Table 2.
Illustrative indicators for community health worker performance measurement
| Illustrative indicators | Indicator relevance/use by: | Suggested data sources** | |||
|---|---|---|---|---|---|
| Facility manager/QI team | District managers | Regional and national MOH | |||
| H: High data use M: Medium data use | |||||
| Domain 1: Supportive systems | |||||
| Sub-domain A: Supervision and performance appraisal | |||||
| 1. | #/% of supervisors trained in management and supervision of CHWs | H | H | M | Training logs |
| 2. | Ratio of CHWs to supervisors | H | H | M | HRIS |
| 3. | #/% of supervisory visits that met the quality criterion | H | H | M | Special studies |
| 4. | Average # of visits per supervisor to monitor/support CHW activities in the last month | H | H | M | Supervisor report/special studies |
| 5. | #/% of CHWs who received a supervisory visit in the last 1–3 months that includes review of reports and data collected | H | H | M | CHW report |
| 6. | Average # of supervisory contacts (in-person visits, phone calls, text messages, etc.) per CHW | H | H | M | CHW report |
| Sub-domain B: Data use | |||||
| 7. | #/% of health workers (CHWs/supervisors/health facility staff) who have access to client data AND who report using the data to make decisions about their provision of services | H | H | M | Special studies (CHW survey) |
| 8. | #/% of national/sub-national/facility/community meetings in which data (from standardized reporting platforms etc.) are discussed/reviewed | H | H | H | Routine meeting minutes |
| 9. | #/% of CHWs who have access to the client data they have collected (for follow-up) in the last 6 months | H | H | M | CHIS/HMIS |
| Domain 2: CHW development | |||||
| Sub-domain A: Recruitment | |||||
| 10. | #/% of CHWs who have been selected in alignment with selection criteria | M | H | H | HMIS/HRIS/training logs |
| 11. | # of CHWs who have been selected/recruited | H | H | H | HRIS |
| 12. | #/% of target communities/populations that have an assigned CHW | H | H | H | HRIS |
| Sub-domain B: Training | |||||
| 13. | #/% of CHWs who have received initial training | M | H | H | HRIS/training logs |
| 14. | #/% of CHWs who have received follow-up training in the last 2 years | M | H | H | HRIS/training logs |
| 15. | #/% of CHWs who have completed the certification program | M | H | H | HRIS/training logs |
| Sub-domain C: Incentives | |||||
| 16. | #/% of CHWs who have received their stipend in the last month | M | H | H | CHW report/supervisor report/special survey |
| 17. | #/% of CHWs who have received a specific non-financial incentive | M | H | H | CHW report/supervisor report/special studies |
| Domain 3: Support from community-based groups | |||||
| 18. | # of planning/review meetings held at the level of the local government to discuss CHW program performance | M | H | H | Meeting minutes/special studies |
| Domain 4: CHW competency | |||||
| Sub-domain A: CHW knowledge | |||||
| 19. | #/% of CHWs who have passed knowledge/competency tests (following training) | H | H | H | Training/accreditation logs |
| 20. | #/% of CHWs who express that they feel confidence in their abilities to provide health education | H | H | H | Special studies |
| 21. | #/% of CHWs who express confidence in their abilities to deliver basic healthcare services | H | H | H | Special studies |
| Sub-domain B: Service delivery | |||||
| 22. | Average # of home visits made by CHWs in the last month (indicator to be disaggregated by type of home visit—i.e., sick child visit, antenatal care) | H | H | M | CHW record/CHW report |
| Sub-domain C: Service quality | |||||
| 23. | #/% of CHWs who correctly identified the case/health problem (as per items in a checklist) | H | H | H | Special studies/supervisor report |
| 24. | #/% of CHWs who correctly addressed (treated) the identified health problem (as per items in a checklist) | H | H | H | Special studies/supervisor report |
| 25. | #/% of CHWs with all the key stock commodities in the last reporting period | H | H | H | CHW report |
| 26. | Average time from onset of symptom to first contact with CHW | H | M | M | Special studies |
| Sub-domain D: Data reporting | |||||
| 27. | #/% of CHWs who submitted reports in the last month | H | H | M | CHIS/HMIS/supervisor report |
| 28. | #/% of CHW reports submitted that were complete/did not have missing information | H | H | M | CHIS/HMIS/supervisor report |
| Sub-domain E: Absenteeism | |||||
| 29. | #/% of CHWs who reported on their activities in the last month | H | H | H | CHIS/HMIS |
