Table 1.
Governing community health worker programmes: important questions and sub-questions (based on [17])
| Questions | Sub-questions |
|---|---|
| How and where within political structures are policies made for CHW programmes? |
Where are policy decisions for CHW programmes made and by whom? Where are laws and regulations relevant to health initiated? Do laws need to be initiated by the cabinet or by the parliament? Can other stakeholders initiate laws or regulations through other mechanisms? Who can initiate such laws and regulations for CHW programmes? Do laws need to be initiated by a government minister or a ministerial permanent secretary? Who are the key stakeholders for policies related to community health services? To what extent are these key stakeholders consulted and involved in policy-making for community health services? Are there important groups who are not consulted or involved, for example, on the basis of ethnicity, gender, or sexual orientation? To what extent is there a consensus orientation in which government authorities cooperate with other stakeholders in policy development? How are inputs solicited from stakeholders? Do the approaches used foster the participation of all key stakeholders? How are the varied objectives, motivations, and views of different stakeholders reconciled within the policy process? How might important historical legacies shape CHW-related policy-making? Are there important health system legacies in relation to governance, finance or service delivery arrangementsa that may shape CHW-related policy-making? Are there important political system legacies in relation to institutions, interests or ideasb that may shape CHW-related policy-making? To what extent are these historical legacies in alignment with the planned policy? What scope is there for reshaping the policy or bypassing these legacies? How might wider health and political systems goals in a particular context influence how CHW programmes are governed? What goals are emphasized currently within the health and political system in a particular context? To what extent will CHW-related policies help to achieve these goals, and how can this be demonstrated within the policy process? What changes need to be made to proposed CHW policies to better align them with relevant governance goals? Where CHW-related policies diverge from prioritized governance goals, how can this be justified and advocated for within the policy process? Are there persons with political influence who can advocate for CHW programmes? |
| Who implements decisions regarding CHW programmes, and at what levels of government? |
What factors might affect the successful implementation of the policy? In what ways can potential barriers be overcome or minimized and facilitators harnessed? Is there a clear plan for implementation of policy decisions that includes the objectives to be achieved, adequate resources, and a time frame, and that addresses important barriers and facilitators? How will implementation ensure that key governance goals, such as equity, participation, and accountability, are maximized? How will implementation of policies be monitored and evaluated to ensure that their objectives are met? |
| What laws and regulations are needed to support the programme? |
Which laws and regulations are relevant to the governing and scale-up of CHW programmes? How are these laws and regulations translated into rules and procedures that may affect programme implementation in the field, and who has responsibility for this? Will any changes be required to these laws and regulations to allow the programme to be scaled up as intended? Will any new laws and regulations be needed? Where laws or regulations need to be promulgated or amended, which government bodies would be responsible for leading this process? Which other bodies would need to be involved in this process? Are there key laws or regulations that may act as critical barriers or bottlenecks to policy implementation and that should therefore be priorities for promulgation or amendment? What is the likely time frame for these legislative or regulatory processes? Can scale-up be implemented in parallel to changes in laws and regulations? |
| How should the programme be adapted across different settings or groups within the country or region? |
Is the programme targeted towards specific groups or settings in the country or region? Are there important differences across groups or settings in the country or region that may affect roll-out of the programme and that may require its adaptation? This could include differences in relation to sociodemographic factors such as age, gender, sex, sexual orientation, ethnicity, religious affiliation, migration background, and language, as well as socioeconomic factors such as income and education or literacy levels How will the programme be adapted, if this is needed? |
aGovernance arrangements are concerned with political, economic, and administrative authority in the management of health systems, as noted above. Financial arrangements include funding and incentive systems, while delivery arrangements include human resources for health, as well as service delivery [61]
bDrawing on political science theory, the term “institutions” is used here to refer to both the formal and informal structures and processes of policy-making (constitutional rules, structures through which decision are made, and features of the policy process, such as the level of transparency). The term “interests” concerns the stakeholders who shape a policy and their views on whether the policy will have benefits or drawbacks for them or others. The term “ideas” refers to the values and knowledge held by stakeholders, including those in government and civil society, and comprises information from both research and experience [62, 63]