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USAID HEALTH CARE IMPROVEMENT PROJECT2
What is the CHW AIM?
• Assesses CHW program functionality
• Aids in improving program performance
• Provides action planning and best practices
USAID HEALTH CARE IMPROVEMENT PROJECT3
How does the CHW AIM work?
• One-day participatory workshop
• Program functionality matrix
• Intervention matrices
• Action planning
USAID HEALTH CARE IMPROVEMENT PROJECT4
Functionality elements
• Recruitment• CHW role• Initial training• Continuing training• Equipment & supplies• Supervision• Individual performance
evaluation• Incentives• Community involvement
• Referral system• Opportunity for
advancement• Documentation &
information management
• Linkages to health systems
• Program performance evaluation
• Country ownership
USAID HEALTH CARE IMPROVEMENT PROJECT5
Applications
• Bangladesh• Benin• Brazil• Ethiopia• Haiti• Kenya• Madagascar• Mauritania• Mozambique
• Nepal• Pakistan • Swaziland• Sierra Leone• Tanzania• Thailand• Uganda• Zambia
USAID HEALTH CARE IMPROVEMENT PROJECT6
Zambia: Background
• Population: 13 million
• Life expectancy: 48 years
• HIV prevalence in adults: 13.5%
• Neonatal mortality: 35/1000
• Health workforce vacancies– 55% among nurses– 63% among clinical officers– 64% among doctors
USAID HEALTH CARE IMPROVEMENT PROJECT7
Zambia: CHWs
• 2005 CHW Handbook
• 2010 National Community Health Worker Strategy
• Estimated 23,500 active CHWs
USAID HEALTH CARE IMPROVEMENT PROJECT8
Zambia: Study questions
• Does application of the CHW AIM tool contribute to CHW
program functionality improvement?
• What is the relationship between program functionality, CHW
engagement, and CHW performance?
• What are the costs associated with implementing the CHW tool
and what is the incremental cost effectiveness associated with
its use?
USAID HEALTH CARE IMPROVEMENT PROJECT9
Zambia: Data Collection
• Program data
• CHW AIM
• Engagement survey
• Engagement interview
• CHW performance (positive living, ART adherence counseling)
• Costing data
USAID HEALTH CARE IMPROVEMENT PROJECT10
Zambia: Does the CHW AIM improve functionality?
• 2/5 organizations improved functionality
• 5/5 made gains in at least 2 program functionality elements as a result of interventions driven by baseline findings
1 2 3 4 50.0
0.5
1.0
1.5
2.0
2.5
3.0
Baseline Endline Mean
Mea
n C
HW
AIM
Sco
re
Site
USAID HEALTH CARE IMPROVEMENT PROJECT11
Zambia: Relationship between functionality, CHW engagement, and CHW performance?
• Positive correlation between CHW AIM scores and CHW performance
• Weak correlation between CHW AIM scores and CHW engagement– Opportunities for advancement– Individual performance evaluation– Incentives
• No correlation between engagement scores and performance
USAID HEALTH CARE IMPROVEMENT PROJECT12
Zambia: Is the CHW AIM cost effective?
• Cost/participant of CHW AIM process: $16.91 - $56
• Limited data to support cost effectiveness analysis
• Cost per client: $0.41 - $3.11
USAID HEALTH CARE IMPROVEMENT PROJECT13
Zambia: Examples of changes
• Continuing training
• Referral system
• Opportunity for advancement
USAID HEALTH CARE IMPROVEMENT PROJECT14
Looking forward
• Recommendations for CHW AIM process– Investment– Technical assistance– Expectations– Prioritization– Timing– Resources– Facilitation
• Recommendations for organizations– Leadership– Community challenges– Country ownership
