Department of Global Health, KIT Royal Tropical Institute, Amsterdam, The Netherlands.
Crigler Consulting, LLC, Hillsborough, NC, USA.
Health Res Policy Syst. 2021 Oct 12;19(Suppl 3):108. doi: 10.1186/s12961-021-00758-2.
While the evidence supporting the effectiveness of community health worker (CHW) programmes is substantial, there is also considerable evidence that many of these programmes have notable weaknesses that need to be addressed in order for them to reach their full potential. Thus, considerations about CHW programme performance and its assessment must be taken into account as the importance of these programmes is becoming more widely appreciated. In this paper, the tenth in our 11-paper series, "Community health workers at the dawn of a new era", we address CHW programme performance and how it is assessed from a systems perspective.
The paper builds on the 2014 CHW Reference Guide, a compendium of case studies of 29 national CHW programmes, the 2018 WHO guideline on health policy and system support to optimize CHW programmes, and scientific studies on CHW programme performance published in the past 5 years.
The paper provides an overview of existing frameworks that are useful for assessing the performance of CHW programmes, with a specific focus on how individual CHW performance and community-level outcomes can be measured. The paper also reviews approaches that have been taken to assess CHW programme performance, from programme monitoring using the routine health information system to national assessments using quantitative and/or qualitative study designs and assessment checklists. The paper also discusses contextual factors that influence CHW programme performance, and reflects upon gaps and needs for the future with regard to assessment of CHW programme performance.
Assessments of CHW programme performance can have various approaches and foci according to the programme and its context. Given the fact that CHW programmes are complex entities and part of health systems, their assessment ideally needs to be based on data derived from a mix of reliable sources. Assessments should be focused not only on effectiveness (what works) but also on contextual factors and enablers (how, for whom, under what circumstances). Investment in performance assessment is instrumental for continually innovating, upgrading, and improving CHW programmes at scale. Now is the time for new efforts in implementation research for strengthening CHW programming.
虽然社区卫生工作者（CHW）项目的有效性有充分的证据支持，但也有相当多的证据表明，许多这些项目存在明显的弱点，需要加以解决，以便充分发挥其潜力。因此，在越来越广泛地认识到这些项目的重要性的同时，必须考虑到 CHW 项目的绩效及其评估。在本文中，作为我们的 11 篇论文系列中的第 10 篇，“新时代的社区卫生工作者”，我们从系统的角度探讨 CHW 项目的绩效及其评估。
本文基于 2014 年的 CHW 参考指南，该指南是对 29 个国家 CHW 项目的案例研究的汇编，2018 年世卫组织关于优化 CHW 项目的卫生政策和系统支持的准则，以及过去 5 年发表的关于 CHW 项目绩效的科学研究。
本文概述了评估 CHW 项目绩效的现有框架，特别关注如何衡量单个 CHW 的绩效和社区层面的结果。本文还审查了评估 CHW 项目绩效的方法，从使用常规卫生信息系统进行方案监测到使用定量和/或定性研究设计和评估清单进行国家评估。本文还讨论了影响 CHW 项目绩效的背景因素，并思考了未来在评估 CHW 项目绩效方面的差距和需求。
根据项目及其背景，CHW 项目绩效的评估可以有不同的方法和重点。鉴于 CHW 项目是复杂的实体，也是卫生系统的一部分，它们的评估理想情况下应该基于从可靠来源混合得出的数据。评估不仅应侧重于效果（什么有效），还应侧重于背景因素和促成因素（如何、为谁、在什么情况下）。在不断创新、升级和扩大 CHW 项目方面，对绩效评估的投资是至关重要的。现在是加强 CHW 规划实施研究的新努力的时候了。
