Table 3.
The role of community and health systems in reinforcing Community Health Worker programming
| Community system elements | |
|---|---|
| Leadership/Governance | |
| 1. Vision | Leadership articulates a clear vision for achieving health and development outcomes for the community |
| 2. Service and resource availability | Leadership identifies all curative and promotional health and social services available to the community and their social accessibility to community members |
| 3. Equity | Leadership ensures vulnerable and disenfranchised groups have equitable access to essential health and social services |
| 4. Collective action | Leadership ensures collective processes and actions that can promote the community’s health and development |
| • Mobilizes community assets to engage in key policy, legal, and governance activities (such as campaigns, solidarity movements, and other advocacy actions) | |
| • Ensures participatory decision-making by actively engaging community members in identifying problems and concerns, implementing their plans to solve these problems, and taking responsibility for their actions | |
| • Facilitates consensus-building and collaboration that fosters trust, respect, negotiation, openness, conflict resolution, creativity, and responsibility among members | |
| • Identifies areas in which community groups and members need to make changes in the way they work together and provides guidance and support in making these changes | |
| • Respects and values the viewpoints of community members and cultivates community input and action | |
| • Ensures transparency and accountability through meetings and other means of communication with stakeholders and community members | |
| • Manages power relationships within and beyond the community to promote community development and well-being | |
| • Fosters ownership over team decisions by suggesting new ideas, expressing opinions, and pointing out ways to overcome obstacles | |
| 5. Knowledge management | Leadership acknowledges, documents, and disseminates individual and community achievements and challenges encountered in improving the community’s health |
| 6. Mentoring | Leadership fosters the development and emergence of new leaders and other assets |
| 7. Sustainability | Leadership ensures any successes in improving the community’s health can be sustained beyond short-term projects: |
| • Sustains a program’s focus of activity and gains funding and resource commitments | |
| • Encourages the development of mutually reinforcing partnerships with formal health and development structures and actors beyond the community | |
| • Supports strengthening productive linkages with groups within the community | |
| • Encourages and cultivates self-help activities | |
| Social belonging/cohesion | |
| 1. Trust/belonging | • Community members exhibit trust among group members and feel part of the community |
| • Community members have positive perceptions of their communities, value their diversity, celebrate together, and have a sense of control and ownership in relation to planning and implementing local programs and activities to improve their health and well-being | |
| 2. Historical perspective | Community members understand the community’s history |
| 3. Compassion | Community members show a sense of compassion for others in the community |
| 4. Identify | Community members have a shared identity and are willing to take action based on that identity |
| 5. Commitment | Community members have a commitment to achieving outcomes and positive change and a shared responsibility for improving the community |
| Resource mobilization | |
| 1. Identification | The community routinely identifies external and internal resources (funding, people, organizations, facilities, material, time) to help achieve its health goals |
| 2. Procurement | The community routinely accesses external and internal resources (funding, people, organizations, facilities, material, time) to help achieve its health goals for the community |
| 3. Use | The community uses resources (funding, people, organizations, facilities, material, time) in new, creative, and effective ways to achieve its health goals |
| 4. Allocation | The community makes informed decisions about fair distribution of resources and resolves conflicts regarding distribution, including distribution of common resources |
| Health system elements | |
| 1. Governance | • Formulates and aligns all health sector strategies and technical policies |
| • Identifies roles of public, private, and voluntary health system actors and of civil society at central and decentralized levels of the health system | |
| • Provides robust oversight and regulation of health markets and all health activities in the public and private sector | |
| • Holds all health system actors in the public and private sectors accountable for activities and results | |
| • Provides incentives that reward good performance and sanctions poor performance to all health system actors in the public and private sector | |
| • Ensures collaboration and coordination across sectors in government and with actors outside government | |
| • Ensures generation, analysis, and use of intelligence on health sector performance trends | |
| 2. Financing | • Raises adequate funds for the health sector |
| • Allocates these funds in accordance with population needs and in ways that ensure people can use needed services | |
| • Pools funds when possible to ensure people are protected from financial catastrophe or impoverishment associated with having to pay for services | |
| • Purchases packages of high-quality, high-impact services | |
| • Promotes transparency and accountability in financing systems | |
| • Ensures generation, analysis, and use of intelligence on the performance of the health financing system | |
| 3. Health workforce | • Develops national workforce policies and investment plans |
| • Defines the roles, responsibilities, and performance expectations (as stated in service agreements or contracts, for example) of all health workers | |
| • Ensures appropriate recruitment and development of the workforce (skill mix/cadre development) | |
| • Ensures appropriate deployment and distribution of health workers relative to fixed facilities and burden of disease | |
| • Uses strategic information to monitor the availability, distribution, and performance of health workers | |
| • Establishes regulatory mechanisms to maintain the quality of education/training and practice | |
| • Engages with multiple stakeholders and sectors for human resources for health (HRH) planning and workforce development | |
| • Develops retention schemes that take into consideration local and international labor markets | |
| • Designs training programs and other capacity development activities that facilitate integration across service delivery and disease control programs | |
| 4. Service delivery | • Organizes and regulates the health care delivery system in a way that ensures delivery of effective, safe, quality personal and non-personal health interventions to those who need them, when and where needed, with minimum waste of resources |
| • Develops an organized provider network to ensure close-to-client care | |
| • Adapts, adopts standard practice guidelines for the delivery of essential services in line with the HRH plan | |
| • Delivers package of integrated services based on population health needs | |
| • Generates demand for services through an understanding of the user’s perspective, raising public knowledge, and reducing barriers to use (cultural, social, financial, gender, etc.) | |
| • Ensures proper management of service delivery at all levels to maximize service coverage, quality, safety, and minimize waste, including supervision, performance incentives, and a functioning referral system | |
| • Oversees infrastructure and logistics (i.e., buildings, utilities, waste management, transport, communication) | |
| 5. Medical products, vaccines, and technologies | • Ensures equitable access to essential medical products, vaccines, technologies, equipment, and supplies of assured quality, safety, efficacy, and cost-effectiveness by: |
| ○ Developing national policies, standards, guidelines, and regulations in accordance with local laws | |
| ○ Setting and negotiating prices, using information on prices and international trade agreements | |
| ○ Ensuring reliable manufacturing practices and quality assessment of products | |
| ○ Developing procurement, supply, storage, and distribution systems | |
| • Promotes rational use of essential medicines (drugs, vaccines), commodities, technologies, equipment, and supplies | |
| 6. Information | • Ensures the collection (via population-based, facility-based, and special surveys), analysis, dissemination, and use of timely and high quality information on: |
| ○ Health status | |
| ○ Financial risk protection | |
| ○ Health service use | |
| ○ Client satisfaction with services | |
| ○ Health behavior | |
| ○ Health system performance | |
| ○ Events that threaten public health security | |
| • Ensures long-term capacity to archive and manage information, as well as promote its availability in the public domain and application | |