| 30. | # of days CHW has performed at least one CHW responsibility in the last month | H | H | H | Special studies/supervisor report |
| Domain 5: CHW well-being | |||||
| Sub-domain A: Motivation | |||||
| 31. | Composite metric | H | H | H | Special studies |
| Sub-domain B: Job satisfaction | |||||
| 32. | #/% of CHWs who expressed satisfaction with the community support they receive | H | H | M | Supervisor report/special studies |
| 33. | #/% of CHWs who expressed satisfaction with the support they receive from health facility staff | H | H | M | Supervisor report/special studies |
| Sub-Domain C: Attrition/retention | |||||
| 34. | In the last 3 months, #/% of CHWs who have reported on their activities | H | H | H | CHIS/HMIS |
| Domain 6: Community access | |||||
| Sub-domain A: Use of services | |||||
| 35. | #/% of households who received at least one visit by a CHW in the last 3 months | H | H | M | Special studies |
| Sub-domain B: Knowledge of service availability | |||||
| 36. | #/% of community members that know the name of the community CHWs | H | H | M | Special studies |
| 37. | #/% of community members who can name at least 3 services that the CHW provides | H | H | M | Special studies |
| Sub-domain C: Referral/counter-referral | |||||
| 38. | % of individuals referred by CHW to the health facility per 100 clients seen (and subset by reasons for referral) | H | H | H | CHIS/HMIS/CHW record |
| 39. | #/% of clients that completed the referral at the health facility (referral completion) | H | H | H | CHIS/HMIS |
| 40. | #/% of referred clients seen at receiving service (health facility) that is seen back at referring service (CHW) with complete counter-referral information (counter-referral) | H | H | H | CHIS/HMIS |
| 41. | Average # of referrals made per CHW in the last month | H | H | H | CHW report/CHW record |
| Domain 7: Community-centered care | |||||
| Sub-domain A: Empowerment | |||||
| 42. | Composite metric | M | H | H | Special studies |
| Sub-domain B: Experience of care | |||||
| 43. | #/% of women/households who express satisfaction with services they received from the CHW in the last 3 months | H | H | H | Special studies/community scorecards |
| 44. | #/% of women who report that in their interaction with the CHW they felt humiliated or disrespected (scale 1–5) | H | H | H | Special studies/community scorecards |
| Sub-domain D: Credibility/trust of CHW | |||||
| 45. | #/% of women/clients who report they trust the health information provided by the CHW | H | H | H | Special studies/community scorecard |
| 46. | #/% of women/clients who report they trust the treatment services provided by the CHW | H | H | H | Special studies/community scorecard |
Measurement Consideration 8: Equity, Gender, and Accountability: Each of the above indicators may be disaggregated by one or more of the following characteristics to assess possible equity gaps or disparities: education, ethnicity, family type, health risk-level, immigration/migrant status, language, marital status, occupation, refugee/asylee status, religion, sex, social capital, tribe, village size, wealth
Measurement Consideration 9: Economic Evaluation: While no extant routine or recommended indicators for measuring CHW program performance were identified, metrics for cost-related benefits of institutionalizing CHW programs and engaging communities are important to capture and require further exploration
**Special studies may include cross-sectional, intermittent surveys of a sample of CHWs, supervisors and/or community members. In case of quality of care, a special study might include direct observation of the CHW during a client interaction
HRIS Human Resource Information System: a national/sub-national HRH database or registry, either digital or paper-based (e.g., iHRIS), that manages health workforce information such as number of health workers (e.g., CHWs) recruited, trained, and on payroll
CHIS/HMIS Community Health Information Systems/Health Management Information Systems
CHW record: Routine records or community-based client registries maintained by CHW
CHW report: Summative reports on the number of home visits and types of client seen, typically submitted on a pre-determined schedule by CHWs to their supervisors
Supervisor report: Summative reports on activities of CHWs and other community-based logistics, routine submitted by supervisors to district or regional level administration
Bold entries are domain and sub-domain sections