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Community Health Workers & HMIS

Community Health Workers & HMIS. The backbone of developing country Health (Information) Systems. Who are they?. Anganwadi. Lay Health Worker. Field Nurse. ASHA. TBA. CHW. HSA. ANM. Barefoot Doctors. Multipurpose Health Worker. Volunteer Health Worker. Health services. or

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Community Health Workers & HMIS

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  1. Community Health Workers & HMIS The backbone of developing country Health (Information) Systems

  2. Who are they? Anganwadi Lay Health Worker Field Nurse ASHA TBA CHW HSA ANM Barefoot Doctors Multipurpose Health Worker Volunteer Health Worker

  3. Health services or or both Outreached Facilitybased

  4. Profiling Community Health Workers Not easily profiled.. Profile: Men & Women, Young & Old, Literate & Illiterate – reflect local societal & cultural norms – acceptance Task: Coverage of Basic health services – especially mother and child health. Education: Eight to ten years (sometimes nothing) Employment: regular employee; contractual; volunteer CHW training: 2weeks; 3months (India); 6 months Recruitment: Sometimes Chosen by a village health committee or village chief Ideally recruited from communities they serve (accessible/trusted/cost-effective)

  5. Policy Primary level care policy initiated globally with Alma-Ata declaration in 1978. Primary Health Care (PHC) =>CHW programs Mass training of Voluntary Health Workers / CHWs in developing countries during 1980s

  6. Decentralization from National --> to district (DHIS2) fro District --> to community (mobiles?) strengthen health worker/ health system link to the communities through district health boards, hospital boards, empowerment of village health committees, etc. many reforms seek to endow greater autonomy to decentralized units (e.g. chiefdoms in Sierra Leone)

  7. What do CHWs do? Cover up to 1000 households – 5000 population - 5-10 villages – catchment area More preventive than curative services (ANC, immunization, family planning) Mostly Female outreach health workers within Maternal and Child Health Male outreach health workers often work with control of epidemics / disease surveillance

  8. Health worker challenges • Access to training is desirable (donor programmes pay a lot!) BUT trainings out of touch with reality; treatment guidelines, equipment and supplies that do not exist at their workplace/facility, • Using private funds for motorbike fuel (if available) for outreach services and reporting , BUT insufficient reimbursement, lack of maintenance of broken equipment • Monthly/quarterly/Biannual meetings at facility/district, BUT rarely constructive feedback on data little analysis and use of local data ++Reporting burden!

  9. Motivation/demotivation Feedback from the local community is significant to motivation, retention and performance – i.e. patients & Village health committees Formal supervision is often perceived as means of control Irregular supervisory feedback only when there are errors, mistakes, shortcomings

  10. HMIS performance Unequal access to monetary incentives (training/programme funding) may result in envy and poor cooperation among co-workers, and is as serious demotivator towards HMIS Lack of local use of processed data at facility level Reporting for the sake of reporting

  11. Career? Lack of career prospects & low salary Sometimes NOcareer path for HMIS related tasks

  12. Performance and rewards Collectivistic culture build performance management schemes upon group identities awards for groups rather than for individuals Include HMIS metadata in performance evaluations: timeliness, completeness

  13. Chiefdom/ Facility league table Malaria Deliveries Nutrition Data Quality Antenatal Immunization

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