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Task shifting to CHWs is not new

Credentialing CHWs in Support of Competency-Based Task Shifting Dr. Jose M. Zuniga on behalf of CHW QA and Credentialing Task Team. Task shifting to CHWs is not new. CHWs are not a new addition to our health systems

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Task shifting to CHWs is not new

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  1. Credentialing CHWs in Support ofCompetency-Based Task Shifting Dr. Jose M. Zuniga on behalf ofCHW QA and Credentialing Task Team

  2. Task shifting to CHWs is not new • CHWs are not a new addition to our health systems • CHWs are associated with the Alma Ata primary care movement, but they long preceded this movement • CHWs are also known as lay health advisors, promotoras, patient navigators, doulas, community health agents, etc.

  3. Elements of ideal CHW program Emphasis on priority health needs of the population Adequate training, supplies, and supervision; and feasibility of technical competence needs of the population Improved accessibility, acceptability, and participation of beneficiaries Impact on health services delivery and benefits Selection of more efficacious interventions Improved quality of care Greater coverage and equity, and reduced disparities What have we learned?

  4. Roots of credentialing • Credential derives from the Latin credere, or “TO PUT TRUST IN”

  5. What do we mean by credentialing? “A standardized process whereby a skills-based metric is utilized to verify the ability of non-professional health workers to perform certain tasks previously performed by higher-level cadres of health workers, given proper training and supportive supervision.” TO PUT TRUST IN…

  6. Why are they important? For the HRH agenda: • Quality assurance • Benchmarking • Incentive • Driving change

  7. Benefits of CHW credentialing • Advance legitimacy within health and human services communities • Improve outcomes related to CHW services • Help open the door for CHW reimbursement • Offer assurances to current and potential CHW employers that credentialed CHWs have basic competencies

  8. Potential problems with CHW credentialing • Erosion of indigenous qualities that make CHWs effective (a critical asset for program success) • Encourage priority credentialing of current CHWs • Encourage CHW programs to supplement formal training with training specific to the community served • Ensure CHW training builds upon CHWs’ affinity with their home communities

  9. Loss of current non-credentialed CHWs • Create credentialing credits that currently practicing CHWs can obtain, such as on-the-job training, hours of service, and other life experiences that contribute to effective service delivery • Other unforeseen problems • Involve currently practicing CHWs in developing and refining a new credentialing program

  10. Co-Chairs Adele Webb, ANAC; and Jose M. Zuniga, IAPAC Advisors David Benton, ICN; and Fadwa Affara, ICN Charles Farthing, AAHIVM Greg Grevera, ANAC Eric Hefer, IAPAC; and Debra Shikati, IAPAC CHW QA and Credentialing Task Team

  11. Objective To identify generic nomenclatures, competencies, and competency-based credentialing mechanisms as part of a response to assuring the quality of the contribution made by CHWs in support of scaling up access to HIV/AIDS services.

  12. Phase 1 • Preparatory Phase • Recommend generic nomenclature to identify categories of CHWs • Recommend a generic list of competency-based tasks by category of CHW Informed by GWU/SPHHS Regulatory Framework Group, Antwerp/PIH/Harvard Clinical Mapping Teams, WHO resources, IAPAC Clinical Competencies Survey, IMAI clinical care competencies matrices, etc.

  13. Phase 2 • Development Phase • Identify ways of crafting quality improvement and competency-based credentialing mechanisms by category of CHW • Submit a draft report on quality improvement and credentialing of CHWs (allowing for country feedback) • Submit a final suite of reports on quality improvement and credentialing of CHWs • Present final report in October 2007

  14. Strategically addressing resistance • Congratulations to WHO and PEPFAR for recognizing the importance of professional associations and engaging with us as stakeholders to make this effort politically viable • Not surprisingly, many professional associations have historically opposed and resisted the delegation of tasks to other cadres of workers • Resistance to delegation is not exclusive to “elite doctors”

  15. Times are changing… • Preliminary results of reveal agreement around shifting 236 of 271 tasks from physicians to nurses • e.g., prescribe first-line ART, prescribe simultaneous TB and ART (where appropriate), recognize/manage IRIS • Preliminary results of survey reveal agreement around shifting 76 of 236 tasks from nurses to CHWs • e.g., basic HIV education, pre-ART counseling, ART support, rapid HIV testing (and confirmatory HIV test) • Key clause in question: “given adequate training, evaluation (credentialing), and supervision”

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