A conceptual framework for measuring community health workforce performance within primary health care systems
A conceptual framework for measuring community health workforce performance within primary health care systems
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DOI：
10.1186/s12960-019-0422-0
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发表时间：
2019-11-20
影响因子：
4.5
通讯作者：
Warren, Charlotte E.
中科院分区：
文献类型：
--
作者：
Agarwal, Smisha;Sripad, Pooja;Warren, Charlotte E.
背景资料：随着《阿拉木图宣言》发表40周年，全球正在努力重新关注加强初级卫生保健系统，重点是利用社区卫生工作者实现全民健康覆盖的目标。有效的，可持续的社区卫生系统的制度化目前受到限制，缺乏标准的衡量标准，以衡量CHW的性能和系统，他们的工作。通过迭代协商，支持比尔和梅林达·盖茨基金会，并与美国国际开发署和联合国儿童基金会的合作伙伴关系，本文详细介绍了一个框架，指标清单，并监测CHW性能在低收入和中等收入countries.Methods：同行评议的文章，报告和全球数据收集工具进行了审查，以确定在监测CHW性能的关键测量域。采用经修改的德尔菲方法，与全球利益攸关方、社区卫生执行者、倡导者、计量专家和卫生部代表连续举行了三次协商会议，就优先指标达成共识。在此过程中，进行了一次结构化的网上调查，以确定通过文献审查和利益攸关方初步协商确定的具体衡量领域、子领域和指标的重要性和价值。参与者支持率超过75%的指标在专家的定性投入下得到进一步完善。确定了21个次级测量领域，包括测量社区卫生工作者的激励措施、监督和绩效评估、数据使用、数据报告、服务提供、服务质量、社区卫生工作者缺勤和自然减员、社区使用服务、服务体验、转介/反转介、可信度/信任、和方案费用。商定了46项指标来衡量这些次级领域。在没有完整的人口普查和数字化的卫生信息系统，质量指标监测CHW programs is limited.Conclusions：更好的数据收集方法，在社区层面上需要加强管理的CHW计划和社区卫生系统。拟议的指标清单平衡了初级卫生保健系统内CHW绩效的详尽和务实的测量。通过拟议的框架和相关指标的CHW计划的实施者可以提高计划的有效性，加强他们对国家社区卫生系统的责任，推动计划质量的提高，并可持续地提高这些计划的影响。
Background: With the 40th anniversary of the Declaration of Alma-Ata, a global effort is underway to re-focus on strengthening primary health care systems, with emphasis on leveraging community health workers (CHWs) towards the goal of achieving universal health coverage for all. Institutionalizing effective, sustainable community health systems is currently limited by a lack of standard metrics for measuring CHW performance and the systems they work within. Developed through iterative consultations, supported by the Bill & Melinda Gates Foundation and in partnership with USAID and UNICEF, this paper details a framework, list of indicators, and measurement considerations for monitoring CHW performance in low- and middle-income countries.Methods: A review of peer-reviewed articles, reports, and global data collection tools was conducted to identify key measurement domains in monitoring CHW performance. Three consultations were successively convened with global stakeholders, community health implementers, advocates, measurement experts, and Ministry of Health representatives using a modified Delphi approach to build consensus on priority indicators. During this process, a structured, web-based survey was administered to identify the importance and value of specific measurement domains, sub-domains, and indicators determined through the literature reviews and initial stakeholder consultations. Indicators with more than 75% support from participants were further refined with expert qualitative input.Results: Twenty-one sub-domains for measurement were identified including measurement of incentives for CHWs, supervision and performance appraisal, data use, data reporting, service delivery, quality of services, CHW absenteeism and attrition, community use of services, experience of services, referral/counter-referral, credibility/trust, and programmatic costs. Forty-six indicators were agreed upon to measure the sub-domains. In the absence of complete population enumeration and digitized health information systems, the quality of metrics to monitor CHW programs is limited.Conclusions: Better data collection approaches at the community level are needed to strengthen management of CHW programs and community health systems. The proposed list of metrics balances exhaustive and pragmatic measurement of CHW performance within primary healthcare systems. Adoption of the proposed framework and associated indicators by CHW program implementors may improve programmatic effectiveness, strengthen their accountability to national community health systems, drive programmatic quality improvement, and plausibly improve the impact of these programs.