performance of community health workers: optimizing the benefits of their unique position between...
TRANSCRIPT
Optimizing the benefits of their unique position between communities and the health sector
PERFORMANCE OF COMMUNITY HEALTH WORKERS
Maryse Kok, PhD
Performance of Community Health Workers
CommunityHealth Sector
CHW
!?!
Health systems are complex, social institutions
Source: Sheikh et al. (2011)
An example from Malawi
Influencers of Community Health Worker performance
“Hardware”• Supervision structure• Training • Supplies
“Software”• Relationships• Trust• Power
Source: 1mCHW campaign
Mechanisms related to trusting or weak relationships
• Feelings of self-fulfillment• Feelings of being supported
• Perception that CHWs serve in their interest
• Recognition• Respect• Credibility
Feelings of connectedness and serving the same goals
Feelings of familiarity and free discussion
Misunderstandings related to lack of communication
• Disrespect• Doubts about CHWs’
competencies
• Feelings of disconnectedness• Feelings of unfamiliarity• Feelings of not being
supported• Lack of confidence in upper
level• Perceptions of dishonesty and
unfairness to upper level
• Fear for lack of confidentiality• Doubts about CHWs’
competencies• Perceptions of dishonesty
(towards CHW)• Perception that CHWs do not
serve in their interest• Confused or disappointed
feelings
Health sector CHW Community
Broader context‘In a context where...’
Programme context‘and…,’
Mechanism Outcome ‘,leading to…’
Community participation is promoted by the government
CHWs are recruited from their area of origin and/or selected with involvement of the community, and thus share the same socio-cultural attributes as their clients
Communities and CHWs feel connected to and familiar with each other and communities feel that the CHWs serve in their interest
Trusting relationships between CHWs and their communities
There is a history and value of volunteerism
Volunteering is an official element of the CHW programme
CHWs and volunteers feel connected and serving the same goals through their teamwork
There is a history and value of traditional leadership
Traditional leaders are involved in the CHW programme
Communities have more respect for and credibility towards CHWs
Source: Kok et al. (2016)
Broader context
Programme context‘and…,’
Mechanism Outcome‘,leading to…’
Constrained human resources for health
Tasks shifted to CHWs and supplies are available
Enhanced respect for and recognition of CHWs; CHWs have increased feelings of self-fulfilment
Trusting relationships between CHWs and their communities
Tasks shifted to CHWs and supplies lacking and/or roles and responsibilities of CHWs are unclear to communities
CHWs feel stressed because of being unable to fulfil communities’ expectations and communities feel disappointed and/or confused
Weak relationships between CHWs and their communities
Tasks shifted to CHWs and programmes have clear professional support structures
CHWs and health professional feel connected and serving the same goals through their teamwork
Trusting relationships between CHWs and actors in the health sector
Tasks shifted to CHWs, but roles and responsibilities of CHWs are unclear to health professionals and/or clear professional support structures for CHWs are lacking
CHWs feel disrespected by health professionals and health professionals doubt about CHWs’ competence
Weak relationships between CHWs and actors in the health sector
Source: Kok et al. (2016)
Gender
Training and Supervision
Source: supervision curriculum REACHOUT
Performance of Community Health Workers
CommunityHealth Sector
CHW
!?!
Realities of intermediate position
"Neither does the health services system hold our hand, nor do they leave our hand“ (ASHA India)
“We would like it very much if officials from the ministry of health visit us and listen to our concerns as some problems cannot be solved by our coordinators.” (VHT Uganda)
Source: HIFA
Discussion & recommendations “Hardware”
“Software”
Optimal performance
Twitter: @marysekok