Table 1 Operational definitions of measurement constructs in the Community Health Worker Performance Measurement Framework
Indicator Domain | Definitions/explanations | References | |
|---|---|---|---|
Inputs | |||
1. | Policies | National-level policies that support the development and deployment of CHW programs | |
CHW selection | Age, education and other policy-supported requirements for being eligible to become a CHW are listed | ||
CHW tasks/workload | Description of the role and tasks to be performed by a CHW from the community, CHW and health systems perspectives | ||
2. | Governance/stakeholders | Engagement with the Ministry, agencies and other stakeholders to support the CHW program | |
3. | Logistics | Provisions, material and technological to support CHW functions. | |
Transportation | Provisions, either monetary (fare for busses) or physical (bicycle) for CHWs to physically access target population | [5] | |
Commodities (including job aids) | Required equipment, medicines and supplies to deliver services, as well as resources such as job aids to support the quality of services | ||
4. | Funding | Level of government/donor and other stakeholder investments in CHW programs in country | |
5. | Information management systems | Support for CHW to document home visits including community-based health information systems, report visit-related data to the health system and link it to an assessment of CHW performance | [18] |
Programmatic processes | |||
Indicator domains | Definition/explanation | References | |
1. | Supportive systems | Structural processes that influence CHW functions at various levels of the health system (facility/local/sub-national/national) | |
A. | Supervision and performance appraisal | Consistent and continued support for problem solving, service delivery and skill development, including evaluation and supportive feedback on the work performed by the CHW in a set period | |
B. | Data use | The use of data by individuals at various levels of the health system to make decisions and improve operational processes | |
2. | CHW development | ||
A. | Recruitment | How and from where a community health worker is identified, selected, and assigned to a community | [18] |
B. | Training | Training is provided to the CHW to prepare for his/her role in service delivery and ensure s/he has the necessary skills to provide safe and quality care. | |
C. | Incentives | Includes financial incentives such as salaries and bonuses, and non-financial incentives such as training, recognition, uniforms and other opportunities for advancement | |
3. | Support from community-based groups | Role that the community (any organization or group at the community level) plays in selection, supervision, offering incentives and providing feedback to the CHW | |
Community health systems performance outputs—CHW level | |||
Indicator domain | Definition/explanation | References | |
4. | CHW competency | Degree to which CHW has the knowledge and skills necessary to carry out the assigned tasks | |
A. | CHW knowledge | Degree to which CHWs have theoretical knowledge of counseling, preventative and curative and other tasks they are responsible for | |
B. | Service delivery | Quantity of promotional, preventive and curative services CHWs provide to community members | |
C. | Service quality | Adherence to standards and procedures (counseling, health promotion, treatment accuracy) | [6] |
D. | Data reporting | Regularity and completeness of CHW reports on the services they provide at the community level | [50] |
E. | Absenteeism | Frequency with which CHWs do not carry out tasks | [6] |
5. | CHW well-being | The overall well-being of the CHW may be seen as a measure of effectiveness of the system that supports the CHW program | |
A. | Motivation | An individual’s degree of willingness to exert and maintain effort on assigned tasks; a CHW’s confidence, belief in his/her ability to produce a desired result | |
B. | Job satisfaction | Degree to which CHWs derive personal satisfaction from serving the community and providing services | |
C. | Attrition/retention | The rate at which practicing CHWs resign, retire or abandon their positions | |
Community health systems performance outputs—community level | |||
Indicator domain | Definition/explanation | References | |
6. | Community access | Delivery of CH services in a timely manner within the client’s home/community OR clients’ physical/social access to CHW service | |
A. | Use of services | Clients are routinely seeking and using promotional, preventive and curative services that CHWs offer | |
B. | Knowledge of service availability | Clients’ ability to identify the location of CHWs and services they provide | [6] |
C. | Referral/counter-referral | The acceptance and use of services provided at a health facility following referral by a CHW | |
7. | Community-centered care | Community involvement, experience, and perceptions of services provided by CHWs | |
A. | Empowerment | Both individuals and communities participate actively in community health activities | [49] |
B. | Experience of care | Clients’ experience of services delivered by CHWs, including respectful care, and clients’ perception of quality of care. | [6] |
C. | Economic evaluation | Comparison of two or more possible courses of action, with respect to the costs, consequences, and/or benefits of each | [52] |
D. | Credibility/trust of CHW | Degree to which clients consider the services provided by CHWs to be credible and reliable | [6] |