Effectively trained, supported, supervised and equipped community health workers are at the heart of everything we do, and we work to ensure that they have the resources they need to effectively serve neighbors in need.
Living Goods supports CHWs who are part of official government networks, and we work with government partners to ensure that CHWs are motivated and able to meet our expectations for service delivery at the community level. All CHWs we support will have passed basic literacy and numeracy tests; we also conduct robust interviews to gauge their motivation and knowledge base. And we work with governments to replace low performers whenever needed.
Training and certification
Once selected, all our supported CHWs receive at least three weeks of in-depth training and subsequently participate in regular in-service refresher trainings (typically monthly). All CHWs must pass a written test and practicum to be certified as a CHW. Each CHW receives an Android smartphone loaded with the Smart Health app, a mobile application co-developed with Medic Mobile, which enables us to easily standardize household registrations, assessments, diagnoses, and treatment protocols.
To ensure CHWs deliver high-quality education, assessments, and treatments, we also provide them with other tools they need to do their jobs, including uniforms, thermometers, mid-upper arm circumference tape to measure pediatric malnutrition, educational flipbooks, and basic medications to treat common illnesses or support family planning. In some of our field offices, CHWs also sell a variety of health-related products for a small profit margin to interested households, including fortified porridge, fuel-efficient stoves, water filters, and oral rehydration salts.
To ensure effective supervision for the CHWs we support, we set clear targets for key performance indicators such as pregnancies registered, and sick children assessed and treated. Supervisors, including Living Goods managers and government health supervisors, have access to real-time data, performance dashboards, and checklists. They also conduct regular in-person supervision of community-level services. This enables supervisors to identify potential service anomalies, spot disease outbreaks, recognize high-performing CHWs who can mentor other staff, and prioritize which CHWs need the most support. We also conduct periodic client satisfaction surveys to ensure effective, high-quality care.
Ensuring compensation for results
We believe that health workers should not work for free. Living Goods strongly advocates for countries to allocate funding to fairly compensate CHWs. However, where that is not happening consistently, Living Goods’ employs an innovative-earned income option that can provide CHWs with both income and motivation. With this option, Living Goods-supported CHWs sell low-cost, high-impact products and medicines to augment their income. Most CHWs are already entrepreneurs by necessity—so this aligns their small business to deliver highly relevant products as well. While medications are offered for free in most public systems, they are often out of stock. Even then, patients usually incur transport costs and lost wages to get “free” drugs. Our small fee for medications is typically far less than the transport costs they would otherwise incur.
Data promotes accountability
Our focus on defining clear performance metrics and real-time data ensure accountability and high performance. Our digital tools—such as prioritized daily task lists—help CHWs optimize how they spend their time. Supervisors also have daily task lists, and can easily track the work and status of individual CHWs as needed. When gaps are noted—such as an insufficient number of postnatal care visits happening within the first 48 hours of life—supervisors can provide CHWs with individually tailored support. Similarly, those who consistently meet or exceed targets can be tapped to mentor other nearby CHWs on best practices.
We invest in the best independent research to measure our impact and inform program, policy, and practice. We ran a three-year randomized control trial (RCT) in Uganda that demonstrated that our approach was reducing child deaths by 27%. We are in the midst of a new RCT to assess current impact levels, which we will use to optimize how we support the delivery of primary health care at the community level.
Performance Management Guidebook
The Performance Management Guidebook has been developed through a collaborative process with expert teams at Living Goods. The research that supported this documentation was provided by subject-matter experts and the critical details that enriched the narrative were obtained through interviews with internal teams. We also acknowledge the World Health Organization Guidelines on Health Policy and System Support to Optimize Community Health Worker Programmes which was reviewed alongside various reports and other documents.
These guidelines are written as recommendations for program managers and implementing teams at Living Goods, highlighting key enablers and principles for building a successful, quality and resilient community health program. This document provides operating procedures for CHW selection, training, motivation, supervision, incentives, and equipping with requisite tools and essential medicines.
Drawing from the experiences of CHWs and their supervisors in Kenya and Uganda, the organization has documented the core elements of data-driven performance management, incorporating evidence and case studies. Performance management for community health programs drives effectiveness of CHW networks to deliver better outcomes, improves motivation and reduces attrition, and ultimately yields a high return on investment.
March 28, 2021
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