Table 1. Model framework for a community health worker (CHW) subsystem within the health system.

Model parameter	Inputs	Processes	Outputs
Service delivery	Activities and skills: – CCM for malaria, pneumonia, malnutrition, diarrhoea – deworming – TB screening – assistance in adherence to drugs for HIV infection and TB – health promotion and disease prevention	Changing household health behaviour; improving access to disease control/prevention; improving access to basic curative health services at the household/community level	Improved community health status through increased coverage of high-impact interventions
	Referral to primary health clinics and follow-up; availability of emergency transport	Linking to broader health system (advanced care)	Increased use of advanced care and institutional delivery
Health workforce	CHWs selected through community/facility partnership	Improving access to health services at the household/community level	Improved health through increased coverage of high-impact interventions
	Senior CHWs (experienced CHWs, selected for supportive supervision)	Monitoring of quality of care	Improved service quality, data reporting and CHW retention
		Supportive supervision of CHWs
	CHW managers (facility-based workers with training in management skills)	Monitoring CHW programme, including system performance	Improved links to referral facilities and community governance structures
		Linking to both facilities and communities	Improved quality of CHW subsystem
Information	Health data reporting, and vital statistics tracking by CHW	Monitoring and discussing community health indicators	Data used to inform programme strategy, engage communities, and improve health status
	Utilization of information by CHW programme managers stakeholders (CHWs, supervisors, district health management team, facility staff, etc.)	Using health indicators to inform management	Data used to guide community actions for health and programme improvements
	Information feedback mechanisms	Informing communities about epidemiology, health status, service delivery and quality of care	Data used to identify service delivery weaknesses and track quality improvement results
		Giving prompt feedback to community
	Mobile technology suite (cell phone, text messaging, voice)	Collecting real-time data	Improved quality of services
		Facilitating alerts for emergency care
		Providing decision support at point-of-care
Medical products, POC diagnosis and technology	Equipment, consumables and tools to assess sickness and commodities for diagnosis and treatment (ORS, zinc, ACTs, RDTs, sputum containers for TB, deworming drugs [albendazol, praziquantel], antibiotics for pneumonia)	Delivering health service	Improved health status of community members through increased coverage of high-impact interventions
		Conducting surveillance for danger signs
		Providing community-based treatment of specified diseases/conditions
Financing	Remuneration of CHWs	Supporting CHWs as full-time professionals	Development of a professional, paid workforce with well-defined terms of reference
	Financing for professionalization (training, uniforms, equipment, commodities, professional development/career advancement)	Regularly training CHWs;	Improved CHW motivation and capabilities to provide quality care (with appropriate tools)
		Incentivizing CHWs for high performance and retention
Leadership and governance	Community governance structures	Supporting local specification and community-based selection and oversight	CHW workforce efficiently supervised and managed and trained in skills necessary to improve maternal and child health indicators;
	Governance structures from ministries of health and partner organizations	Ensuring CHW programme adherence to government policy	Community mobilized and engaged in CHW subsystem.
	Quality improvement processes and organizational culture	Developing culture of quality improvement within the workforce
	Career ladder, professional training curricula and national certification	Attracting strong CHW candidates;	Improved CHW motivation and better candidates
		Motivating CHWs to execute roles and responsibilities

ACT, artemisinin-based combination therapy; AZT, zidovudine; CCM, community case management; HIV, human immunodeficiency virus; ORS, oral rehydration salts; POC, point-of-care; RDT, rapid diagnostic test; TB, tuberculosis.