Rodríguez Daniela C, Peterson Lauren A
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Rm. E-8612, Baltimore, MD, 21205, USA.
Abt Associates, Bethesda, MD, USA.
Hum Resour Health. 2016 May 6;14(1):19. doi: 10.1186/s12960-016-0115-x.
Factors that influence performance of community health workers (CHWs) delivering health services are not well understood. A recent logic model proposed categories of support from both health sector and communities that influence CHW performance and program outcomes. This logic model has been used to review a growth monitoring program delivered by CHWs in Honduras, known as Atención Integral a la Niñez en la Comunidad (AIN-C).
A retrospective review of AIN-C was conducted through a document desk review and supplemented with in-depth interviews. Documents were systematically coded using the categories from the logic model, and gaps were addressed through interviews. Authors reviewed coded data for each category to analyze program details and outcomes as well as identify potential issues and gaps in the logic model.
Categories from the logic model were inconsistently represented, with more information available for health sector than community. Context and input activities were not well documented. Information on health sector systems-level activities was available for governance but limited for other categories, while not much was found for community systems-level activities. Most available information focused on program-level activities with substantial data on technical support. Output, outcome, and impact data were drawn from various resources and suggest mixed results of AIN-C on indicators of interest.
Assessing CHW performance through a desk review left gaps that could not be addressed about the relationship of activities and performance. There were critical characteristics of program design that made it contextually appropriate; however, it was difficult to identify clear links between AIN-C and malnutrition indicators. Regarding the logic model, several categories were too broad (e.g., technical support, context) and some aspects of AIN-C did not fit neatly in logic model categories (e.g., political commitment, equity, flexibility in implementation). The CHW performance logic model has potential as a tool for program planning and evaluation but would benefit from additional supporting tools and materials to facilitate and operationalize its use.
影响社区卫生工作者（CHW）提供卫生服务表现的因素尚未得到充分理解。最近的一个逻辑模型提出了来自卫生部门和社区的各类支持，这些支持会影响社区卫生工作者的表现和项目成果。这个逻辑模型已被用于评估洪都拉斯由社区卫生工作者实施的一个生长监测项目，即社区儿童综合关爱项目（AIN-C）。
通过文件案头审查对AIN-C项目进行回顾性评估，并辅以深入访谈。使用逻辑模型中的类别对文件进行系统编码，并通过访谈解决差距问题。作者审查了每个类别的编码数据，以分析项目细节和成果，并识别逻辑模型中的潜在问题和差距。
逻辑模型中的类别呈现不一致，卫生部门的信息比社区的更多。背景和投入活动记录不完善。关于卫生部门系统层面活动的信息在治理方面有，但在其他类别方面有限，而社区系统层面活动的信息则很少。大多数可用信息集中在项目层面活动，有大量关于技术支持的数据。产出、成果和影响数据来自各种资源，表明AIN-C项目在相关指标上的结果喜忧参半。
通过案头审查评估社区卫生工作者的表现留下了一些无法解决的关于活动与表现关系的差距。该项目设计有一些关键特征使其符合实际情况；然而，很难确定AIN-C项目与营养不良指标之间的明确联系。关于逻辑模型，几个类别过于宽泛（如技术支持、背景），AIN-C项目的一些方面并不完全符合逻辑模型类别（如政治承诺、公平性、实施灵活性）。社区卫生工作者表现逻辑模型有潜力作为项目规划和评估的工具，但需要额外的支持工具和材料来促进其使用并使其可操作化。
