROVEMENT PROJECT

University Research Co., LLC
7200 Wisconsin Avenue, Suite 600
Bethesda, MD 20814
Tel: (301) 654-8338
Fax: (301) 941-8427
www.hciproject.org