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CHW oversight models
Page history last edited by Dan Schwarz 2 mos ago
This page outlines the PIH Model for CHWs (accompagnateurs), specifically with regards to supervision and accountability.
Pertinent PIH Model points with regards to Nyaya's problems with CHW's
General
- PIH runs on a CHW Leader (CHWL) model, with CHWLs supervising CHW's
- These CHWLs are responsible for the accountability and performance of their respective CHWs
- Each CHW is responsible for between 5 - 25 patients (the exact number varies per program and the type of patients (HIV, TB, etc.) assigned to the CHW)
- View PIH guidelines for CHW :: patient ratios here (1/2pg table outlining each country organization's guidelines)
- By using weekly CHWL reports (paper-based), the overall clinical supervisors receive data feedback from each CHWL regarding their respective CHWs
- These reports are completed both with and without the CHWs' involvement
- CHWLs communicate directly with CHWs
- CHWLs also make solo, unannounced home visits to all patients of each CHW
- The frequency of these visits unspecified, but based on the specified patient loads per CHW, a safe assumption would entail CHWL home visits to each patient every 1-2 weeks
- PIH CHWL Report Documents
- View the Rwandan CHWL Checklist for CHW performance here (1pg form to be completed by CHWL for each CHW documenting performance by patient)
- View the Rwandan CHWL weekly CHW summary report here (1pg aggregate form of performance detailed per CHW for all the CHWs of a particular CHWL)
- View the Haitian CHWL checklist for CHW performance here (1pg form, less detailed than the Rwanda team's forms above)
- When problems arise with a particular CHW, their CHWL reports to their supervisors (the clinical team), and a meeting is scheduled with the CHW, his/her CHWL, and the team
- Minor problems can be handled between the CHWL and the CHW by themselves
- Meetings are reserved for larger problems
CHWL vs. CHW responsibilities
- Job descriptions and responsibilities are very clearly outlined per country organization (Haiti, Rwanda, Lesotho, etc) for both CHWs and CHWLs
- View a list of CHW "Do's and Don'ts" from PIH Rwanda here (1pg bulleted list of responsibilities)
- View the Rwandan description of CHWL responsibilities here (1.5pg bulleted list of responsibilities based on setting: general, field, hospital, home visits with hospital team)
Remuneration / Payment protocols
- Remuneration differs per country organization
- PIH Rwanda has an itemized payment scale per patient type and service rendered
- Also includes penalties (subtractions) for failed duties (missed appointments, extra remaining pills for DOTS patients, etc.)
- View the Rwandan payment protocol here (1pg itemized payment schedule for CHWs)
- PIH Haiti has a salary based model (~$60/mo)
- Payment schedule does not change with job experience, seniority, etc
- View the Haitian payment protocol here (1 paragraph statement: ~$60 / month; far less detailed than Rwanda's payment protocol above)
Resources
General PIH Model Online CHW Materials
Definition of CHWL :: CHW relationship
Supervision
Historically, PIH’s CHWs have been directly supervised by clinical staff, usually a doctor or nurse involved in the care of HIV or TB patients. As our programs have grown, we have increasingly recognized a need for more formal supervision structures that take advantage of the experience and skills of more senior CHWs. Recently, we have introduced the role of Accompagnateur Leader at several of the program sites.
CHW leaders
Most often, the leader is an existing CHW who has been chosen based on the high quality of his/her work, leadership qualities and standing in the community. The length of time the CHW has been working as an accompagnateur and his/her level of education are also factors. The number of CHWs supervised by each CHW leader varies. In the PIH program in Rwanda, a CHW leader supervises between 15 and 25 CHWs, while in the PIH program in Haiti a CHW leader may oversee up to 50 CHWs. (*Note: This number (50) is not reflected in internal documentation, and could not be otherwise verified other than in the excerpted website text.)
Roles and responsibilities
The primary responsibility of the CHW leader is to ensure that the CHWs are visiting their patients daily, administering medications correctly, and vigilantly monitoring patient health. The leader also helps the clinical team by answering patients’ questions, joining the team on patient visits, and identifying problems between CHWs and patients.
Another point of supervision is at the pharmacy, which CHWs visit regularly to pick up medications for their patients. Pharmacy logs and interactions with the pharmacist are important points of supervision.
The CHW leader and other members of the health center identify problems between CHWs and patients through unannounced visits to patients’ homes. When a conflict does arise, the CHW is called to the health center to discuss the situation. CHW leaders meet regularly with health center staff to exchange information and discuss common issues. CHWs meet monthly with health center staff for ongoing training and to discuss any problems or concerns.
Recommendations
- Nyaya would likely benefit from instituting a CHWL :: CHW structure that involves rigorous monitoring and evaluation of all CHW activity, as per PIH's model described above.
- Using PIH documents (see various attachments), the requisite monitoring and evaluation documentation can be quickly adapted for Nyaya's purposes / specific needs.
References
- PIH Model Online, Community_Health_Workers
- PIH Model Online, CHW Forms_and_Examples
CHW oversight models
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